This is a very short article titled Sacro-iliac Lipomatosis or Herter’s Disease (also known as back mice) published in the editorial of the Pennsylvania Medical Journal in 1952.

Apparently, Dr. Raymond was not aware of the previous studies of Ries, Copeman or MacDermot and thought that it was the first time there was a publication about this entity. Some years before, a doctor called Herter from Cleveland explained them about it, so in a homage to him he decided to name it Herter’s disease.

It is a very short article written in short statements as an editorial.

I could not find any publication from Herter from Cleveland (the doctor that explained to Raymond).

Later, Dr. Raymond published a second article about it.

The article does not present any figure.

Personal notes about the article:

SACRO-ILIAC LIPOMATOSIS (HERTER’S DISEASE)

A Relatively New Clinical Entity

By Malcolm L. Raymond, M.D.

-Patients present to physicians with the common complaint of low back pain.

-It is interesting to notice that the lumbosacral region is under continuous strain.

-They wanted to call attention to a condition that they thought to be overlooked because it was relatively unknown.

-Reports on the BLUE SHIELD had brought requests of an entity unknown to their office.

-Patients and their friends had stated that they never heard of the condition.

-When this cause is at work, the patient would be wrongly treated unless the condition is recognized.

-A common error was to make the diagnosis of rheumatic nodules if nodules happened to be palpated.

-A few years ago in a surgical convention they heard Dr. Herter from Cleveland describe a backache with radiating pain due to herniated nodules of deep fat protruded through the deep fascia over the sacroiliac joints, commonly in obese females. He reported a small series of cases.

-After Dr. Herter’s visit they began to watch for the condition and saw and operated upon 9 of such patients in less than 2 years, all obtaining complete relief.

-The patient complained over one or both sacro-iliac joints, which may or may not radiate upward, downward, or laterally, even to abdomen (mistakenly they had a case that had a previous hysterectomy without relief, because it was confused with pelvic disease).

Raymond’s examination technique for the sacro-iliac lipomatosis

-The patient lying on the abdomen, one deeply palpates over the level of the sacro-iliac joints and laterally to the line of the joint.

-A nodule will be felt as a discreet, firm mass, 2 or 3 centimeters in diameter, more or less globular, extremely sensitive when rolled firmly beneath the fingertips, and laying deeply, often just over the bone. This maneuver will promptly elicit any radiation of pain.

Raymond’s pain theory for the sacro-iliac lipomatosis

They had the opinion that the herniated fat carried with it through the hiatus fine nerve filaments that are thus pulled or pressed upon, setting up referred pain from the sensory cells in the corresponding ganglia.

Medical treatment for the sacro-iliac lipomatosis

Infiltration with 2% procaine 2 to 5 cc may give temporary relief. In their experience its duration was only a week or two.

Surgical treatment for the sacro-iliac lipomatosis

Under local anesthesia, except in the sensitive individual, the masses are exposed with a transverse incision down to the deep fascia. Careful palpation in the depths of the wound is necessary. The nodule is excised, the fascial hiatus closed with N1 1 chromic catgut, the fat with interrupted or figure-of-eight suture, plain No 1, and the skin with clips.

The patient should remain in bed a few days, resting on the sides or abdomen. When permitted up, pressure on the chair back should be avoided. Stooping forward should be gradually to two weeks.

The pathological findings of the sacro-iliac lipomatosis masses

The gross anatomy was of a dense lipoma.

They did NOT perform microscopic sections.

Summary

The relief of pain that previously was even disabling was prompt and dramatic.

In 2/9 cases the nodule was single, in 7/9 it was multiple and in a few it was on both sides.

In one case the nodule was lying more laterally, with a history of a previous trauma at that point.

One patient had so much pain that was not able to sleep on her back for many months. As in all their cases, her pain was gone the day following operation.

One patient that returned to work too soon suffered a recurrence of the herniation on the same side and the same radiation.

Out of respect to Dr. Herter, in their institution they designated the condition as Herter’s nodules and it so appeared in all their records and reports.

Published in September 2018 by Marta Cañis Parera    

Reference

RAYMOND ML. Sacro-iliac lipomatosis (Herter's disease); a relatively new
clinical entity. Pa Med J. 1952 Nov;55(11):119-20. PubMed PMID: 13003443.