The treatment of muscular paresis by means of eccentric movements / by Rodolph Abercrombie.

  • Abercrombie, Rodolph.
Date:
1913
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Credit: The treatment of muscular paresis by means of eccentric movements / by Rodolph Abercrombie. Source: Wellcome Collection.

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    2 7 8 Mepicau JOURNAL [FEB. 8, ro73. _ patient endeavours to delay its fall. By this means the deltoid may be exercised while still too weak to raise the arm from the side. Paresis of the short muscles of the hand and of the flexors of the fingers provide suitable cases for this form of treatment. As before, the muscles are first put into their shortest position and then elongated, while the patient resists the extension. Mode of Application. The question as to how often the movements should be performed is of importance. They should be performed from five to ten times at each sitting, and the sittings may be given once or twice daily. A common mistake is to exercise paretic muscles too frequently. If this is done, the muscles become exhausted and recovery is retarded, not hastened. The manceuvres must be performed slowly and carefully with a strength proportionate to the muscle’s power. The results obtained will obviously depend largely on the nature and causation of the paresis. In general terms, cases of lower-segment paralysis are better suited to this form of treatment than cases of upper-segment paralysis. In order that the treatment may be of benefit, the affected muscles must not be absolutely paralysed, but must possess some trace of contractile powcr. But it must be remembered that a muscle, which in its over- stretched position may appear absolutely paralysed, may yet possess latent contractile power which may be obvious in its shortest position. In general terms, it may be said that if a muscle possesses any contractile power at all, that power may be increased by the persevering use of eccentric movements. This holds good even in long- standing cases; in such cases possibly the result is obtained by the hypertrophy of individual muscle fibres. As mentioned before, treatment by eccentric movements may well be used in conjunction with electrical treatment and massage. Percussions and vibrations may also be used, and in certain cases the limb may be splinted so as to prevent over-stretching of the affected muscles. The writer, however, considers that eccentric movements are paresis. Theoretical Explanations. I suggest that an explanation of the above phenomena is to be found in the microscopic structure of striped muscle fibre. Schifer’s? views on the histology of muscle are here followed, but are only given in bare outline; the division of the muscle fibre into sarcostyles and sarcomeres is omitted as not essential to the present question. A striated muscle consists of fibres each of which is marked by transverse bands of alternate light and dark material. According to Schifer, the dark bands are made up of longitudinal channels or tubules arranged parallel with the long axisof the muscle fibre. Each such channel or tubule is closed at one end (line of Hensen), but at its other end opens by means of a minute pore towards the light band, which is composed of clear translucent material. In Schiifer’s view, when the muscle contracts, the translucent material of the light band flows or is drawn into the channels of the dark band, and becomes hidden from view. By this means each individual channel of the dark band becomes shorter and wider, and by the sum of similar processes shortening and widening of the muscle fibre occurs. The evil effects of over-stretching on a muscle may now be considered in the light of ‘this minute structure. Mr. Robert Jones® has recently emphasized the injurious effects of over-stretching. He suggests that it has the effect of causing the nerve cells to become inactive, though not extinct. I put forward the view that the evil effects of over-stretching have nothing to do with the nervous apparatus of the muscle, but have their origin in certain changes produced by the stretching on the muscle itself. When a muscle fibre is over-stretched its sheath (sarco- lemma) is brought into a state of tension, causing lateral compression cf its contents. By this lateral compression the longitudinal channels which compose the dark bands will be compresssd one against tho other, and this will have the effect of obstructing the orifices of the minute pores througi which the translucent material gains entrance to the channels. This affords a simple mechanical explanation of the ill effects of over-stretching for since the ingress of the translucent material into tie channels of the dark band is impeded, so also will physio. logical contraction of the muscle be hindered or prevented, even though the ner vous mechanism of the muscle may be intact. ; The same considerations explain why a muscle, which appears functionless when over-stretched, can yet exhibit contractile power when put into its shortest position; for in the latter position the sheath of the muscle fibre is relaxed, the channels of the dark band do not press on one another, and therefore their pores will be unobstructed . and the ingress of the translucent material easy. Tt will also be clear why physiological contraction is so important in the treatment of paresis, for it is the only means of causing ingress and egress of the translucent material to and from the channels, passive manipulations being powerless to effect this. The rapid improvement that sometimes takes place in a paretic muscle as the result of exercise (as in the case of wrist-drop quoted above) may be explained by supposing tliat through disuse the entrances to the channels may become clogged, and possibly the translucent material altered in consistence. A few physiological contractions may serve. to clear the entrance to the channels, and thus bring about rapid improvement in the muscle’s power. CONCLUSIONS. 1. In order to perform eccentric movements, the manipulator first brings the affected muscle into its shortest position and then gradually elongates it, while the patient resists the elongation. 2. Such movements are of more value in the treatment of paresis than the more ordinarily employed muscular movements. 3. The explanation of the effect of such movements is to be found in the microscopic structure of striped muscle. REFERENCES. 1 Tubby, Defor mities, including Diseases of the Bones and, Joints, vol. ii, p. 615. 2 Gray’s Anatomy, seventh edition, p. 38. 8 Rober& Jones, BRITISH MEDICAL JOURNAL, December 9th, 1911, p. 1520, eee RAYNAUD’S SYNDROME AND SYPHILIS. BY HENRY SEMON, M.D., M.R.CP., SENIOR ASSISTANT, DERMATOLOGICAL DEPARTMENT, UNIVERSITY COLLEGE HOSPITAL, Ir would appear that Sir Jonathan Hutchinson was the ~ first to call attention to the relation of syphilis to certain cases of Raynaud’s disease,’ so that the idea of their possible association is by no means new. Since his paper (1889) there have been an ever-increasing number of reports of similar cases, and the occurrence of one in the out-patient department at the Great Northern Hospital, which Dr. Whitfield has kindly allowed me to make use of, and was the subject of an animated discussion at the Dermatological Section of the Royal Society of Medicine,? must be my excuse for once more calling attention to the importance of recognizing not only the syndrome which Raynaud described, but still more to the vital necessity, from the patient’s point of view, of tracing to its ultimate cause or causes the etiology of the condition. Inasmuch as the physician has in a majority of cases only the clinical evidence to go upon, it would be better to look upon Raynaud's discase, not as a disease sur generis—a tendency which is. undoubtedly still generally prevalent-—but rather as an associated clinical picture, a symptom complex, dependent, perhaps, on a variety of factors in which the angiospastic conception of Raynand plays only a part, and for which some organic and structural change of the vascular ae concerned is mainly responsible. The case referred to is that of a woman aged 56, who has suffered for over seven years from symptoms which Raynaud would have called typical, and which in the nan pee have terminated in gangrene (of the dry Ss bhee thumb, first, fourth, and little fi and of thé digits of the right ‘hana is more than the pulp of the dista
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