http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2457047/pdf/brmedj06852-0012.pdfHistory Of Postural Paralysis. This document from The British Medical Journal, Published Augus 8th 1938 is very interesting, and confirms the importance of posture for neurological function. It is a must read for anyone using or considering Inclined Therapy.
Print and study thoroughly.
Plain Text Version
PARALYSIS DUE TO POSTURE
BY
E. B. CLAYTON, M.B., B.Ch.
DIRECTOR OF PHYSICAL TREATMENT DEPARTMENT, KING'S COLLEGE
HOSPITAL
The following cases of nerve paralysis, which are apparently
due to pressure during the maintenance of some
posture, have been collkcted from the notes of patients
attending the Physical Treatment Department of King's
College Hospital during the last ten years.
Anterior Tibial Nerve Paralysis
Case 1.-In a woman, aged 59, there was a sudden onset
of foot-drop when she was kneeling to clean a grate in April,
1926. On examination the external popliteal nerve was
found to be tender and thickened at the neck of the fibula.
Only the anterior tibial group of muscles were affected, the
peroneus longus and brevis being normal. The faradic
reaction was present but reduced, in April; by July it had
completely disappeared. However, there was return of fairly
strong foot dorsiflexion by September.
Case 2.-A man, aged 42, had a sudden onset of foot-drop
while gardening in a crouching position in March, 1926. Only
the anterior tibial group of muscles were affected. There was
a history of a wound in the thigh during the war, but there
was no paralysis at that time. The duration of paralysis was
sixty days.
Case 3.-A man, aged 23, had sudden foot-drop after
kneeling for over an hour in October, 1923. It lasted for
twenty-four days.
Circumflex Nerve Paralysis
Case 4.-A woman, aged 52, discovered paralysis of the
deltoid muscle on waking one morning in February, 1936.
She was suffering from fibrositis in the scapular region following
an attack of influenza previous to the paralysis, the
duration of which was two weeks.
Case 5.-A man, aged 37, discovered paralysis of the
deltoid muscle on waking one morning in March, 1936. The
paralysis disappeared in a short time, but returned the
following day. He had been previously suffering from fibrositis
in the scapular region, and for a fortnight before the
paralysis developed cramp if sleeping on either arm. The
duration of the paralysis was only a few days.
Ulnar Nerve Paralysis
Case 6.-A lad, aged 21, experienced a sudden onset of
ulnar paralysis when riding a bicycle in April, 1932. He had
had this before, when it only lasted one day, but the duration
on the second occasion was twenty-six days. The paralysis
only affected the intrinsic hand muscles, and was apparently
due to pressure of the hand on the handle-bar.
Musculo-Spiral Nerve Paralysis
Case 7.-A man, aged 52, suddenly developed wrist-drop
after lying down for about fifteen minutes with the hand
behind the head, in February, 1926. It was a wet evening.
On examination the musculo-spinal nerve seemed to be
thickened at the middle of the posterior surface of the
humerus. The paralysis lasted for eight weeks.
AUG. 8. 1936 PARALYSIS DUE. TO POSTURE THE RITISH 2
Case 8.-A man, aged 37, had a sudden attack of wristdrop
after sleeping in a chair on a Saturday night after
indulging in alcohol, in December, 1927. The duration was
thirteen days.
Case 9.-In a man, aged 31, there was sudden onset of
wrist-drop after sleeping with one arm hanging over the side
of the bed, in January, 1928. He denied alcohol as the cause.
He returned to work after fifteen days, not completely
recovered.
Case 10.-A man, aged 37, had a sudden onset of wristdrop
after falling asleep with his head on his wrist, in
January, 1933. It lasted for seven weeks.
Case 11.-In a man, aged 68, a sudden onset of wrist-drop
occurred from the pressure of an arm over a chair in February,
1935. His teeth were very septic. It lasted for two months.
Case 12.-A man, aged 40, woke up with right wrist-drop
in June, 1930. He came to hospital five days later, when
weak active extension of the wrist had returned. No note is
available as to the duration of treatment.
In the four following cases, wrist-drop developed suddenly
without any history of pressure on the musculospiral
nerve.
Case 13.-A man, aged 59, developed wrist-drop one Sunday
morning, with pains in the scapular region, in January, 1931.
It lasted four months.
Case 14.-In a woman, aged 32, wrist-drop developed suddenly
one afternoon in June, 1q32. There was a history of
rheumatism in the shoulder one month before, but there had
been no pain immediately before the onset of the paralysis.
No note was made of the duration of treatment.
Case 15.-A lad, aged 18, had wrist-drop one evening after
work, in September, 1932. It lasted for twenty-three days.
Case 16.-In a man, aged 58, wrist-drop came on suddenly
while he was resting his elbow on the padded arm of a chair,
in November, 1929. There was thickening of the musculospiral
nerve near the external condyle of the humerus. The
duration was five weeks.
The following two cases of ulnar nerve paralysis also
occurred without any history of pressure on the nerve.
Case 17.-In a woman ulnar nerve paralysis developed suddenly
in September, 1926. The hand had been " going
numb " over the ulnar cutaneous area for some time previously.
There was thickening of the ulnar nerve above the
elbow. The duration was ten weeks.
Case 18.-In a woman, aged 58, ulnar nerve paralysis
developed suddenly after she had finished her washing, in
September, 1935. The ulnar nerve was thickened above the
elbow. The paralysis lasted for seven weeks.
These last six cases show that paralysis, presumably
from perineuritis, may develop suddenly without pressure,
and, in some cases, without any previous pain or
numbness.
Transient Paralyses
An effort was made to discover to what extent minor
cases of pressure paralysis occur which do not last a
sufficient time to require treatment. Inquiries from
hospital out-patients showed that the foot may " go
dead" on crossing the knees, and that the hand or
occasionally the whole arm may "be dead " on waking
in the morning. This " deadness clears up quickly on
movement. In many cases it only occurs occasionally,
and seems to be associated with cold and damp weather,
or fatigue. I could not obtain any history of foot-drop
or wrist-drop.
By making inquiries from people with a knowledge of
anatomy I found that:
1. Ulnar paralysis on waking in the morning, after resting
the arms on the side of a chair, or from sleeping with
the hands behind the head, is fairly common.
2. The foot may " go dead," but only rarely do the
leg muscles become definitely paralysed by sitting with the
knees crossed.
3. In a few cases the whole arm is occasionally paralysed
on waking in the morning.
These paralyses always clear up quickly on movement.
In several instances they did not occur regularly, and
were more likely to occur in damp and cold weather or
when the person was fatigued. In one case the presence
of a septic focus increased the intensity and frequency of
occurrence, but did not seem to increase the duration.
Thus the causes are similar to those of fibrositis, with
which it is often associated. I could find no case of wristdrop
or of foot-drop from kneeling.
Points of Interest
The twelve cases of pressure paralysis due to posture
represent the total number which attended the Physical
Treatment Department of King's College Hospital during
ten years. Since, presumably, all patients of this type
who attended the hospital would be ordered physical
treatment, the number seems very small, considering that
several of the postures in which paralysis occurred are
regularly assumed.
No cases of ulnar nerve paralysis from pressure on the
arm, or of foot paralysis from crossing the knees, occurred
in this series, though these two types are frequently found
in the mild form which clears up on movement. On the
other hand, I could not trace any mild cases of wrist-drop
on waking in the morning, or foot-drop after kneeling,
which recovered too quickly to require treatment, either
among hospital patients or friends.
No patient came a second time to the hospital with a
recurrence of the paralysis. This is a point against any
anatomical peculiarity being the cause.
The fact that the majority developed in the colder
months of the year suggests that cold and damp may be
a predisposing cause.
The external popliteal division of the sciatic nerve was
compressed from kneeling rather than the internal division.
Presumably the nerve must have been compressed
between the biceps tendon and the fibula.
The six wrist-drop cases were in men, and of the four
cases of wrist-drop not due to pressure only one was in a
woman. In only one case was a history of paralysis
following indulgence in alcohol obtained.
The electrical reactions varied. In one case the faradic
reaction disappeared, but in the majority it was normal
or slightly reduced, and the galvanic reaction was rather
sluggish.
Conclusion
Some of these cases can be explained as perineuritis
with added pressure. A few were probably due to pressure
only. It seems likely that in the others fatigue, cold
and damp weather, or a septic focus may have been the
predisposing cause. It would operate by affecting the
circulation of the limb and making the nerve more sensitive
to pressure without actually causing a perineuritis,
since this variation in sensitiveness to pressure is found
to be of common occurrence.
H. Vignes (Progras Med., May 30th, 1936, p. 921)
states that according to WV. H. Perkins the gravity of
spirochaetal Jaundice in pregnancy is closely xrelated to
the height and duration of the fever. Renal involvement
is a bad sign. Haemorrhages are not specially
frequent at the time of delivery. Interruption of pregnancy
is not uncommon. Experimentally Mirto observed
it in 70 per cent. of his animals. In human subjects
abortion or premature delivery may be met with, especially
in the Tropics and under unfavrourable hygienic con1-
ditions. Abortion is particularly frequent in Japan, where
severe forms of spirochaetal jaundice are common. The
foetuls as a rule is infected. No special treatment iS
indicated.
