Old Injuries And So-called Rheumatism

As people advance in years, it is a common experience that tissues

injured years before are the source of no little discomfort and are

particularly prone to be bothersome during changeable seasons and in

rainy weather. A bone broken when the patient was young may twenty or

thirty years later continue to give warnings of the approach of change

in the weather and be a source of annoyance. A dislocation, especially

if complicated in any way by considerable laceration of the tissues in

the neighborhood of the luxated joint, is sure to be a source of

discomfort of this kind. These painful conditions are generally more

noticeable when patients are run down, or when they have been recently

affected by exhausting disease of any kind, during convalescence from

severe ailments or injuries, or when they are undergoing a special

mental strain. These conditions, like nearly all others worse in damp

weather, are sometimes grouped under the term rheumatism and have been

treated by internal medication. Almost needless to say, such treatment

is sure to fail or to be of only temporary anodyne benefit. As

rheumatic remedies are usually coal-tar products they may even be

distinctly harmful, especially for old patients. It has been shown

that the salicylates, for instance, are much less rapidly eliminated

in the elderly than in the young, in those with defective circulation

or kidney insufficiency than in the well. Their accumulation in the

system causes anemic tendencies and disturbs nervous control.

Just what is the underlying pathological condition in these cases is

not easy to say. In the case of luxations with laceration of tissues

there has undoubtedly been such a disturbance of venous and lymphatic

circulation by the break in continuity of tissues and the resultant

scar tissue, that lymphatic if not also venous congestion occurs

whenever there is any circulatory disturbance. For the maintenance of

normal nutrition of nerve endings a constant flow of blood past them

and a proper action of the lymphatic channels to carry off waste

products is essential. It is easy to understand how much these may be

disturbed in the injuries under consideration. When a bone is broken

there is usually laceration of the surrounding tissues. Owing to the

fixation required to procure proper bony union, the circulation to the

part is much more defective than usual and so the repair of torn lymph

and venous vessels is not as complete as would otherwise be the case.

This seems to explain why such injuries are especially called to the

attention of the patients in damp weather. It is not so much during a

rain storm as some hours before it, about the time when the barometer

begins to drop, that these old injuries become sensitive. Indeed, it

is often said that old persons who have suffered one of these injuries

earlier in life carry a barometer around with them.

Not a few of the lesions called sprains, especially those of the

ankles and wrists, though also of other joints, are often really

breaks of small bones, or at least laceration of ligaments and other

structures. These may long afterward prove a source of pain and

discomfort, worse always in unsettled weather, or after the feet have

been wet, and may seem to be due to some constitutional condition,

though they are merely local. These occur more commonly in women than

in men and the condition needs careful investigation and must not be

put under the vague diagnosis of rheumatism, or the patient will

probably not be improved by the treatment suggested. In all these

cases the general condition must be looked to, and it must not be

forgotten that fat may not mean health, and that increased weight may

be a prominent factor in the production of symptoms in these cases,

especially when individuals live a sedentary life.

There is an important therapeutic method for the prophylaxis of these

conditions that has been attracting attention and yet probably not all

the attention it deserves in recent years. Prof. Lucas-Championniere

of the University of Paris has pointed out that when fractures and

dislocations are treated by the open method with easily removable

apparatus and the employment of massage within a few days after the

fracture, the subsequent discomfort of these lesions is much lessened.

It seems worth while to emphasize this treatment by manipulations and

massage, because it represents a psychotherapeutic factor in the

treatment of these injuries. The hiding away of a limb or a joint for

days and perhaps weeks, while they wonder whether it is getting better

or not is most discouraging to patients. To have the physician see it,

to have him declare that it is getting on well, to have the evidence

of their own senses that conditions are gradually improving, is of

itself a valuable factor for that satisfaction of mind which conduces

to the regular functioning of tissues. Repair undoubtedly goes on

better under such circumstances. Besides, the lack of constriction or

at least its rather frequent periodic relaxation, the airing of the

skin, the regulation of the circulation by massage and manipulation,

all react upon the mind and prevent it from inhibiting trophic

impulses and encourage it to stimulate them in every way.

As to the after-effects of fractures and dislocations as with regard

to all this series of vague pains and aches, the patient's attitude of

mind is of great importance. As they get older their aches and pains

grow worse, partly because circulation is more defective and partly

because they are prone to be much more in the house and the nerves of

patients who are much within doors are always more sensitive than

those of people who are much in the open. If their attention becomes

concentrated on their pains and aches, because of lack of diversion of

mind, then the condition may become a source of serious annoyance.

When these painful conditions develop patients are almost sure to keep

much to themselves and to nurse their ills, and consequently to

increase their discomfort. The circulation to the affected parts must

be stimulated by local treatment, by rubbings, by the milder

liniments, by massage and manipulations, and by local hydrotherapy.

Douches, as hot as can be borne, on the limb followed by cold,

especially if patients are otherwise in good health, will do much to

relieve the stagnant circulation.

Active and vigorous movement while the affected part is supported at

skin pressure (there must be no constriction) is even more valuable

than massage, liniments or douches in the treatment of all these

painful conditions of joints in which there is any scar-tissue.

Wonderful results may be obtained in an old sprain of the wrist, knee

and ankle by covering in the part completely (taking care to surround

the limb) with strips of adhesive strapping simply laid on at skin

pressure, but following exactly every fold or angle of the part, and

then with the part completely covered in this way to urge immediate

and constant exercise. The maintained pressure prevents any tendency

to venous congestion or exudation and favors absorption of fibrous

tissue, and exercise, which should be immediate, is now possible

through the support furnished by the strapping. The re-assumption of

normal active movement molds the old scars, strengthens the muscles

and ligaments and improves the patient's general condition. The relief

afforded is immediate, and the cause of relief, a simple mechanical

device, is apparent. Rheumatism is forgotten as the old crutch is

discarded and the patient is able to use the limb with confidence.

Recent sprains or bruises treated in this way recover perfectly and do

not leave old scar tissue to be a future seat of pain.

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