Sir.—I would like to comment on the article "Osteomyelitis as a Cause of Brachial Plexus Neuropathy" by Dr Clay (Journal 1982;136:1054-1056). Dr Clay reported two cases of "osteomyelitis" as a cause of brachial plexus neuropathy.
On reviewing her case reports, it is obvious that neither of these infants had a true osteomyelitis, but both apparently had septic arthritis of the shoulder. I think the distinction is very important and very clear. I realize that her main interest in publishing this article was to point up the fact that infections about the shoulder may cause a brachial plexus neuropathy; nevertheless, I think it is important not to lose sight of the correct diagnosis.
In addition, I believe that surgical drainage of both of these patients' shoulders possibly could have prevented the bone destruction that was seen in the follow-up examination. The bone destruction is obviously, therefore, secondary to the joint