Treatment.
—Many of the muscle pains of which patients complain after operation, which are also toxic, are relieved by the administration of aspirin in 0.5 Gm. doses. The injection of a small amount of atropine into the body of the muscle will often give relief. Those remedies which hasten elimination, including hot baths and massage, are often of great value.
MYOSITIS.
This may be non-inflammatory and be due to prolonged use of a member, as in writers’ cramp; or toxic, as in lead palsy; or traumatic, caused by minute lacerations and hemorrhage. The more acute forms may be due to extension from neighboring foci or to direct infection. A form of infection involving both muscles and tendon sheaths, and lately recognized, is the postgonorrheal. It has been shown that gonorrhea may produce an active disturbance in synovial sheaths and in muscle structures and a gonococcus myositis, as well as a gonococcus tendovaginitis, are now well recognized. These do not always proceed to suppuration, but may provoke loss of function for some time.
The suppurative form of myositis is seen more often after typhoid and gonorrhea than after the other internal infections, but may occur after any of them. In these cases abscess results in the belly of the muscle involved, while the pus evacuated will show the appropriate organism. It is met with less often in endocarditis and erysipelas.
Any or all the active and destructive infections may occur primarily in muscle structure. They are usually the result of an extension, although they maybe even in this way very disastrous. The amount of muscle destruction that may be seen in a limb after an infected and neglected compound fracture is astonishing.
Myositis Calcificans.
—Calcification and ossification of muscles are alike due to deposition of calcium salts, but under different circumstances. Myositis calcificans may be the result of tuberculous disease following caseation, as it does in lymph nodes and in other parts of the body, or occurring as a general deposit throughout the muscles, essentially an infiltration, as is seen in the muscles of the legs. Myositis ossificans implies a formation of true bone in muscle substance. A peculiar form arising in the adductor longus results from the pressure of the limb against the saddle; this has been known as rider’s or cavalryman’s bone. Something similar in the deltoid has been called drill bone, because usually seen in soldiers who carry their weapons upon the shoulders; while a form which occurs in the brachialis anticus has been referred to as fencer’s bone, and one in the calf muscles as dancer’s bone. It occurs in two types, one of which is characterized by ossification in succession of the various muscles, this occurring first in the trapezii, latissimi, and rhomboidei. In explanation of these lesions, it has been suggested that all of these connective mesoblastic tissues may manifest certain atavistic tendencies and thus revert to bone. The question is certainly not one of periosteal origin. Binnie has shown, in a remarkable case reported by himself, that ossification is both of the fibrous and cartilaginous type. Only in the localized forms can the periosteum be suspected. In these it may be that there has been detachment of some of its tissue or escape of some of its cells into the muscle area. The ossifying lesions of surrounding muscles will sometimes interfere with the motions of joints after they have been injured. Any localized calcareous or ossific deposit which can be recognized may be removed.
Myositis Syphilitica.
—This occurs in gummatous form, no muscles being exempt; those of the tongue are most frequently involved. It is seen also in the sternomastoid. Not infrequently these gummas have been mistaken for malignant tumors. Sometimes they degenerate and sometimes suppurate. A lesion of this kind will usually be multiple, but it may have enough infiltration around it to be difficult of recognition. Lesions of this kind are also seen in hereditary cases. A more distinctively interstitial affection of muscles leads sometimes to their contracture, as seen about the arms, beginning with malaise and incoördination, and extending to disabling lesions. These will yield to properly directed antisyphilitic treatment.