Cervical Sympathetic Block in Periarthrosis of the Shoulder Joint with Secondary Reflex Dystrophy.

Periarthrosis humeroscapularis with restricted mobility of the shoulder joint is in some cases accompanied by changes in the hand on the same side (shoulder-hand syndrome). In advanced cases the hand is slightly cyanotic and damp, and there is stiffness and swelling of the fingers and hand, mostly in the morning; there may be pain and varying degrees of perspiration; the skin of fingers and palms may, be drawn tight so that the lines of the hand are effaced. The appearance is very much like that of post-traumatic reflex dystrophy, both in the violence of the pain and in the capricious way in which some persons are attacked by reflex dystrophy, others not. Still later in the disease fibrous nodes or strings may appear in the subcutaneous tissue in the palm of the hand or in the interstices, and osteo-arthrosis may in rare cases appear in the interphalangeal joints. The fibrous changes may virtually diminish in most cases, even though there may still be some nodes or tightness hindering the full spreading of the fingers and causing lasting disablement. The changes in the soft tissues of the hand and fingers are of the same hard character as the changes in the soft tissues around the affected shoulder joint. The aspect of the hand, the resemblance to the post-traumatic reflex dystrophy, and the course of the disease, makes one suspect that the sympathetic nervous system is involved; both Kahlmeter (1936) and others have had the same idea, and as post-traumatic reflex dystrophy can be improved or cured by sympathectomy, it seems that it is worth paying attention to the sympathetic nervous system in cases of periarthrosis humeroscapularis simulating reflex dystrophy. One might hope (1) to avoid further development of restricted mobility of the shoulder joint; (2) to avoid further development of stiffness of hand and fingers; (3) to soften the leathery, dry hand in old cases of reflex dystrophy; and (4) to eliminate pain. Treatment