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Muscular Rheumatism.


Definition.—A painful affection of the muscles and their attachments, the fasciae and periosteum. There is most likely some constitutional derangement, and the myalgia is but a local echo of the general condition. The local affection has taken special names according to the seat of the pain; thus torticollis, or wry-neck; lumbago, pain in the lumbar region; pleurodynia, pain in pleura; mastalgia, pain in the breast, etc.

Etiology.—The predisposing causes are various, the most common arising from sudden cooling after severe exertion, or by exposure to a draft of air, as sitting by an open window, by getting chilled by exposure in inclement weather. A severe strain or twist may be followed by a crick in the back, or lumbago.

The rheumatic or gouty diseases also predispose to the trouble. The primary cause is unknown, and some contend that it is neuralgic in character, affecting the sensory nerves of the muscles, while some contend that it is infectious.

Pathology.—The pathology is not constant. In some cases there is little if any muscular change, while in others there is slight granular degeneration of muscular fibril, or, again, atrophy of the muscular tissue. Nodes are sometimes found. There may be inflammation of the sheaths or periosteum, and in some cases thickening and degeneration of the neurilemma of the nerves supplying the part.

Symptoms.—These depend somewhat upon the form or location of pain. It is nearly always local in its effect, there rarely being any fever; usually the pain is intermittent, any motion or sudden jar causing excruciating pain; at times the pain is constant. Deep, firm pressure affords some relief. The attack comes on suddenly, and often as suddenly takes its departure; it may last for a few hours, or persist for several days.

Lumbago.—In this form the muscles of the loins are the ones affected, and it more often occurs among laboring men. The attack is sudden, and the patient imagines that he has strained his back; or he may be in a stooping position, and on attempting to straighten up is seized with a sharp, lancinating pain that may bring him to his knees. When sitting, the patient gets up with great difficulty and much pain; if lying down, he is unable to rise or turn over; in fact, any motion on the part of the patient causes him to cry out with pain.

Torticollis, or Stiff Neck.—In this form the pain is confined to the muscles of the neck, and any motion of the head causes intense pain; as a consequence, when the patient wants to turn his head, he turns the whole body. This form occurs more frequently in the young. Generally the patient's head is inclined to the affected side, thus relaxing the muscles and securing relief.

Pleurodynia.—The pain is in the intercostal muscles, and is often referred to as a stitch in the side; the pain is sharp and lancinating, and intense on full inspiration or on coughing. This is often called pleurisy, but the difference is readily distinguished when we note the absence of fever and the adventitious sound on auscultation.

Abdominal Rheumatism.—There are a number of other forms though less common, which will be recognized by the location of the pain; thus, cephalodynia, pain in muscles of the scalp; mastodynia, pain in muscles of chest; scapulodynia, pain in scapular region; abdominal rheumatism, pain affecting the abdominal region.

Diagnosis.—This is usually quite readily made. In the various forms considered, the sharp pain, the absence of fever, increased suffering of the part affected, will distinguish the lesion as muscular rheumatism.

Prognosis.—This is favorable, rarely, if ever, a patient dying, unless there be severe heart complication. If seen early, the painful conditions are usually relieved in a few hours, or at most a few days. If neglected, however, it may assume a chronic form.

Treatment.—One of the best agents for this form is macrotys given in quite large doses; of the specific tincture one drain, to water four ounces, a teaspoonful every hour; or if the decoction is used, give in teaspoonful doses every hour. Bryonia will combine nicely in pleurodynia.

In all these cases, dry heat is one of the best local applications. Where the pain is excruciating, a few drops of chloroform on flannel, held against the painful part, gives quick relief. For stiff neck, galvanism will sometimes give great relief. For lumbago, I know of no better treatment than dry cupping; I have seen patients straighten up and walk off comfortably, after removing one or two large cups from the lumbar regions.

In those acute cases where the pain is unbearable, a hypodermic injection of morphia, one-fourth grain, gives speedy relief. This, however, should only be given in extreme cases. After an attack, any wrong of the general health should be corrected, and thus prevent a speedy return of this painful though not dangerous affection.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.

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