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Syphilitic Myositis

biceps, patient, syphilis, muscle, arm and tion

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Syphilis may produce lesions of a peculiar kind in muscular tis sue. These were for a long time unrecognized, but their occurrence is now admitted by all writers on the subject. The works of Ricord, Notta, Lagneau, Gosselin, Maurice, and recently Prost (These de Paris, 1891) have shown in a very clear manner the part that syphi lis plays in the pathology of the muscular tissue. All the muscles are not attacked indifferently, those of the right side being more fre quently invaded than those of the left, and those suffering the most which have the most labor to perform. Among these may be mentioned especially the masseter, the steruo-cleido-mastoid, the biceps, and the flexor muscles in general. The extensors are rarely the seat of syphilitic myositis, three cases only in which the triceps brachialis was affected having been reported. In most of the re corded cases it was the biceps that was attacked.

The disease may appear during any of the stages of syphilis, but is most commonly a manifestation of the secondary period, and is frequently accompanied by the eruptions. peculiar to this period. Rheumatism and gout have been invoked together with syphilis iu the etiology of the inflammation. It has been said that while syphi lis played the principal role in the causation of the disease, the mor bid phenomena were manifested by preference in a soil previously prepared by rheumatism or gout. Without wishing to deny wholly the influence of these diatheses, I must confess that the syphilitic infec tion appears to me to be the chief if not the exclusive etiological factor.

The following is what generally takes place: A patient presents himself with the forearm flexed upon the arm, and affirms that he is unable to execute the slightest movement of extension. Examina tion shows the biceps in a state of contracture and attempts to make forcible extension are fruitless and only excite severe pain. The skin presents no evidence of inflammatory action beneath, the color being normal and no heat being perceptible in the part. Careful palpation

shows that the biceps alone is affected, its tendon forming a tense prominence like a cord. To judge from the prominence of the belly of the muscle and from its shortening, it might be thought that it was in a state of contraction, but the•e is not the normal consistency of a muscle in a state of active contraction; it is less hard than a healthy muscle should be. It is smooth, presenting no knobs or bosses on its surface. Strong palpation with the tip of the finger causes pain at the bend of the elbow, at a point on the inner side of the biceps tendon. As already remarked, most intense pain is caused by at tempts at extension of the arm, and these attempts are moreover utterly fruitless, the movements of the elbow being extremely lim ited. We are therefore in the presence of a patient with contracture of the biceps, but we may have difficulty in discovering the cause for the contracture. The patient states that this condition did not come suddenly, but had been growing gradually more marked for some days. At first there was merely some difficulty in moving the arm on account of a certain stiffness in the elbow, and then it was found that the forearm could not be fully extended. This at first did not cause much inconvenience, but little by little the arm became bent and stiff. The patient will frequently be seen to be very nervous, and the first thought often is that the case is one of hysteria ; but the sensi bility of the skin is found to be perfectly normal. Another supposi tion is that there is some lesion of the central nervous system ; but examination shows no alteration in the reflexes. Further examina tion will reveal the fact, either in answer to close questioning or through the discovery of the characteristic lesions of the skin or mu cous membranes, that the patient is suffering from syphilis. In this particular instance careful examination of the affected region will show that it is the muscle that is diseased and not the osseous or ar ticular structures.

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