=Neuritis= is an inflammation of the nerve fibers. It may be confined
to a single nerve, localized; or general, involving a large number of
nerves, when it is known as multiple neuritis. Osteopathically, there
are =invariably lesions= of the osseous or muscular tissues, that
correspond to the nerve fibers involved. The lesion either irritates
the nerve directly or disturbs the circulation to the nerve. In those
cases where the osteopathic lesion is not the immediate exciting cause,
there will be found anatomical irregularities that predispose to the
affection.
=Localized neuritis= may be due to: Local osteopathic lesions; Exposure
to cold; septic foci; traumatism; and inflammation of contiguous
tissues.
=Multiple Neuritis= may be due to: Osteopathic lesions, which are
associated with infectious diseases, as in diphtheria, typhoid, scarlet
fever, etc.; prolonged strain or exposure; metabolic poisons, as in
diabetes, anemia, tuberculosis, cancer, etc.; alcohol, lead, mercury
and arsenic poisoning; and =beri-beri=, which is probably due to lack
of vitamins, or possibly micro-organisms, or carbonic gas poisoning.
The inflammation may chiefly involve the connective tissue
surrounding the nerve—perineuritis—or it may involve the deeper
structure—interstitial neuritis. =Parenchymatous neuritis= is really
a degeneration, due to excessive or prolonged irritation or pressure
which cuts the nerves off from their centers. This is found in deeply
seated osteopathic lesions. In experimental osteopathic lesions
the first effect is degeneration of the medullary sheath. This is
followed by degeneration of the axis cylinder. The local circulation
is notably impaired. An acutely inflamed nerve is red and swollen.
In =perineuritis= there is an infiltration of the nerve sheath with
leucocytes. In the =interstitial form=, lymphoid cells are found
between the nerve bundles. In the parenchymatous form, inflammatory
signs are wanting. The muscles atrophy. Associated in all these forms
the =osteopathic lesion= plays either an exciting or predisposing role,
by disturbing nutrition to the tissue and thus setting up inflammation,
which may lead to Wallerian degeneration[114].
=Symptoms.—Localized Neuritis.=—In the case of a sensory nerve,
there is severe pain following the course of the affected nerve, with
tenderness upon pressure. This may be followed by loss of sensibility.
Trophic symptoms, such as glossiness of the skin and brittle nails,
arise in more chronic cases, while in advanced cases, there is wasting
of the muscles. Sweating, herpes, and occasionally effusion into the
joints, occur. When a motor nerve is principally affected, muscular
power is impaired, motion painful and muscular twitchings will occur.
Finally contractions, wasting of the muscles, and even reactions of
degeneration, may take place. A rare form is the so-called =ascending
neuritis=, in which the inflammation extends upward from the peripheral
nerves to the larger nerve trunks, or even the spinal cord, resulting
in =myelitis=. This occurs most commonly in traumatic neuritis. The
duration is variable. Many acute cases get well in a few days. Other
cases may persist for months and even years.
=Multiple Neuritis.=—Inflammation involving several nerves which are
affected simultaneously or in rapid succession. =Acute form.=—The
attack usually follows overexertion or exposure to cold and wet,
with probably some infection. This form is characterized by a chill,
followed by a rapid rise in temperature which may reach 103 or 104
degrees F.; headache; pains in the back and limbs. There is weakness
of the legs or arms, depending upon region involved, which may be so
severe that the muscles atrophy. Sensory symptoms are variable. Most
cases recover, though there are instances where the vagi, the nerves to
the bladder, rectum, or heart, may be involved.
=Alcoholic Neuritis= results from a moderate amount of alcoholic
drinking, continued over a long time. The first symptoms are usually
numbness and tingling in the fingers and toes. Loss of power soon
becomes marked, first in the lower, and then in the upper, extremities.
The extensor muscles are most affected, causing wrist and foot drop.
Occasionally there is paraplegia. There are hyperesthesia, tenderness
and pain, especially in the legs. The cutaneous reflexes are commonly
intact, and the deep reflexes, as a rule, are lost. Delirium is common,
and hallucinations or illusions occur.
Neuritis from =lead poisoning= usually present the “wrist drop” and
“foot drop”, with colic, and “blue line” on gums.
=Infectious Diseases= neuritis is due to an attack of some infectious
disease, and may be local or multiple. It is due to toxic materials
absorbed into the blood. It is most common after diphtheria. The
symptoms presented are those of neuritis due to any other cause.
=Senile neuritis= is probably due to arteriosclerosis.
=Diagnosis.=—As a rule, the diagnosis is not difficult. In the
alcoholic form in some instances, there may be difficulty, and in cases
with paralysis, care should be taken. The =prognosis= of neuritis is
generally favorable.
=Treatment.=—It is very evident that the successful treatment of
neuritis depends upon being able to ascertain the cause. Rest is
important in all cases. Rarely has one any difficulty in locating the
deranged structures that are predisposing to the attack; and usually
correction of these disturbances, which are in the region involved
will give considerable relief. If the parts are too sensitive to
handle insist on absolute rest and hot fomentations. The affected area
should be kept warm and protected. Attention to the diet, and free
elimination, are important. Metabolic disorders should be corrected,
if possible. Give particular attention to any septic foci. A change of
occupation may be necessary in some cases.
In alcoholic cases, the alcohol should be stopped as soon as possible.
Passive movements and massage are helpful, but of course bear no
comparison to specific osteopathic treatment. Relaxation of muscles
along the spinal column and along the course of the nerve will at least
give temporary relief.
If contractures and other changes remain after the acute attack,
persistent treatment will generally result in recovery. (See also
Painful Shoulders, Part I.)
=Sciatica= is usually a neuritis of the sciatic nerve, although all
painful affections of the nerve are termed sciatica. In some cases it
is a neuralgia when the nerve is swollen and presents an interstitial
neuritis.
=Osteopathic Etiology.=—This affection occurs more frequently in males
than in females. The usual period for sciatica is from the twentieth
to the fiftieth year and the principal causes are =vertebral lesions=
of the lower dorsal and lumbar vertebræ, especially lesions to the
fourth and fifth lumbar. Occasionally the lesion is a subdislocated
innominatum, a downward displacement of a floating rib or a partial
dislocation of the femur. Other causes are exposure to cold,
contraction of muscles, gout, rheumatism and syphilis. Contraction of
the pyriformis muscle may bring direct pressure on the nerve. Focal
infections, arthritis of the articular processes of the lower spine,
and sacro-iliac and hip-joint disease should not be overlooked. In a
few cases there are intrapelvic causes, such as uterine and ovarian
tumors, rectal accumulations and the fetal head during labor. Enlarged
prostate may be a factor. It is possible for the roughened edges of
the sacro-iliac joint, internally, to irritate the sacral plexus as it
passes over and thus keep up the pain. This may explain the occasional
failure of treatment.
=Symptoms.=—Pain in the nerve along its course is the most constant
symptom. The pain is most intense back of the thigh and above the
hip-joint. The pain radiates downward through the entire nerve; it is
of an annoying character and walking is especially painful. In rare
cases there is wasting of the muscles, cramps, herpes and edema. In a
few cases the neuritis may extend to the spinal cord.
=Diagnosis.=—The diagnosis of sciatica is usually easy. Care has
to be taken in the examination to determine whether the affection
is primary or secondary. It is difficult, in some cases, to locate
the origin of the disturbance, especially if it is in the lumbar
vertebræ, as frequently a very slight deviation of a vertebra will
cause the disease; or some focal infection may be difficult to locate;
or malformation of the fifth lumbar may be present; or asymmetry of
the legs or the body be a factor. Careful palpation, measurements,
and the X-ray are of diagnostic importance. =Hip-joint disease= and
=sacro-iliac disease= can generally be easily distinguished from this
affection. The lightning pains of =tabes= may simulate sciatica, but
then there are other well defined symptoms of the disease.
=Treatment.=—Sciatica rarely runs a very long course, though there are
cases that last for years. The treatment almost wholly depends upon the
cause. If the cause can be determined at once, the probabilities are
that severe cases may be relieved by a few treatments. Correction of
the vertebræ, to relieve impingements to the nerve fibers as they pass
through the intervertebral foramina, usually constitutes the primary
treatment. Carefully examine the pelvic organs for disturbances.
Occasionally deep treatment over the iliac vessels will be of great
help. The innominatum, if deranged, should be corrected and all
troubles of the hip-joint that are found must be corrected.
Cases of rheumatism and gout should receive their separate treatments,
besides careful manipulations of the affected leg. Rest in bed should
be insisted upon; this will usually markedly lessen the duration of
the inflammation. Adjustment of the special points found deranged and
a thorough treatment, if conditions permit, of the entire leg will be
beneficial. Hot fomentations applied along the course of the nerve,
and an inhibitory treatment back of the trochanter will at least give
temporary relief. Extension of the leg is effective. Placing a patient
upon his back and flexing the leg and thigh upon the abdomen, at the
same time keeping the leg straight and the foot flexed, is an effectual
stretching method. As a rule, sciatica readily responds to osteopathy.