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In the common form of paralysis resulting from poliomyelitis, many fibres undergo fatty degeneration and are replaced by fat, while at the same time there is a regeneration of muscle fibres. #Fibrositis# or "#Muscular Rheumatism#." This clinical term is applied to a group of affections of which lumbago is the best-known example.
A similar affection is met with in the shoulder and arm brachial fibrositis especially on waking from sleep. There is acute pain on attempting to abduct the arm, and there may be localised tenderness in the region of the axillary nerve. Treatment.
In lumbago lumbo-sacral fibrositis the pain is usually located over the sacrum, the sacro-iliac joint, or the aponeurosis of the lumbar muscles on one or both sides. The amount of tenderness varies, and so long as the patient is still he is free from pain. The slightest attempt to alter his position, however, is attended by pain, which may be so severe as to render him helpless for the moment.
It is met with chiefly in male adults, and is most apt to occur in those who are gouty or are the subjects of oxaluric dyspepsia. Gluteal fibrositis usually follows exposure to wet, and affects the gluteal muscles, particularly the medius, and their aponeurotic coverings. When the condition has lasted for some time, indurated strands or nodules can be detected on palpating the relaxed muscles.
There may be tenderness over the vertebral spines or in the lines of the cervical nerves, and the sterno-mastoid may undergo atrophy. This affection is more often met with in children. In pleurodynia intercostal fibrositis the pain is in the line of the intercostal nerves, and is excited by movement of the chest, as in coughing, or by any bodily exertion. There is often marked tenderness.
The group includes lumbago, stiff-neck, and pleurodynia conditions which have this in common, that sudden and severe pain is excited by movement of the affected part. It would appear to involve mainly the fibrous tissue of muscles, although it may extend from this to aponeuroses, ligaments, periosteum, and the sheaths of nerves. The term fibrositis was applied to it by Gowers in 1904.
A similar condition may implicate the fascia lata of the thigh, or the calf muscles and their aponeuroses crural fibrositis. In painful stiff-neck, or "rheumatic torticollis," the pain is located in one side of the neck, and is excited by some inadvertent movement. The head is held stiffly on one side as in wry-neck, the patient contracting the sterno-mastoid.
INJURIES: Contusion; Sprain; Rupture Hernia of muscle Dislocation of tendons Wounds Avulsion of tendon. DISEASES OF MUSCLE AND OF TENDONS: Atrophy; "Muscular rheumatism" Fibrositis; Contracture; Myositis; Calcification and Ossification; Tumours. DISEASES OF TENDON SHEATHS: Teno-synovitis.
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