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Updated: May 10, 2025
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.
The muscles of expression soon share in the rigidity, and the face assumes a taut, mask-like aspect. The angles of the mouth may be retracted, producing a grinning expression known as the risus sardonicus. The next muscles to become stiff and painful are those of the neck, especially the sterno-mastoid and trapezius.
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.
When the disease commences in the pre-auricular or submaxillary glands, it tends to spread to those along the carotid sheath: when the posterior auricular and occipital glands are first involved, the spread is to those along the posterior border of the sterno-mastoid.
The supra-hyoid gland lies a little farther back, immediately above the hyoid bone, and receives lymph from the tongue. The sterno-mastoid glands glandulæ concatinatæ form a chain along the posterior edge of the sterno-mastoid muscle, some of them lying beneath the muscle. They are commonly enlarged in secondary syphilis.
The facial artery can be distinctly felt as it passes over the upper jaw at the front edge of the masseter muscle. The pulse of a sleeping child can often be counted at the anterior fontanelle by the eye alone. About one inch above the clavicle, near the outer border of the sterno-mastoid, we can feel the pulsation of the great subclavian artery.
The aneurysm usually springs from the third part of the artery, and appears as a tense, rounded, pulsatile swelling just above the clavicle and to the outer side of the sterno-mastoid muscle. It occasionally extends towards the thorax, where it may become adherent to the pleura. The radial pulse on the same side is small and delayed.
In the same group are three or four glands which lie entirely under cover of the upper end of the sterno-mastoid muscle, and surround the accessory nerve before it perforates the muscle. The deep cervical glands are commonly infected by tubercle and also by epithelioma secondary to disease in the tongue or throat.
The cystic lymphangioma, lymphatic cyst, or congenital cystic hygroma is most often met with in the neck hydrocele of the neck; it is situated beneath the deep fascia, and projects either in front of or behind the sterno-mastoid muscle.
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