In pleurodynia—­intercostal fibrositis—­the pain is in the line of the intercostal nerves, and is excited by movement of the chest, as in coughing, or by any bodily exertion.  There is often marked tenderness.

A similar affection is met with in the shoulder and arm—­brachial fibrositis—­especially on waking from sleep.  There is acute pain on attempting to abduct the arm, and there may be localised tenderness in the region of the axillary nerve.

Treatment.—­The general treatment is concerned with the diet, attention to the stomach, bowels, and kidneys and with the correction of any gouty tendencies that may be present.  Remedies such as salicylates are given for the relief of pain, and for this purpose drugs of the aspirin type are to be preferred, and these may be followed by large doses of iodide of potassium.  Great benefit is derived from massage, and from the induction of hyperaemia by means of heat.  Cupping or needling, or, in exceptional cases, hypodermic injections of antipyrin or morphin, may be called for.  To prevent relapses of lumbago, the patient must take systematic exercises of all kinds, especially such as bring out the movements of the vertebral column and hip-joints.

[Illustration:  FIG. 109.—­Volkmann’s Ischaemic Contracture.  When the wrist is flexed to a right angle it is possible to extend the fingers.

(Photographs lent by Mr. Lawford Knaggs)]

#Contracture of Muscles.#—­Permanent shortening of muscles results from the prolonged approximation of their points of attachment, or from structural changes in their substance produced by injury or by disease.  It is a frequent accompaniment and sometimes a cause of deformities, in the treatment of which lengthening of the shortened muscles or their tendons may be an essential step.

#Myositis.#—­Ischaemic Myositis.—­Volkmann was the first to describe a form of myositis followed by contracture, resulting from interference with the arterial blood supply.  It is most frequently observed in the flexor muscles of the forearm in children and young persons under treatment for fractures in the region of the elbow, the splints and bandages causing compression of the blood vessels.  There is considerable effusion of blood, the skin is tense, and the muscles, vessels, and nerves are compressed; this is further increased if the elbow is flexed and splints and tight bandages are applied.  The muscles acquire a board-like hardness and no longer contract under the will, and passive motion is painful and restricted.  Slight contracture of the fingers is usually the first sign of the malady; in time the muscles undergo further contraction, and this brings about a claw-like deformity of the hand.  The affected muscles usually show the reaction of degeneration.  In severe cases the median and ulnar nerves are also the seat of cicatricial changes (ischaemic neuritis).

By means of splints, the interphalangeal, metacarpo-phalangeal, and wrist joints should be gradually extended until the deformity is over-corrected (R.  Jones).  Murphy advises resection of the radius and ulna sufficient to admit of dorsiflexion of the joints and lengthening of the flexor tendons.