1947 Bach – Local tenderness

Bach presents a simple review with much skeptic points about the clinical entity characterized by local tenderness or painful nodules called FIBROSITIS or FIBROSITIC nodules (another name for back mice) which, by then, was a very common diagnosis in Britain.

He even questions at certain point:

“Is there such a thing as fibrositis?”

He was not the only author that was so critical with that clinical entity. Nevertheless, he considered that 71 out of 100 patients presented non-articular rheumatism or fibrositis in his study.

He presents a table with all the causal factors that have been related to this tissue LOCAL TENDERNESS or pain.

Notes on the article:

Non-articular rheumatism: “fibrositis

By Francis Bach D.M.

Bach starts commenting…

-that Gowers introduced the term FIBROSITIS in 1904.

-that Balfour also described the “fibrous thickenings” in chronic muscular rheumatism in 1816.

-that Stockman described the lesions histologically as “non-inflammatory fibrotic changes and endarteritis in the subcutaneous and myo-fascial layers” in 1920.

He also mentions other authors related with the study of muscular rheumatism: Brogstitter, Kinge, Lange, Jaccond, Slocombe, Kellgren, Elliot, and Copeman.

Bach points out that fibrositis is widely used but there is no agreement of his pathological basis.

The skepticism was increased since, lately, a large number of clinical conditions that previously were considered typical of fibrositis had been published to have other causes. For example,  “cases of lumbago, sciatica and brachial neuritis” due to PROLAPSE OF THE NUCLEOUS PULPOSUS at the appropriate level or pain due to osteoporosis or the fractures of the Looser’s syndrome”.

Bach defines fibrositis as: “pain that SEEMS to be located in the soft tissues of the trunk and limbs and for which there is no obvious cause” (Personal note: This is a definition that does NOT correspond at all to previous works like Stockman’s or Copeman’s or many other authors’, they would not have use the word “seems”). It presents as pain and stiffness during movement localized in the subcutaneous tissues, superficial and deep fasciae, aponeurosis, ligaments and capsules of joints, tendons, bursae and periostium, and the sheaths of the nerve trunks.

Palpation may reveal: local turgor, spasm, indurations or nodules. Under pressure these areas can be exquisitely painful, tender or even painless.

The clinical points for diagnosis are:

  • Local tenderness
  • Reproduction of symptoms by pressure on the tender areas or on certain localized “trigger-points”
  • Palpation of nodules
  • The relief of symptoms by injection of procaine into the trigger-areas.

Bach mentions Elliot’s objections about these diagnostic criteria:

  • Some areas are difficult to palpate since there is not a bone under them to give counter-pressure.
  • By pressure one cannot differentiate between superficial and deep planes.
  • Local tenderness is not exclusive to local disease.
  • The pain on response to pressure may be located at any point in the sensory pathway between the nerve endings in the tissues palpated and the thalamus (Personal note: It is the first time I read such an explanation).
  • Tenderness means a reduction in the threshold for pressure pain.

Elliot presented his theory that the pain in fibrositis is the effect of localized involuntary muscle spasm arising by reflex from lesions elsewhere. He considered the nodules to be small groups of muscle fibers that are in spasm owing to irritation of the nerve roots supplying them.

Bach mentions very briefly that BIOPSIES of the nodules have revealed “lipomas, neurofibroma, fibrositis and NO recognizable pathological changes” (Personal note: In my opinion, a very brief and wrong description of all the studies that performed biopsies).

-The local infiltration of the tender spots would give relief even if the lesion is due to a root lesion, prolapsed disc or spinal tumor (Personal note: He does not explain how these would happen).

-Skiagrams (radiographs) are not of value in fibrositis.

-No abnormalities are found in the blood analysis. Bach mentions a work published by Mester from Buxton that found an increased blood-fibrinogen in cases of muscular rheumatism.

Bach even says that the clinical signs are so varied and the etiology so obscure that even one wonders:


Bach then reviews concepts from histology, anatomy, evolutionary facts, psychological characteristics, and even gender differences. For example, fibrositis seems to be more common in female cases. Finally, he presents a table:

local tenderness

71 out of 100 patients from Bach presented fibrositis.

Bach then presents a list of many varied treatments to treat the fibrositis syndrome.

Published in April 2019 by Marta Cañis Parera


Bach F. Non-articular rheumatism: fibrositis. The British journal of physical medicine: including its application to industry. 1947. 10 (05) p 132-6. ISSN: 0366-2616.