Professional Neuroses

PROFESSIONAL NEUROSES, a term denoting a disorder of muscular motor functions that hinders the performance of complex movements necessary for a given type of professional work; the specific sign of P. n. is precisely the circumstance that the dysfunction of a muscular group is detected exclusively during the synergistic setting required for that type of work, whereas each muscle individually and their entire group in other dynamic combinations retain the ability to fully manifest their functional efficiency. The term "coordination professional neuroses" (Benedict) and "professional ataxias" (Kuindzhi) can be considered the most accurate expression of the pathophysiological essence of P. n. Symptomatology. Weakness (rapid fatigue) of the musculature, cramps, trembling, and painful sensations hinder or make impossible the performance of habitual professional work; these symptoms may arise in isolation, but more often they occur in various combinations, and pain is observed in almost all combinations. The serious practical significance lies in the fact that sensory disturbance is the most essential component influencing the disturbance of the automated motor process; phenomena of paralytic weakness belong to the final symptoms, and their predominance over others characterizes the last phase of the disease; cramps and trembling are typical for the developed form of P. n. Based on the foregoing, it can be considered that the predominance of a particular symptom, characterizing the stages of disease development, has some prognostic significance. Therefore, practically useful can be considered the division of P. n. into spastic (more correctly, convulsive), paralytic, trembling, and neuralgic forms. Varieties of P. n. are very numerous, since each profession requiring prolonged repetition of a complex motor act can prove to be a soil for P. n. Neuroses of the upper extremity were observed in pianists, violinists, cellists, typists, telegraph operators, cow milkers, money counters, barbers (shaving cramp); on the lower extremities, neuroses were noted in grinders, turners, seamstresses on foot-operated machines, and dancers. Among other muscular groups, cramps of the muscles of the lips and tongue were observed in trumpeters; the circular muscle of the orbit in watchmakers; the muscles of the larynx in singers. True forms of P. n. are not frequent; however, in everyday practice, with insufficiently deep clinical examination, diagnostic errors and the overly widespread use of the term may occur. Pathogenesis. The localization of the pathological process has not been established beyond doubt (most authors lean toward subcortical centers); even in the question of whether P. n. is of central or peripheral origin, unanimity has not yet been reached. Numerous supporters of the central theory of P. n., advanced by Duchenne and Benedict, base themselves on the essence of P. n. as a disorder of coordination; some of them (Striimpell, Gowers) assume that P. n. are similar in pathogenetic mechanism to stuttering; others treat them as "neuroses of expectation" or as "professional fears." Supporters of the peripheral theory, headed by American neurologists Poor and Beard, base themselves on observations that in P. n. it is always possible to detect local lesions of muscles or nerves; they believe that P. n. can become a disease of the central nervous system only secondarily. It should be assumed that in the presence of a neuropathic predisposition of central apparatuses, the revealing moment can be very weak peripheral influences. Therefore, one cannot mechanically oppose the central and peripheral origin of P. n. In the etiology of P. n., neuropathic predisposition has undeniable significance; this assumption is supported by observations of families in which P. n. in various forms were found in many members; the same order of indication is the infrequency of combinations of P. n. with other functional and organic diseases of the nervous system; then a predisposing moment are cases of acquired weakness of the nervous system (in anemia, alcoholism, diseases of the sexual organs, sexual perversions, etc.). Along with general causes stand local pathological processes: scars after trauma of nerves and muscles, limited myositis, arthritis, ganglia of tendon sheaths, exostoses, etc. Differential diagnosis. Attributing the disease to the category of P. n. does not present difficulty, since the main sign is the occurrence of a pathological symptom complex during a certain type of work; however, it is necessary to bear in mind that in neurasthenic and hysterical states, trembling, muscular weakness, and pain may also be observed only during a certain form of work and thereby simulate P. n.; therefore, a deep examination is necessary in each case; also a detailed objective examination of the sensory, motor, and trophic spheres is necessary to exclude neuritis, neuralgia, myopathy, etc. An extremely important circumstance is that professional movements can provoke the manifestation of certain diseases in the initial stages of development and thereby create a ground for diagnostic errors (multiple sclerosis, paralysis agitans, tabes dorsalis, intermittent claudication). The prognosis in true professional neuroses regarding the complete restoration of lost function is mostly unfavorable, however, working capacity can usually be restored. - Treatment should always be conducted while freeing the patient from work, the application of physiotherapeutic procedures in strict accordance with the individual features of the case is most effective under conditions of simultaneous influence on the general tone of the organism. The main form of struggle, however, should be preventive measures.