Myositis of the back muscles is an inflammatory process accompanied by pain syndrome and the formation of nodules in the thickness of muscle tissue. It proceeds acutely or chronically. It is manifested by muscle tension and pain, mainly occurring in the morning or after physical exertion. To clarify the diagnosis and determine the cause of myositis, a general and biochemical blood test, MRI, antibody analysis, electromyography and biopsy of the affected muscles can be prescribed. Conservative treatment includes symptomatic (painkillers and anti-inflammatory drugs, physiotherapy) and pathogenetic therapy aimed at eliminating the underlying disease.
ICD 10
M60 Myositis
General information
Myositis of the back muscles is a fairly widespread pathology. It can be observed in a number of infectious and non-communicable diseases, be acute or chronic. The occurrence is possible at any age, both men and women suffer. Most often, myositis develops in the lumbar region, less often in the cervical and thoracic spine. The treatment is carried out by orthopedic traumatologists.
Causes
Myositis of the back muscles can be both an independent disease and a complication of other pathological processes. The most common cause of development is acute infectious diseases (flu, sore throat, acute respiratory infections). In addition, symptoms of myositis can appear with parasitic infections and intoxications due to metabolic diseases, poisoning with drugs, alcohol, and some other industrial and household toxins.
Predisposing factors for the development of myositis, according to specialists in the field of traumatology and orthopedics, are injuries, viral diseases, hypothermia, prolonged physical activity at low temperatures, excessive load, lack of motor activity, constant overstrain of a certain muscle group when performing professional or household duties, prolonged stay in an uncomfortable position, muscle cramps, stress, etc. nervous overstrain.
Classification
Along with the usual myositis, there are special forms of the disease: acute purulent myositis, myositis with specific infections (tuberculosis, syphilis), traumatic ossifying myositis, genetically determined ossifying myositis (progressive ossifying dysplasia), idiopathic and juvenile dermatomyositis and polymyositis, dermatomyositis and polymyositis with malignant tumors and some connective tissue diseases.
Symptoms
The clinical symptoms of myositis of the back muscles are largely determined by the cause of the disease. A common sign is pain in a certain area of the back (cervical, thoracic, lumbar) that occurs after sleep, then gradually decreases and increases again with physical exertion or being in an uncomfortable position. On examination, edema (usually insignificant) and muscle tension are detected. Mild hyperemia of the skin in the affected area is possible. Movements in the antero-posterior and lateral directions are usually limited. Palpation is painful, when feeling, nodules and areas of compaction are determined. With chronic myositis, atrophy of the inflamed muscle is often detected.
Cervical myositis usually occurs after being in a draft. Patients complain of pain on one side (right or left), extending from the lower part of the occiput to the shoulder or shoulder joint. With thoracic and lumbar myositis, the pain is also more often unilateral. With inflammation of the muscles of the thoracic region, irradiation along the ribs is possible. With myositis in the lumbar region, the pain can be both mild, causing minor discomfort, and intense, significantly limiting movement and walking.
Types
Acute purulent myositis occurs due to infection of the back muscles with skin injuries, the spread of purulent infection from neighboring tissues (with pyoderma, furunculosis, carbuncle) or the drift of pathogens with blood flow. Streptococci, gonococci, pneumococci and Ebert’s bacillus can act as pathogens. It is possible to form limited purulent foci in the form of one or more abscesses or the development of a phlegmonous form of the disease.
The disease begins acutely. There is back pain, accompanied by weakness, bruising, headache and fever. The affected area is edematous, hyperemic. Initially, the muscle is compacted, then foci of swelling form in the muscle tissue. In the early stages, treatment is conservative, patients are prescribed UHF and antibiotic therapy. When an abscess is formed, an autopsy and drainage are performed.
Ossifying myositis is rarely observed and is divided into two subtypes: traumatic and progressive. The first subtype of the disease occurs after injuries to the back muscles and is accompanied by the formation of a site of ossification of muscle tissue in the area of injury. Proceeds favorably, treatment is excision of the ossified area. The second subtype is a genetically determined disease that affects not only the back muscles, but also almost all muscle groups. It occurs as a result of gene mutation, is prone to a steadily progressive course, ends in death due to ossification of the muscles involved in breathing and swallowing.
Dermatomyositis is a systemic disease affecting skeletal and smooth muscles, as well as skin and internal organs. If there are no changes in the skin, they talk about polymyositis. Occurs rarely, women get sick more often than men. It is a multifactorial disease, the number of provoking factors include insolation, some viral and bacterial infections, as well as taking a number of medications. It can occur acutely, subacutely or chronically. It is accompanied by weakness of the muscles of the upper back (neck), abdominal press, pelvic and shoulder girdle, damage to the lungs, heart, joints and gastrointestinal tract. Treatment – taking glucocorticoids and cytostatics.
Tuberculous myositis of the back muscles, as a rule, occurs during the transition of the process from the regional lymph nodes, vertebrae and joints of the spine. In some cases, hematogenic transmission of infection is observed. It can occur in the form of a typical myositis, cold abscess and muscle sclerosis. Antitubercular therapy is carried out, surgical operations are performed if necessary.
Syphilitic myositis usually develops in the tertiary period of syphilis, secondary syphilis is characterized by volatile myalgia without signs of inflammation. The lesion of the muscle, as a rule, is diffuse. In some cases, separate gummas may form in the sternocleidomastoid muscle. Anti-syphilitic therapy is carried out.
Diagnostics
The diagnosis is made on the basis of the patient’s complaints, anamnesis (excessive load, cold, being in a draft, etc.) and objective research data. In parallel, the differential diagnosis of myositis of the back muscles with radiculitis and radiculopathy, complicating the course of osteochondrosis and spondylosis, is carried out. To detect signs of inflammation, a general and biochemical blood test is prescribed. To exclude autoimmune processes, an antibody test is performed.
To assess the condition of the patient’s muscle tissue, they are sent for soft tissue MRI and electromyography. If the tuberculous nature of the disease is suspected, an X-ray of the spine is performed. In doubtful cases, a biopsy of the affected muscle is performed. If necessary, consultations of an infectious disease specialist, rheumatologist, endocrinologist, phthisiologist, venereologist and other specialists are prescribed.
Treatment
In the acute period, bed rest is indicated. To eliminate the pain syndrome, NSAIDs of general and local action are used. Subsequently, patients are referred for physiotherapy. In chronic myositis, hydrotherapy, thermal procedures (ozokerite, paraffin), mud therapy, steam therapeutic showers, light therapy, electrophoresis with novocaine, iodine and ichthyol, as well as massage and physical therapy are indicated. With significant muscle atrophy, adenosine triphosphate and glutamic acid are used. Patients are referred for sanatorium treatment.
