An editorial column of the BMJ in September 24 1949 is titled:
It is a small column that summarizes Copeman and Ackerman’s (1947, 1949) work about the fibro-fatty nodules (or back mice) being the cause of “muscular rheumatism or fibrositis” and also Orr’s (1948) work about the nodules simulating uretero-renal disease.
It starts saying that the correspondence columns had recently been testimony to the lack of unanimity of opinion on the subject of “fibrositis”. (Personal note: what I call “the fibrositis controversy”)
The clinical entity is well recognized, but pathologically it probably represents a composite group of abnormalities, if a NO DEFINITE LESION is demonstrable, some would prefer to talk simply of “myalgia”.
Copeman and Ackerman have identified a group of patients that would have lumbar and gluteal fat herniation that would give rise to backache and referred pain in the leg. They investigate that by dissection of cadavers of healthy soldiers. In certain fascial areas, especially where the cutaneous branches of the lumbar nerves (CLUNEAL nerves) accompanying the blood vessels pierce the fascia, they observed fat herniation.
In July, Copeman published an article where he discusses the significance of these findings in certain “rheumatic syndromes” (Copeman, 1949). In the case of “lumbar myalgia” there were local tender nodules; pressure on these “trigger nodules” reproduced the patients complaint.
The excised nodules consisted of edematous fibro-fatty tissue herniated through the fascia and continuous with the underlying deep fat.
They accomplish the relief of pain by excision or disruption of the nodule by injection of 10-20 ml of procaine, followed by extensive teasing and undercutting with the needle-point.
Copeman and Ackerman also claim that the customary treatment of “fibrositis” by heat, massage, and movement also demonstrate the nature of the lesions, since these measures improve the blood supply and lymphatic drainage and help to destroy the nodules or reduce the herniation.
Orr, Mathers and Butt confirmed Copeman and Ackerman’s work. They demonstrated nerve fibers in the tender fibro-lipomatous nodules excised from the lumbo-dorsal region of patients who complained of pain that simulated uretero-renal disease (in whom NO urological disease was found). In each case the removal of the nodule affected cure. They stated that VISCERAL disorders might be suggested by pains arising from somatic structures and VICEVERSA.
Published in October 2018 By Marta Cañis Parera
Lumbar “fibrositis”. BMJ Sept 24, 1949. Page 695-696.