Muscle spasm

“ Trembling is connected with disease of the pyramidal tracts, because in this way the influence of the cerebral centres is withheld from the muscles. When a muscle is in a condition of tonic spasm, it is the result of the running together of very rapidly-repeated muscular contractions. It is like the contraction in a muscle from an interrupted electrical current. If the interruptions are slow, the muscular contractions are seen at intervals like a tremor ”

“ The short, sudden contraction we shall call a twitch or simple spasm.
We repeat the experiment, only irritating the muscle instead of the nerve, and we get the same result: a single twitch with a single shock and tetanus when the shocks come in rapid succession.
We have learned from this experiment, then (1) , that when we irritate the nerve going to a muscle, the muscle becomes shorter and thicker, or, in other words, it contracts; (2) , that a single shock of electricity to the nerve is followed by a sudden sharp twitch, a single contraction ”

“ I have just mentioned one instance in which intermittent spasm of a voluntary muscle, the orbicularis palpebrarum, was caused by irritation of a sensory nerve. This leads me to remark that a very important condition to be borne in mind is that constant stimulation of a sensory nerve will often produce clonic or intermittent, and not tonic or continuous, contraction of the muscles which it may set in action. ”

“ Prolonged spastic contraction of voluntary muscles, going on, sometimes for weeks, and even months, is a phenomenon that has often been observed; it may attack the arm only, or may affect all the limbs, and the muscles of the trunk and of the neck: it is for the most part symmetrical, but is occasionally unilateral. It begins in the extremities, and is very commonly limited to them; it is much more gentle than tetanic spasm, and is also painless, or nearly so; but the contraction is often strong enough to resist very vigorous efforts at artificial extension. ”

“ Sometimes all the muscles simultaneously become rigid, so that the body assumes a statuesque attitude (orthotonos) . When the thoracic muscles, including the diaphragm, are thrown into spasm, the patient experiences a distressing sensation as if he were gripped in a vice, and has extreme difficulty in getting breath. Between the attacks the limbs are kept rigidly extended. The clonic spasms may be so severe as to rupture muscles or even to fracture one of the long bones. ”

“ The limp is variable and suggests fatigue; it is much better after rest; it almost invariably follows the pain. Pain of a hyperæsthetic character is usually the first symptom, and it is found most generally in the immediate region of the joint. “In place of an apprehensive state in response to the tests applied will be found a series of symptoms which are erratic and inconstant. A condition of muscular rigidity often exists, but, unlike a true muscular spasm, it can in most cases be overcome in the manner before stated. ”

“ As might be supposed, these spasms affect most usually the upper extremities, although they may affect the lower, as is occasionally seen in workers on the lathe and in pedestrians. Other muscles than those necessary to perform the act that has become difficult may also be seized with spasm coinstantaneous with the spasm of the affected part; thus the left arm may be the seat of associated movements while the right is being used: these are, however, most frequently seen in the affected arm when the other is being used to relieve it ”

“ Mode of Occurrence.—These muscular conditions present themselves under two forms, acute and chronic. The acute condition occurs almost suddenly and is accompanied by spasmodic pain and acute discomfort. Muscles go into spasm to avoid the movement that would necessarily bring pain with it. A typical example is found in torticollis in which the patient wakes up some morning to find a stiffness in the muscles of his neck with limitation of movement much more pronounced on one side, and this usually gets worse as movements are attempted during the day. ”

“ And hence the cramp, or spasm, of these muscles is continued without intermission by this new pain, unlike the alternate convulsions and remissions in epileptic fits. The reason, that the contraction of these muscles of the calf of the leg is more violent during their convulsion than that of others, depends on the weakness of their antagonist muscles; for after these have been contracted in their usual action, as at every step in walking, they are again extended, not, as most other muscles are, by their antagonists, but by the weight of the whole body on the balls of the toes ”

“ Injuries of mixed nerves, with incomplete destruction of the fibres, give rise to many and varied symptoms, some of which are the direct result of the injury—many others of subsequent changes of an inflammatory character (neuritis) in the nerves or in the parts to which they are distributed. Pain is one of the most prominent symptoms immediately resulting from nerve-injury, although as a rule it soon subsides. There is sometimes merely numbness or tingling, or there may be no disturbance of sensation at the moment of injury. Rarely is spasm of muscles an immediate effect. ”

“ This would seem to prove that the spasms in question are not reflex, but either central and spinal, or else muscular—an inference which is strengthened by their being tonic and not clonic. As stated, the spasms, or cramps, frequently affect the limbs, but comparatively seldom involve the muscles of the chest or abdomen, and those of the face hardly ever. They are almost the only causes of pain in the disease, which in not a few instances runs its whole course, even to a fatal termination, without their occurrence. ”

“ In rare cases when the maximum degree has been attained there is continuous pain, but the affected muscles are persistently maintained in a relaxed condition by means of true spasm in the surrounding muscles. Slow passive movement affects the subject of muscular rheumatism, and may often be accomplished with a little management without causing pain. If, at the same time, these muscles be handled by pinching and slight pressure, it will be found that they are very sensitive to the touch. When some tenderness does exist, it is slight and is not located in the district of the lower nerve-trunks. ”

“ This limitation, however, is not invariable; for I have often seen individuals of this species respond with a spasm to irritation of the general contractile tissue. Nevertheless, such response to such stimulation in the case of this species is exceptional—the 125 usual response to muscular irritation being an ordinary locomotor contraction, which forms a marked contrast to the tonic spasm that invariably ensues upon stimulation of the margin, and almost invariably upon the stimulation of a radial tube. ”

“ At the time of admission to hospital he complained of great irritability, nervous twitching, formication in his limbs, war dreams, tachycardia. The heart boundaries were normal. The muscles of lower extremities were attacked by tonic spasms, and felt board-like. This tonic spasm occurred on each attempt at motion, very gradually disappearing when at rest. Passive movements also had the same effect. Fibrillary tremor affected the left quadriceps. On each attempt at motion, pains were felt in the legs. At first the cramps were so severe that all locomotion or even standing was impossible. ”

“ There are but few exigencies that generally occasion more alarm than CONVULSIONS. Fits may come on without premonitory symptoms; there is sudden loss of consciousness, accompanied by irregular and powerful contractions of the muscles. All the voluntary muscles may be affected, 291or there may be only spasm of the features, or of one side, or of a single limb. During a general paroxysm the countenance is distorted, and the face pallid or livid; generally there is stertorous breathing, and as the attack subsides a disposition to sleep. ”

“ In muscular fatigue the insertions are the places most painfully felt. In muscular rheumatism, however, the whole muscle grows painful; and violent contraction such as that caused by the faradic current, or known as cramp, produces a severe and peculiar pain felt in{66} the whole mass of muscle affected. Sachs also thought that he had demonstrated, both experimentally and anatomically, the existence of special sensory nerve-fibres, distinct from the motor fibres, in the frog's muscle. ”

“ It is indeed only one of the many spasms which may affect the muscular system. They generally begin in the fingers and toes, which become bent and stiff; they seize upon the muscles of the calves of the legs, and render the muscular wall of the abdomen as hard as a board. The pain they produce is extremely severe, and unless the patient is exceedingly prostrated he endeavors to assuage it by a constant change of position. ”

“ The muscles of the limbs, chest or abdomen or some part 161of them may be the seat of tonic or clonic spasm. The skin is usually hypersensitive and this is aggravated by heat. The urine is liable to be retained because of the pain of stretching to micturate. Paralysis usually follows and implies extension to the myel, compression of the cord by reason of exudation, or implication of the spinal nerves at the points of exit. In myelitis on the other hand the spasms may be entirely absent, and paralysis sets in early and extends rapidly according to the seat and extent of the lesion. ”

“ Pressure even sometimes allays pain. The constant effort to avoid pain gives rise to a feeling and appearance of stiffness, and thus characteristic attitudes and positions of the head, trunk, or limbs are voluntarily and persistently maintained. There is no spasm of the affected muscles; the distortion is the result of stiff contraction of the associated muscles, which thus forcibly fix the faulty one and hold it in a state of relaxation. ”

“ Spasm is a marked symptom in many diseases of the brain and of the spinal cord. Spasms may result from irritation of the motor nerves as conductors, or may result from irritation of any part of the sympathetic nervous system, and they usually indicate an excessive action of the reflex motor centers. Spasms may be induced by various medicinal agents given in poisonous doses, or by effete materials in the circulation, such as nux vomica or its alkaloid strychnia, lead preparations, or an excess of the urea products in the circulation, etc. ”

“ They have no direct action on the brain or the vaso-motor nerves. They increase the irritability of the peripheral motor nerves, and of the motor columns of the cord. They do not induce muscular paralysis, but, on the contrary, increase the irritability of voluntary muscle. They induce convulsions mainly through their augmenting the irritability of the anterior column of the cord, the motor nerves, and muscles. They firstly increase and secondly diminish temperature. Death ensues from asphyxia and respiratory collapse. ”

“ A spasm is as different as possible from an ordinary contraction, and will continue to pass long after the ordinary contractions have been blocked by severity of section. It is scarcely possible to suppose a nerve-plexus here—the tolerance towards section being so great, although it varies in different cases. Besides, suppose this to be a segment of animal cut as represented. On irritating margin at a all the bell goes into a spasm, and it is evident that whatever the nature of the conductile tissue, all the connections must pass through the tract of tissue at b. ”

“ The knowledge that we already possess of the nerve centers is from observation of the condition of the muscles. In a given case, by comparing the state of the muscles during life as they may be affected with paralysis or spasm with the brain-lesion found after death, and by collecting and comparing many cases, it has been found that destructive or irritative lesions of certain parts of the brain cause paralysis or spasm of a certain set of muscles corresponding. ”

“ The rubbing should never cause pain, but, on the contrary, should relieve any pain that exists, as well as the muscular spasm which is one of the most important causes of pain and of displacement in recent fractures. ”

“ A second is catochus, like the preceding, but with a higher96 power of spasm, so that the joints are rigidly fixed; and if you overcome one for a moment with superior strength, being let go, it flies back to where it was. A third, partial spasm of equal rigidity, arching the body forwards or backwards or laterally, or fixing one limb or more. The fourth, clonic spasm, for instance, the contortions and convulsive struggles of epilepsy. The fifth, an impulse to rapid and varied muscular actions, nearly equalling convulsions in violence, but combined so as to travesty ordinary voluntary motion ”

“ Facial Spasm.—Clonic contraction of the facial muscles (histrionic spasm) occasionally results from irritative lesions in the cortex or pons. Sometimes all the muscles are involved, sometimes only one, for example the orbicularis oculi (palpebrarum) —blepharospasm. This condition may be induced reflexly from irrigation of the trigeminal nerve, notably of branches that supply the nasal cavities and the teeth.
The treatment consists in removing any source of peripheral irritation that may be present, in employing massage, and in administering nerve tonics, bromides, and other drugs. ”

“ ETIOLOGY.—It is certain that the same causes that produce spasm in childhood are efficient in the adult, though there is an absence of some of the conditions that render the disease so frequent in infancy. The cartilages have become more firm, and consequently are not so easily moved by the action of the constrictor of the vestibule of the glottis; the size of the cavity in proportion to the necessities of the body for air is larger; the control of the voluntary over the automatic actions of the muscles of mixed function is greater; the reflex irritability of the nervous apparatus is less. ”