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February 21, 1959


Author Affiliations

Palo Alto, Calif.

From the Department of Anesthesiology, Palo Alto Medical Clinic.

JAMA. 1959;169(8):795-797. doi:10.1001/jama.1959.03000250013005

The shoulder-arm syndrome is a painful disability that sometimes follows a sprain, laceration, or simple fracture. Although the immediate cause may have been trivial, the patient continues to have a swollen, discolored, tender, painful, and functionless arm and hand. An accurate diagnosis must be made before treatment is begun, and the possibility that the patient has an incompletely reduced dislocation, ununited fracture, or neuroma must be excluded. If the diagnosis is correct, it will be confirmed by the relief-afforded by injecting a short-acting anesthetic agent about the stellate ganglion on the same side as the disability. Such relief corroborates the diagnosis, makes it possible to start physical therapy on a previously painful limb, and indicates a good prognosis. The psychological complications of this syndrome are such that sometimes the special abilities of a psychiatrist are absolutely necessary for special and difficult patients. The structural and functional components of the condition must both be treated, and the best results are obtained by the physician who is most genuinely interested in the patient.