title: Muscular hypertonicity: a suspected contributor to rheumatological manifestations observed in ambulatory practice.
abstract: OBJECTIVE
  The objective of this retrospective study of non-inflammatory rheumatic disease patients was to investigate if the individuals clinically identified with muscular hypertonicity (MHT) had increased clinical manifestations compared with those of age- and gender-matched patients with the same disorders.
  
  
  METHODS
  The MHT status was clinically identified in the rheumatologist's myofascial protocol examination as relatively increased passive resistance of relaxed muscle on a slow gentle stretch. Clinical and laboratory data were abstracted on a pre-coded form, including symptom and physical examination features, serum assays, and medications.
  
  
  RESULTS
  The 19 MHT cases complained of greater subjective stiffness (p=0.010) and tiredness (p=0.018) at initial encounters and increased aching pain (p=0.049) and were prescribed more (p=0.003) mild narcotic analgesics than the 19 comparison patients. The cases had higher (p=0.027) serum creatine kinase levels, and patients with diffuse MHT had greater frequency of heavy (30+pack-years) cigarette smoking (p=0.002) than comparison subjects. Narcotic usage was also greater in cases with diffuse involvement.
  
  
  CONCLUSIONS
  Non-inflammatory rheumatic disease patients with MHT had an overall similar profile as that of comparison patients but had greater musculoskeletal complaints, and those with diffuse involvement had greater narcotic usage. Further research, including quantitative measurements of muscle stiffness, are required to determine whether MHT is a documented entity associated with increased rheumatological manifestations.
authors.affiliation: Department of Medicine, Illinois University Faculty of Medicine, Peoria, United States.
authors.forename: Alfonse T
authors.initials: AT
authors.lastname: Masi
authors.affiliation: Department of Medicine, Barnes West Medical Consultants, St. Louis, United States.
authors.forename: Sona
authors.initials: S
authors.lastname: Kamat
authors.affiliation: Department of Physical Therapy and Rehabilitation, Montana University Faculty of Health Professions & Biomedical Sciences, Missoula, United States.
authors.forename: Richard
authors.initials: R
authors.lastname: Gajdosik
authors.affiliation: Department of Medicine, Washington Minor and James Medical University, Seattle, United States.
authors.forename: Naila
authors.initials: N
authors.lastname: Ahmad
authors.affiliation: Department of Medicine, Illinois University Faculty of Medicine, Peoria, United States.
authors.forename: Jean C
authors.initials: JC
authors.lastname: Aldag
keywords: Skeletal muscle; creatine kinase; fibromyalgia syndrome; hypertonicity; myofascia; stiffness