Myositis Tuberculosa.
—This affection is usually the result of extension from adjoining foci. As in the case of syphilis it may assume the infiltrating or the gummatous type. It is more frequently encountered than the muscular expressions of syphilis; it does not yield nearly as readily to treatment, and calls for excision of the affected area and for cauterization or other protection as against re-infection.
PARALYTIC AFFECTIONS OF MUSCLES.
More or less permanent paralysis is sometimes the result of contusion or direct injury of a nerve trunk. Thus the paralysis of the deltoid which follows injury to the circumflex nerve in connection with dislocations of the shoulder is a frequent accident. It does not require continued pressure upon the nerve to produce this. It may follow a dislocation reduced within a few moments. Again, paralysis of the arm muscles is occasionally the result of pressure made by crutches. It has been known to occur from similar pressure while the patient was upon the operating table with his arm hanging over the table’s edge. This is an accident which should be carefully avoided. Moreover, it follows sometimes from mere violent muscle effort. The condition, while simple in its etiology, is difficult and sometimes impossible to cure.
Treatment.
—The treatment should consist mainly of massage and electricity, with the elimination of all possibility of toxemia. The resources of [tendoplasty] (see above) should also be considered, as well as those of neuroplasty.
ATROPHIES AND CONTRACTURES OF MUSCLES.
Muscular paralysis is always followed by atrophy, which will lead to marked diminution in size of the part; when the atrophy concerns a single muscle or muscle group it will frequently be followed by deformity due to action of the opposing muscles. Tonic spasm of muscles unopposed may lead to contractures, often with ankylosis. The degree of deformity which is produced may eventually require amputation of a limb.
Other forms of contractures are produced either as the result of central or spinal scleroses or as expressions of irritative spasm provoked by a neighboring bone or joint trouble. The two types may cause similar deformities, which vary widely in their etiology. The former are seen in certain cases of brain and spinal-cord diseases, the latter especially in connection with tuberculous arthritis. Inasmuch as the flexors are stronger than the extensors these deformities consist largely of hyperflexion. Ultimately the shape and growth of bones and the nutrition, appearance, and function of the part are influenced.
Muscle atrophy which is the result of confinement in one position, as after the treatment of fractures, is of minor importance and tends to disappear spontaneously as soon as function is resumed.