introduction

PART w. THE MUSCULOSKELETAL SYSTEM AND SKIN INTRODUCTION Kenneth Williams Diseases of skeletal muscle, bone, and skin related to alcohol abuse are grouped together in this section. The association between diseases of these organs and alcohol consumption has been recognized only relatively recently. While pain and some degree of disability may result, none of these disease entities are life-threatening. Alcoholic myopathy, first described in 1955, is the best studied of these disease problems. Dr. Knochel’s paper summarizes the categorization of the 3 types of alcoholic myopathy and reviews the mechanisms postulated as causing the muscle injury. He then presents his own argument that acute alcoholic myopathy may be induced by acute hypophosphatemia. He suggests that, in the alcoholic experiencing the alcohol-withdrawal syndrome, acute hypophosphatemia and its attendant complications might be avoided by phosphate supplementation. The most common bone lesion in alcoholics is traumatic fracture experienced during inebriation. Certainly the alcoholic must be seen as being at high risk of experiencing trauma in automobile accidents, falls, etc. Dr. Saville’s paper reviews the mechanisms probably operative in producing prematurely developed osteoporosis. This condition would place the alcoholic at increased risk of fracture of hip, wrist, humerus, and spine from less than usual trauma. Proceeding to a description of “nontraumatic osteonecrosis of the hip” (also called avascular necrosis of the femoral head), he reviews the important clinical considerations. A clinical categorization and review of common skin problems seen in the alcoholic person is found in Dr. Woeber’s paper. He suggests that the alert practitioner should suspect underlying alcoholism when confronted with certain dermatologic problems. 273

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PART w. THE MUSCULOSKELETAL SYSTEM AND SKIN

INTRODUCTION

Kenneth Williams

Diseases of skeletal muscle, bone, and skin related t o alcohol abuse are grouped together in this section. The association between diseases of these organs and alcohol consumption has been recognized only relatively recently. While pain and some degree of disability may result, none of these disease entities are life-threatening.

Alcoholic myopathy, first described in 1955, is the best studied of these disease problems. Dr. Knochel’s paper summarizes the categorization of the 3 types of alcoholic myopathy and reviews the mechanisms postulated as causing the muscle injury. He then presents his own argument that acute alcoholic myopathy may be induced by acute hypophosphatemia. He suggests that, in the alcoholic experiencing the alcohol-withdrawal syndrome, acute hypophosphatemia and its attendant complications might be avoided by phosphate supplementation.

The most common bone lesion in alcoholics is traumatic fracture experienced during inebriation. Certainly the alcoholic must be seen as being at high risk of experiencing trauma in automobile accidents, falls, etc.

Dr. Saville’s paper reviews the mechanisms probably operative in producing prematurely developed osteoporosis. This condition would place the alcoholic at increased risk of fracture of hip, wrist, humerus, and spine from less than usual trauma. Proceeding t o a description of “nontraumatic osteonecrosis of the hip” (also called avascular necrosis of the femoral head), he reviews the important clinical considerations.

A clinical categorization and review of common skin problems seen in the alcoholic person is found in Dr. Woeber’s paper. He suggests that the alert practitioner should suspect underlying alcoholism when confronted with certain dermatologic problems.

273

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