Monday, July 24, 2017

Myopathies series - Part 4

Hello! :)

In previous post, I left you with a question

How do we identify the site and cause of lesion?

Important points in history and neurological examination that is suggestive of myopathy are:-

1. MUSCLE WEAKNESS

According to Taber's medical dictionary, Lacking physical strength or vigor; infirm especially as compared with what would be the normal or usual for that individual.

Most muscle diseases produces symmetrical weakness of the large muscles of the girdles and trunk.

A) HIP GIRDLE (MOST COMMONLY AFFECTED)
- Difficulty in getting up from squatting position or from low chair,
-Inability to climb stairs,
-Waddling gait.

B) UPPER GIRDLE WEAKNESS
- Difficulty in hanging clothes on a cloth line
-Difficulty in taking down item from high shelves.

C) TRUNK WEAKNESS
-Difficulty in turning in bed and getting up from recumbent position.

D) NECK MUSCLE WEAKNESS 
-Inability to control neck while in a vehicle as it rapidly accelerates and decelerates.
-neck pain and stiffness.

E) CRANIAL MUSCULATURE WEAKNESS
1. FACIAL WEAKNESS:-
-Inability to close eyes fully.
-Difficulty in drinking with a straw.

2. OCCULAR WEAKNESS:- (I will explain this below in bit detail )
-ptosis
-extraoccular movement weakness are seen.

F) DISTAL MUSCULATURE WEAKNESS
-Difficulty in opening lids of jar
-turning keys in keyholes

-tend to trip on uneven ground with repeated falls.




2. GAIT

3. FATIGUE

According to Taber's medical dictionary, the condition of an organ or tissue in which its response to stimulation is reduced or lost as a result of over activity.

Abnormal fatigability after exercise can result from certain metabolic and mitochondrial myopathies.

And as I have already discussed the importance of duration and intensity of exercise that provokes fatigue. It helps to distinguish metabolic myopathies.


4. MYALGIA
-Episodic= metabolic myopathies

-Constant=inflammatory muscle disorders


5. OCULOBULBAR WEAKNESS

6. SENSORY SYSTEM = NORMAL 

7. MYOGLOBINURIA 

- Why? As caused by the excessive release of myoglobin from muscles during periods of rapid muscles destruction (rhabdomyolysis)
-Results in renal failure in severe cases.
-Patient complains of exercise induced myalgia then ask about "Cola colored" or "red colored” urine during this episodes. 

That's all for today.
I hope it helped.
In next post I will continue with the relation of age and progression to diagnose myopathy. 


-Upasana Y. :)

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