Muscular Rheumatism.
Definition. —A rheumatic affection of the muscles, causing pain and stiffness of the diseased muscles, which usually disappears after some days. It some times assumes chronicity, being then accompanied by the formation of fibrous bands and nodules in the muscles. Symptoms.—The principal symptom is pain, which may be spontaneous or caused by movements or pressure of the diseased parts. The pain in some cases is limited to the first muscles affected, but sometimes it suddenly disappears from these and attacks another group of muscles. Fever sometimes attends the disease. The symptoms vary ing to the muscles affected. In rheuma tism of the intercostal muscles breathing is painful and the disease may be founded with pleurisy. When the mus cles of the abdominal wall are affected, there is excessive tenderness to pressure and the symptoms may resemble those. of acute peritonitis; but the absence of fever is of great value as a diagnostic sign. Rheumatism of the muscles of the back occasionally gives rise to opisthot ones, and suspicion of spinal meningitis, may arise. Rheumatism of the muscles of the neck causes stiffness, and, when the muscles of one side only are affected, rheumatic torticollis is produced.
Danger incident to the too-common diagnosis of obscure pain as muscular rheumatism.
In twelve cases of alleged rheumatic wryncck not one was really due to rheumatism. The abnormal position was not caused by pathological contraction of the sterno-cleido-mastoid, but was pri mary and was assumed to lessen pain; the muscle contracture was secondary and due to position. The pain and ten derness were in all cases on the convex side and not closely related to the mus cles. Tenderness was especially elicited over the fourth upper spinous processes. In every instance the lateral flexion of the rigidly-held head could be increased without pain. None of the muscles of the concave side showed increased tonus. Pain was not caused by visible exten sion of the neck; hence spasm was not the cause of the torticollis. It was evi
dent that the joints of the convex side of the cervical spine were diseased, or that the roots of the nerves passing out at this side were affected.
Two hundred eases of lumbago were observed. In not one was muscular dis ease noted. In 119 cases there was affec tion of the articulations of the lumbar vertebrre characterized by tenderness to. pressure over the joints, limitation of lateral flexion and lateral curvature, the concavity of this curvature being toward' the sound side. Twenty-one cases were instances of neuralgia of the cutaneous. nerves which have their origin in the• three lower lumbar branches. The re gion of the vertebral articulations was. not tender. Some were alcoholics. some• were beginning tabetics, and one was suffering from ostcomalacia. Erben (Central)). f. Chin, Sept. 10, 'OS).
The acute form of muscular rheuma tism passes away in a few days; the chronic form may continue for weeks and months and often provokes forma tion of new connective tissue, with its consequence: stiffening of the muscles and contractures. Sometimes small fi brous bands and nodules are formed in the muscles and give rise to much pain and tenderness. Rheumatism of the muscles is in some cases complicated with myositis, which may be general or localized,—limited, for instance, to the muscle of the heart.
Etiology.—Overwork, especially when combined with exposure to cold and dampness, has always been considered as the common cause of the rheumatism of the muscles. Many persons are very sensible to draughts. The disease com monly occurs after the thirtieth year, but is also found before that age. Some individuals have a special predisposition to the disease, and it is very liable to recur in the muscles which once have been affected by it; especially in the muscles of the neck.
In all probability the muscular form of rheumatism is also caused by mi crobes, but their presence in the affected muscles has as yet not been proved by direct observation.