Wilson summarizes in this article that primary and secondary fibrositis just required an average of 5-7 treatments of physical therapy administrated in 7 days (he does not explain the physical therapy technique deeply). Short wave diathermy and microthermy followed by massage is very useful. The subcutaneous injections of neostigmine were an adjunct therapy.
He presents illustrations where he shows the common sites of the NODULES AND REFERRED PAIN in fibrositis (he did not do any biopsy to be sure what the nodules were or the fact that the localizations were related to the points were sensitivity cutaneous nerve branches become superficial).
On the discussion they mention the possible relationship between the fibrositic pain and the infected tooth or the mouth infections. That tendency to relate the fibrositis syndrome with the teeth infections was very common by then, and even nowadays some investigators relate the infection in the teeth to certain pain syndromes.
Personal note: Despite he affirms the presence of the nodules, HE DOES NOT MENTION THE POSSIBLE ETIOLOGY or FISOPATHOLOGY of the creation of the nodules. He doesn’t even theorize about it. He does not mention the fatty tissue at all. He does not mention the sensitive nerve cutaneous branches involvement either. He focuses more on the clinical expression of the entity. He DOES NOT discuss why the neostigmine subcutaneous injections should work.
Notes on the article:
By George D. Wilson, M.D.
Asheville, North Carolina, EUA
Read in Section on Physical Medicine, Southern Medical Association, Forty-Second Annual Meeting, Florida, October 25-28, 1948
Wilson starts his article with the following statement:
“One of the commonest disabling conditions that comes to a physician’s office is fibrositis”.
He described it as an “inflammatory condition of the fibrous tissue, characterized by stiffness and pain, which is increased by active motion. It is NOT diagnosed by the laboratory test. (Personal note: He seems not to be aware of the studies that dismiss the “inflammatory process”, and that later became a point of discussion about the existence of the clinical entity itself, especially when the investigators from the Mayo Clinic argued it. He, nevertheless, makes it clear that the laboratory tests are negative).
He mentions Gowers’s work in 1904 and that the English discuss about it whereas in America it seems a more neglected subject. It seems that it is less common in America than England but it is just a matter of nomenclature, according to Wilson. Many just called it MUSCULAR RHEUMATISM.
He mentions Hunt’s and Gordon’s works that associate the symptoms of “hyperthrofic arthritis” to fibrositis. Wilson mentions that despite the Roentgen film showed hyperthrophic changes in osteoarthritic patients, the pain relief came by the treatment of the associated fibrositis (Personal note: Also other authors, like Copeman (1949) related the pain relief of the osteoarthritic patients to the treatment of the painful nodules).
Fibrositis treatment was by then according to WILSON: slicylates, vitamine therapy, single procaine injections, Roentgen therapy, and, especially, PHYSICAL THERAPY.
Wilson states that there were VARIOUS FIBROUS TISSUES involved with fibrositis:
-the nerve tissue
-the epithelial tissue
It concerns tissue that develops from the MESODERM: it forms ligaments, tendons, aponeuroses, investing membranes, nerve sheaths, and fascia.
That’s why they use other names to explain special parts of fibrositis: synovitis, tenosynovitis, periostitis, bursitis, and perineuritis (Personal note: It seems that all the discussion about the suitability of the term fibrositis leads to the mainstream medicine to use these terms instead and the complete disappearance of the term fibrositis, so much that I myself, as a doctor, never heard about it).
Wilson mentions other works from previous authors:
-STOCKMAN (English) believed that new fibrous tissue was formed with a tendency to contract and get swollen, painful and tender (Personal note: I would not describe Stockman’s results like this, this is Wilson’s explanation).
-THOMSON AND GORDON noted that the morbid lesions in fibrositis took the form of NODULES.
There may be a generalized INDURATION of an entire muscle or it may be a localized induration especially palpable in the middle of the TRAPEZIUS or the lower third of the erector spinae group.
The symptomatology of the primary and secondary fibrositis
Wilson defines PRIMARY FIBROSITIS as the fibrositis that is unaccompanied by and independent of other diseases.
SECONDARY FOIBROSITIS was related to hyperthrophic arthritis, alcoholism, diabetes, tuberculosis, menopausal syndrome, faulty metabolism, hypothyroidism, and repeated trauma.
In the primary fibrositis, pain can be sharp coming suddenly.
The fibrositic nodules are tender to pressure, and there is usually a bursitis, tensosynovitis or perineuritis associated.
There can be a HYPOALGESIA or HYPERALGESIA.
IT IS USUALLY UNILATERAL.
1- CEPHALODYNIA: It is related to the fibrositis involving the tissue of the scalp from the occiput to the frontal region. TELLING called the nodular headache and mentioned it was the most common form of headache. Digital pressure elicits TENDER NODULES UNILATERALLY below the superior nuchal line. Then the pain can be radiated through one of the occipital nerves.
Perelson mentions: “I could find NO reference in the literature which points out the presence of tenderness of the greater and lesser occipital nerves in different clinical forms of headache as a fairly constant finding”.
2-TORTICOLLIS: The trapezius, scalene, and the sternomastoid muscles are involved. The muscle is palpable THICK, TENSE and tender. The strenomastoid is palpated as CORD-LIKE. One side is more involved than the other.
3-SCAPULODYNIA: It involves the rhomboids and elevator scapulae. FIBROSITIC NODULES are palpable along the vertebral border of the scapula and upper inner angle of the scapula, a finger’s breath from the bony edge of the scapula.
4-DORSODYNIA: It is the fibrositis of the dorsal muscles, especially the erector spinae group.
5-PLEURODYNIA: It is the fibrositis commonly found in the intercostal and pectoral muscles. Deep breathing is painful and maybe limited. Nodules are palpable in the tendinous insertion of the pectoralis major and the inferior lateral border of the muscle may feel bread-like.
6-THORACOLUMBAR SYNDROME: It is fibrositis of the thoracolumbar musculature (from the 12th thoracic vertebra to the sacrum). Pain may be dull or sharp limiting the motion as arising from a chair or assuming an erect posture. Pain may radiate to the groin. A NODULE can be palpated in the costovertebral angle. Pain may also radiate to the buttocks, thigh, and knee level. IT IS OFTEN DIAGNOSED AS SCIATICA.
7-FIBROSITIS OF THE ABDOMINAL WALL: As described by Wilson and Klinger.
Examination and diagnosis of the primary and secondary fibrositis
The diagnosis is based on exclusion and on an “ARTFUL THUMB” (which is the physicians’s best tool). Palpation of localized tender, indurated muscles, bursa or tendons and periarticular tissues is diagnostic. In secondary fibrositis, the searching thumb isolates fibrositic nodules.
Better if the patient sits on the edge of the treatment table and the examiner stands behind.
Better to begin behind the mastoid area and proceed downwards.
Goniometry can be used to see the improvement after treatment.
The treatment of primary and secondary FIBROSITIS according to Wilson
Deep heat with short wave diathermy can be beneficial. After heat then massage. Then motion as the patient’s muscles allow.
They obtain faster results using neostigmine 1cc of 1:2000 solution SUBCUTANEOUSLY given consecutively for 7 to 10 days.
Wilson’s cases about primary and secondary fibrositis
-80 cases: 44 primary fibrositis (14 men and 33 women, average age 33), 36 secondary (average 50 years, 12 men and 24 women).
-44 patients primary fibrositis: all had negative X-Ray.
-29/36 secondary fibrositis had a Roentgen film that revealed OSTEO-ARTHRITIS of the spine.
They manly received a weekly-based treatment of physical therapy with massage, heat, and subcutaneous injections.
The commonest complaint was infra-occipital fibrositis with headache. There was the presence of FIBROSITIC NODULES in the posterior cervical muscle attachments.
IN the discussion of the article:
-Dr. Temple Fay from Philadelphia points out that he has observed these nodules on the nerves at operation, and they also observed “AN EFFUSION OF FLUID BETWEEN THE PLANES OF THE MUSCLES”. He comments something he thinks can be a clue. A vaccine from Streptococcus viridians from the mouth had the effect of STIRRING UP THE SYMPTOMS of PAIN along these tender spots and nodules. They had the theory that there was a kind of bacterial process of sensitization (allergy) rather than a direct infection.
Schwartzman established what is known as “Schwartzman’s reaction” indicating that many common bacteria can cause specific reactions at a distance from the focus in 1935.
Wilson and Temple both had the experience that some patients improved after the removal of the infected tooth. That’s why Temple suggested that the allergy theory with autogenus vaccines could be investigated.
-Dr. Walter J. Lee, Richmond: He comments the problem of the use of the term “fibrositis” since there are NO INFLAMMATORY CELLS involved (as described by Dr. Lynch of the Mayo Clinic); nevertheless, he says they can accept the term in a “sympathetically way”.
Walter mentions that he had the idea that fibrositis may be one of the “EARLIEST MANIFESTATIONS OF OLD AGE”. Maybe the degenerative processes in the bone become manifest only later on, and then we called them osteo-arthritis.
-Wilson mentions that he felt, as Dr. Gordon did, that there was an involvement of the autonomic nervous system in fibrositis.
Published in March 2019 By Marta Cañis Parera
-Not free online article: Wilson D. Fibrositis. Medical World. 1947. 67 (8) p 231-6. ISSN: 0951-4880.