1953 Long & Lamphier – Fibrositis and the disc syndrome

This article titled Fibrositis and the Disc Syndrome was published in 1953. In its conclusions the authors make it clear that they considered that the patients with persisting back or sciatic pain should not undergo disk exploration and surgery as first option, since the local infiltrations can sometimes relieve the cases of “lumbago”. Not even exploratory techniques such as myelogram should be done at the first moment.

“Those of us who see the end results of disc surgery in industry are appalled by the poor end results obtained by men of excellent surgical reputations. During the past year 51 cases diagnosed and treated as fibrositis were reviewed. A great many of these cases could well have been clinically classified as herniated intervertebral discs, and if explored, would probably have been labeled as a poor result… It is the contention of the writer that such cases coming under the heading of fibrositis should be recognized as such, with attempted conservative treatment before submitting such a patient for myelographic studies, and possible exploration because of persistent back or “sciatic” pain.”

They present a small review to show how much chaos there is in relation to the term fibrositis.

They do not go deep to the etiology theories.

They even explain a specific friend case that improved his low back pain immediately after local infiltration of the muscles of the back.

FIBROSITIS AND THE DISC SYNDROME

Gillmor Long M.D. and Timothy A. Lamphier M.D.

Boston, Massachusetts

The authors start the article saying that despite fibrositis is a known entity in most of the treatises on surgery, its interpretation by clinicians varies a lot.

  • Some think that the term fibrositis and myositis should be considered synonymous.
  • Others relate fibrositis to the tenderness or spasm of a group of muscles.
  • The medical dictionary DORLAND defines fibrositis as an inflammatory hyperplasia of the white fibrous tissue of the body, especially of the muscle sheaths and fascial layers. It is marked by pain and stiffness and it is also called muscular rheumatism.
  • The author named FINDER called the frozen shoulder or chronic adhesive bursitis “fibrositis of the shoulder”.
  • GASTON named the stiffness and back pain that follows to exposure to cold and wet and similar to lumbago “fibrositis of the back”.
  • In 1920, STOCKMAN believed that fibrositis was a result of inflammatory hyperplasia taking place in the fasciae, aponeurosis, and articular capsules…on biopsies he observed a serofibrinous inflammation that may become absorbed or organized.
  • In 1944, COPEMAN AND ACKERMAN published their findings that the fibrositis of the back was due to herniation of some fat lobules through the weakened fascial tissue.
  • In 1942, STEINBERG differentiated primary and secondary fibrositis. He was convinced that fibrositis is a metabolic disorder and treated the patients with vitamin E.
  • MOYNAHAN AND NICHOLSON stated that fibrositis is synonymous with: muscular rheumatism, torticollis, brachialgia, lumbago, and sciatica of unknown etiology. They found that novocaine injection could “cure”.
  • -GUTSTEIN-GOOD interpreted fibrositis as a VASOMOTOR disturbance.
  • SLOCUMB wrote an article in which he pointed out that fibrositis was often misdiagnosed as atrophic arthritis or chronic nervous exhaustion. He stated that palmar fibrositis could lead to Dupuytren’s contracture or that perineural fibrositis could present as sciatic syndrome.
  • KURSEN defined fibrositis as a white fibrous tissue inflammation characterized by the presence of nodules; “the nodules should be broken up and massaged away”.

The authors’ case reports

They selected 51 patients with past history of low back pain (LBP) related to knife-like pains affecting the lower back following a sudden bending while at work. (aged 20-66).

  • 18/51 had past history of LBP.
  • 70% of them had been visited by other doctors, 90% of them had the diagnosis of ruptured disc.
  • 70% of the 51 patients improved with local infiltrations with Eucupin solution in oil with benzocaine and benzyl alcohol and physiotherapy.
  • 9/51 had no relief from infiltration and became “worse than before the treatment”.
  • They DID NOT PALPATE nodules in none of the 51 patients.
  • The authors insisted that many working men that present pain while bending over should be treated in a conservative manner with infiltrations and physiotherapy before searching for disc problems, since most of them get better after this treatment.
  • AITKEN warned that some patients with LBP might present a FALSE positive myelogram that may lead the patient to undergo surgery by error.

Published in May 2019 by Marta Cañis Parera

fibrositis