These are a group of maladies of the nervous system, due to excessive
use of certain muscles in some oft-repeated act, and characterized
by spasm of the muscles concerned. There are several varieties, as
writers’ cramp, telegraphers’ cramp, piano players’ cramp, violin
players’ cramp, typewriters’ cramp, etc.
Professional spasms, that involve muscles of the shoulder girdle, are
not rare among osteopathic practitioners, due to prolonged faulty
methods of technique.
=Osteopathic Etiology.=—A nervous temperament predisposes to the
development of the affection. Previous injuries and strains of the
involved parts are important factors. Faulty methods of writing, and
in the other disorders, strained or cramped positions of the affected
tissues, predispose to attacks. Slight =lesions= of the bones, joints,
ligaments and muscles are commonly found, involving the motor and
sensory nerves of the immediate locality. The majority of all cases
occur between twenty and fifty years of age.
Distinctive =pathological= changes have not been found. Each case
has particular lesions of its own. The details of the case are
characteristic of the one case only. The affection is often primarily a
spinal one, due to deranged action of the spinal centers concerned in
the various acts; though, no doubt, excessive use of a group of muscles
may result in contractions, spasms, contractures and nutritional
changes, that in turn will establish definite osteopathic lesions. This
is an illustration of a “vicious circle.”
=Symptoms.=—Symptoms of the various varieties of professional neuroses
develop slowly and gradually. A cramp or spasm affecting the used
member is an early symptom. Tremor, weakness, stiffness, fatigue and
heaviness of the affected part are present most of the time. In severe
cases neuritis may develop, and a glossiness of the skin be present.
Associated with the inability to perform the usual work, may be mental
worry and depression.
=Diagnosis.=—The history of the case and the limitation of the disease
to one member, usually make the diagnosis easy: =Cerebrospinal=
diseases, as hemiplegia; early =tabes=, affecting the arms; and
progressive =muscular atrophy=, have to be carefully excluded.
=Prognosis.=—As a rule is favorable. Osteopathic treatment, in the
majority of cases treated, has resulted in recovery.
=Treatment.=—Rest of the part, mental quiet and attention to the
nutrition of the patient, are the first essential considerations. A
change of occupation may be necessary if excessive use of parts and
faulty methods can not be corrected. The treatment consists of a
correction of the parts irritating or disturbing the spinal centers
or nerves affected. The ulnar, radial and median nerves all innervate
muscles employed in writing. Lesions of the cord affecting these
nerves may be found from the fifth cervical to the sixth dorsal. In a
few cases lesions occur as high as the atlas. When the =radial= and
=median= nerves are involved the lesions are principally found in the
upper dorsal vertebra. When the =ulnar= nerve is involved the lesions
are usually slightly lower. The lesions may affect the fibers of these
nerves directly (mechanically), but more probably the vasomotor nerves
are involved, as in this region the vasomotor fibers to the arm pass
from the cord to the sympathetic fibers. The brachial plexus originates
higher than the upper middle dorsal region, still some of its nerves
are frequently affected in the dorsal region by osteopathic lesions,
for removal of the same relieves the disorder.
Other lesions affecting the arms are oftentimes found in the ribs on
the side involved. Any of the first five ribs may become deranged and
affect the innervation of the arm. The clavicle in a few cases may
be abnormally low. A bursitis may be present. Occasionally slight
subdislocations of the shoulder joint (especially anterior) and elbow
joint are found. Gymnastic exercises of the arm and hand, coupled with
a general treatment of the shoulder, arm and hand, are beneficial.
Hydrotherapy, massage and friction of the involved member are useful.
In severe cases “breaking up” fibrotic tissue, and muscle training
frequently secures good results.