Arthritis Deformans Clinical Features Condition of the Joints Coal Muscles

atrophy, joint, disease, muscular, limb, patient and spinal

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Auscultation of the diseased joints, which I have frequently tised, has not afforded evidence of the condition of the parts in any way superior to that obtained by palpation.

Impaired mobility of the parts is naturally a prominent feature of the disease, and may be extreme when the bone changes are advanced, but actual bony ankylosis never takes place except in the joints of the spinal column, and there is no tendency to the formation of fibrous adhesions which contribute so largely to the immobility caused by other forms of chronic joint disease.

In advanced cases and even in the earlier stage of the disease the movements may be seriously impaired by spasm of the muscles. This is best seen in connection with the temporo-maxillary joint, which is often involved at quite an early period in the course of the disease, the affection usually showing itself as a temporary stiffness of the jaw at first. In many instances no more serious effects are observed, but occasionally the lower jaw becomes permanently fixed so that the patient has to be fed through gaps in the teeth. Speci mens will be found in museums in which the condyle and its cavity are surrounded by extensive osteophytic outgrowths which must have most seriously interfered with movement at the joint, but even in severe cases the jaws of a patient which cannot ordinarily be sepa rated to a sufficient extent to admit of the introduction of solid food, may be found to he separable to a much greater extent when the patient is put under an anaesthetic; showing how large a share mus cular spasm has had in limiting the movements.

The same thing is noticed in the minor degrees of spinal affection which often manifests itself at first as stiffness of the neck or back. The movements of the spine are often interfered with to a greater ex tent than the joint disease will explain, and the stiffness may be at first temporary and pass off. Moreover when the cervical spine is affected the head is often drawn to one side. But spoudylitis of this kind may assume far more severe forms, and considerable osteophytic outgrowths may be produced around the spinal joints ; or, as has been said, actual bony aukylosis may take place. As in other diseases of

the spinal column, radiating pains and causalgia may bear witness to the implication of the emerging nerve roots by the morbid process.

Muscular Atrophy. —After the joint lesions and deformities, mus cular atrophy is perhaps the most conspicuous of the phenomena of arthritis deformans.

By some this atrophy is regarded as merely an example of that which is apt to affect the muscles in the neighborhood of joints which are the seat of any form of chronic and even of acute arthritis, and it is quite certain that the disease under consideration must, like other forms of arthritis, be attended by such wasting, so that, in part at least, the changes in the muscles must be of this secondary nature. There are, however, those who believe that there are other influences at work in its production, and that the joint lesions and wasting may be looked upon as parallel manifestations of the same morbid process, due to a common cause and advancing pari passe.

The so-called arthritic muscular atrophy is a phenomenon of much interest, and one which cannot be explained as merely an effect of disuse, as has been clearly shown by Charcot and others. In cases in which the patient is confined to bed by an affection of one hip or knee joint, both lower extremities are kept at rest, but the wasting of the muscles of the diseased limb altogether exceeds that on the sound side, and moreover the atrophy of the thigh muscles is accompanied by an exaggeration of the knee jerk.

Raymond" arrived at the following conclusions as the outcome of an experimental study of the muscular atrophy following traumatic joint lesions in animals : I. That the limb the joint of which is injured exhibits various symptoms, such as functional impotence, increased reflexes, idio muscular contractions, and muscular atrophy.

2. That such atrophy is not produced when the posterior nerve roots corresponding to the limb are divided. Hemisection of the cord hastens the atrophy of the muscles of the corresponding limb, but does not affect that of the opposite limb when the joints of both are injured.

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