=Definition.=—A painful disease of the voluntary muscles and of their
fascia and the periosteum. It is regarded by many as a neuralgia of
these muscles. The pain is greatly increased by motion and pressure.
=Osteopathic Etiology= and =Pathology=.—Osteopathic experience with
cases of muscular rheumatism shows that the nerves, as they pass to
and from the spinal muscles, are affected. The lesion is caused,
principally, by subdislocations of the vertebræ, ribs or pelvis,
according to the region involved. A gouty or rheumatic diathesis,
heredity, exposure to cold and wet and previous attacks are
predisposing causes. Men are more often affected, owing to their more
frequent exposure. The disease affects persons of all ages. It occurs
in acute, subacute and chronic forms.
In cases of frequent recurrence focal infections and intestinal toxins
are often important factors. Vertebral and muscular lesions, septic
foci, intestinal stasis, exposure to cold and drafts are principal
causes.
=Pathologically=, there is swelling of the muscles of the nature of
myositis. In chronic cases there is often atrophy of the muscles, due
to interference of the trophic nerves.
=Symptoms.=—These are generally local and are never accompanied by
marked constitutional disturbances. There is seldom fever, and the
pulse is only slightly increased in frequency. Pain is the chief
symptom; it is increased by motion or pressure. Tenderness is generally
present and there may be swelling of the tissues. Rheumatic nodules
have been found. The duration is usually three or four days, though it
may last longer with frequent recurrences.
=Lumbago= is a painful affection of the muscles of the lumbar area and
their tendinous attachments. The onset is generally sudden. In severe
cases it sometimes renders the patient helpless. In =torticollis,= or
stiff neck, the muscles of the side and back of the neck are affected.
It is usually confined to one side of the head. Any attempt to turn the
head causes a sharp pain. In =pleurodynia= the intercostal muscles, and
sometimes the pectorals and serratus magnus, are affected. It usually
affects but one side, more frequently the left; it is the most painful
form of the disease, since the pain is aggravated by breathing. The
respiratory movements are consequently restricted on the affected
side. The absence of fever and physical signs will distinguish it from
pleurisy. In =intercostal neuralgia= the pain follows the distribution
of the nerves and there are tender spots along their courses.
=Cephalodynia= affects the muscles of the scalp. =Scapulodynia=,
=omodynia= and =dorsodynia= affect the muscles of the shoulder and
upper dorsal. =Abdominal rheumatism= affects the muscles of the abdomen.
=Prognosis.=—The prognosis is good. Favorable results are the general
rule under careful treatment.
=Treatment.=—Muscular rheumatism is usually an easy affection to cure.
The cause of the disturbance is generally found in the region involved,
and is due, in the majority of cases, to some dislocated tissue,
usually osseous, that irritates the nerves to the muscles. In addition
to correcting the lesions, removal of septic foci, free elimination,
lessened diet, stretching of the muscles, application of heat, ironing
and rest are beneficial.
In =lumbago= there is invariably found a slight lateral deviation of
some vertebræ along the lower dorsal or lumbar region. Occasionally
deformity of the vertebræ, asymmetry, or arthritis are factors. The
radiograph may be a diagnostic aid. Occasionally, a floating rib or
an innominate becomes displaced. Stretching the loins by placing the
patient upon his side or back and flexing the thighs on the abdomen is
very beneficial. Maintain the tension for three or four minutes. Hot
fomentations and rest are helpful.
=Torticollis=, or stiff neck, is generally due to a lesion of the
middle cervical vertebræ. The lesion is usually between the third,
fourth and fifth vertebræ, occasionally as low as the second dorsal.
A reduction of the subdislocation will often relieve the attack.
Stretching of the muscle and application of heat will also be of
aid. In some cases of torticollis (chronic) there is a curvature of
the cervical spine, and occasionally the muscles are more or less
fibrinous. Surgical measures may be instituted. In such instances a
cure cannot always be accomplished. The tonsils, nose and teeth should
be examined for sources of infection.
A few cases of acute torticollis are caused by some of the deep
muscular fibres becoming caught around a process of a vertebra. Severe
contraction of the muscles by cold or extensive rotary flexions of the
neck, may result in torticollis. Occasionally a case is found due to
injury at birth. The cervical vertebræ should be carefully examined.
The spinal accessory is the nerve generally involved. Lesions to
the spinal accessory occur commonly at the third, fourth and fifth
cervicals, or the atlas and axis. The muscles involved in torticollis
are the sternocleidomastoid, trapezius, splenius and scaleni.
Operations should not be performed until a thorough course of treatment
has failed to relieve.
=Pleurodynia= is often a neuralgia of the pleural nerves. It is
usually caused by subdislocations of the ribs exactly over the regions
involved. Occasionally, a lesion may exist to the corresponding
vertebra, but rarely. The rib is at times completely dislocated.
Applications of heat and rest of the part are of aid. Strapping of the
region will give considerable relief.
In =cephalodynia= the muscles of the scalp are generally involved
by lesions in the upper five cervical vertebræ. In =scapulodynia=,
=omodynia= and =dorsodynia= the muscles of the shoulder are usually
affected by displacements of the second and third ribs, although the
lesion may be found slightly lower in the ribs, or in the corresponding
vertebræ. The lower cervical vertebræ may also be at fault. In
recurring and chronic cases carefully examine for infectious sources.
Dislocations of the shoulder occur frequently; and muscular fibres may
slip out of the bicipital groove (rarely). In a few cases muscles may
become contracted about the coracoid process, or the acromial end of
the clavicle may become dislocated.
=Abdominal rheumatism= is generally caused by lesions in the lower six
dorsal vertebræ, which involve the innervation to the muscles. In some
cases lesions of the lower ribs are found, and in a few instances a
lesion may be discerned in the upper lumbar vertebræ.
=Myalgia= of the =upper extremity= is caused by lesions of the cervical
or upper dorsal vertebræ or upper ribs. Occasionally some trouble may
be found in the shoulder or elbow joints. In the =lower extremity=
lesions may be found in the lower dorsal or lumbar vertebræ, or there
may be derangements of the pelvic bones. Occasionally disorder is found
at the hip and knee joints.