Dear Marta,

To be quit honest, I do not know. Perhaps you are right, but I rarely see it.

Kind regards,

Herman Kroon

Thanks for answering Herman. We see it a lot. Because we are now being concious that WHEN WE PALPATE we are first approaching the FIBRO-FATTY tissue than the muscles. Our body is envolved in a thik fatty layer. We feel the DEEP encapsulated edema as nodules, indurations, bands or hardenings.

This edema could be seen as in the photo I will attach.

Dear Marta,

A very interesting observation. I wil pay more attention to it.

Kind regards,

Herman

The edema is really causative in patients with fibromyalgic syndrome ?

Or, secondarily to a disused status of the skeletal muscle due to severe pain in the patients? I cannot distiguish.

Hello Koichiro,

Thanks for your replay.

The patients with fibromyalgic syndrome present certain painful areas all over the body, that would correspond with anatomical points were an ENCAPSULATED EDEMA of the DEEP FATTY TISSUE is under TENSION producing pain (the tension it may also cause certain cutaneous neuropathys, as for exemple superior cluneal neuropathy in the lumbar /gluteal area, and the cutaneous neuropathy may cause associated REFLEX MUSCLE SPASMS, like spasm of the erector spinae at the back).

The encapsulated edema COULD respond to an HORMONAL disturbance related to the HYPOFISI-OVARIAN-THYROID DISTURBANCE (that has been suggested). The edema would be worst at night. The hormonal disturbance would also at the same time cause arthrosis degeneration like osteophytes.

The ENCAPSULATED EDEMA of the deep layer of FIBRO-FATTY tissue lays specially between the superficial and the deep fascial layer. It gets entraped there. And it may develop a fibrotic transformation.

In cetain body areas (IF YOU PALPATED WITH SOME CREAM carefully) you can feel the encapsulated edema like NODULES, or INDURATIONS, OR BANDS or JUST PAINFUL POINTS. At the lumbar zone the nodules have recieved the funny name of “back mice” (By Peter Curtis). At the inner lateral part of the knee it easy to feel that it is a fatty painful nodule/indduration.

During the history of medicine the patients with this syndrome have been studied. at the beginning of the 20th century the pathological entity recieved the VERY WRONG name of “fibrositis” by the English doctors, the sufix -itis mean “inflammation”. THERE IS NOT INFLAMMATION just EDEMA (this had lead to many confusion, SO they couldn’t find any pathological findings with the histological microscopic study once the SWOLLEN tissue was removed, because the edema just FADES).

William Sidney Charles Copeman (and others) worked on that theory. We also do.

This is the link to his presentation of the Rheumatology Congress in Barcelona In 1952.

http://backmice.info/sin-categoria-en/did-copeman-really-talk-about-fibromyalgia-naming-it-water-retention-syndrome-in-barcelona-congress-in-1951/

Have you noticed the silent or painful nodulations or indurations in the patients?

Regards,

Marta

Thanks so much for your immediate reply.

I should check ENCAPSULATED EDEMA of the patients with fibromyalgic syndrome by palpation from now on. Ultrasonic examination may be benifitable.

When the dimples of Venus are disappearing ( the Michaelis rhomb , used as marker by obstetrics ) where in modern times pretty womans are showing the sexy antlers tattoo, we have an indication for tissue swelling in this aea. This symptom often is connected with fibromyalgia in the lower quadrants, and the kidney meridians are irritated. This is caused by an entrapment of the nerves behind the inner ankles ( ! ). Then the diagnostics for Fibromyalgiasyndrom have to be started, as described in two papers from the Temple University, Philadelphia. After decompression and neurolysis of the entrapped little peripheral nerves the symptoms are disappearing and the fibro also. ( My surgical experience since 1998 - 3 patients the week ). Peers aren‘t allowing publications of method and results. Isn‘t „scientific“. Painfree patients are of no interest. It‘s strange, but the typical indicator for a very effective New Method......

Hello Dr. Johann,

Thanks for you reply. Indeed, one of the areas of peripheral nerve compression is nearby the dimples of Venus. Then, Do you treat your patients with fibromyalgia syndrome by cluneal nerve neurolysis?

We hypothesize that the tissue that it is swelling there is that DEEP FATTY TISSUE provoking PERIPHERAL NERVE COMPRESSION AND PAIN.

Could yopu send me your publications?

Regards,

Marta

In handsurgery well known is a similar reaction: the swelling of Gubler on the dorsum of the hand connected with n.radials damage.Causa prima is the nerval lesion, the swelling is the consequence. In fibromyalgia the causa prima is the nerval lesion of parts of the n.tibials creating a similar swelling behind the knee, the baker cyst, who is coming and disappearing as she likes, and sometimes can't be isolated during an operation. The same problem is visible in the treatment of the calcaneal spoor, in the treatment of tennis elbow, and so on.

Before any research is to be astonished the correct way to solutions.