Iatrogenic muscle fibrosis. Arm levitation as an initial sign
B. E. Levin and W. K. Engel
Three patients had iatrogenic muscle fibrosis, without weakness or sensory
loss. Deltoid muscle fibrosis produced the unique clinical sign of gradual,
involuntary, and irreducible arm levitation. The third patient had both
levitated arms and levitated legs, a result of injections in the rectus
femoris muscles. Repeated intramuscular injections apparently resulted in
muscle fibrosis and intramuscular nerve-twig damage. Pentazocine (Talwin)
is a particularly offending agent. One patient showed an unusual tissue
reaction to foreign material, which may have played a role in her muscle
fibrosis. Nevertheless, dramatic recovery of muscle function followed
surgical sectioning of the fibrous deltoid bands.
