Muscular Diseases! MR. IM

Acute Anterior Compartment Syndrome: What is it? Pressure build-up in anterior compartment of lower leg, specifically between the tibialis anterior muscle, the relatively inelastic fascia (epimysium), consisting of a dense fibrous layer of connective tissue, and the tibia and fibula. Ischemia (cut-off of blood supply, and thus oxygen & glucose) of blood vessels and nerves, with subsequent necrosis (tissue death) Associated with swelling of affected area, pain, muscle tightness and tenderness, and stretched skin appearing glossy and hot Inability to perform dorsiflexion of feet, difficulty walking

Causes Intracompartmental pressure leads to ischemia—cut-off of blood supply, and thus oxygen & glucose—of blood vessels and nerves, with subsequent necrosis (tissue death) Often caused by a direct force of impact to area, muscle tear, or skeletal fracture

Treatments Depending on severity: Steroids/NSAIDS (Ibuprofen) to treat inflammation Ice pack to reduce swelling Surgical incision of anterior leg compartment to relieve pressure (fasciotomy) Paralysis/Amputation if not treated in time

Muscular Dystrophy: What is It? Muscles become very weak, break down, and are replaced with fat deposits (atrophy) Associated with scoliosis, movement difficulty, and muscle deformation Can on-set at any age and progress quickly or slowly.

Causes Genetic. Varies based on specific gene affected resulting in a particular dystrophy Malfunction in creating the dystrophin protein, which is involved in connecting actin to the sarcolemma / sarcoplasmic reticulum and regulating calcium levels

Treatment Symptoms-based treatment: Physical Therapy Occupational Therapy Regular Exercise

Carpal Tunnel Syndrome: What is It? Repeatedly occurring numbness, tingling, burning or pain in fingers and wrist upon pronation/supination, flexion/extension, opposition etc.

Causes Inflammation of the flexor and extensor retinaculum (tendons proximal to wrist which form a “tunnel” for median nerve to pass through to innervate phalanges I-IV (thumb-ring finger). Inflammation leads to pressure being exerted on the median nerve, possible lesions Obesity, arthritis, and frequent, repetitive motion can contribute to symptoms

Treatment Anti-inflammatory drugs Bracing & Occupational Therapy/PT Surgery to cut ligaments/tendons of carpal tunnel to create space/relieve pressure from inflammation Corticosteroid injections Stem cell therapy

Myasthenia Gravis: What is It? Muscle fatigue that gets better with rest but worse with activity. Fine motor muscles in the face (eyelids, facial expressions, talking, swallowing) are most common but it will also affect limbs.

Causes Autoimmune disorder where the antibodies attack the acetylcholine receptors in the muscle membrane.

Treatment Immunosuppressant drugs Drugs that stop the breakdown of acetylcholine (ACh) aka Acetylcholinesterase inhibitors Surgery on thymus https://www.youtube.com/watch?v=2NEjf347Xpk

Tendinitis: What is It? Pain, stiffness, swelling, or burning sensation around a joint. Tendons connect muscles to bone. Common in Achilles tendon (ankle) and Patellar tendon (knee)

Causes Often made worse by exercise and triggered by stress. Over-stretching or fatigue Overuse

Treatment Anti-inflammatory drugs (Advil) physical therapy RICE with gradual return to exercise

Pyomyositis: What is It? Fever, muscle pain, pus-filled abscesses in the muscles, fatigue Common in tropical areas

Causes Bacterial infection of the skeletal muscles (often the gluts and quads), most often by Staphylococcus aureus

Treatment The abscess within the muscles must be drained surgically and then treated with antibiotics.

Fibromyalgia: What is It? Chronic, widespread tendon/muscle tenderness Heightened pain in response to touch Sleep disturbance/chronic fatigue Muscle twitching Must last at least three months and fail “pressure points test” Most common in women aged 20 to 50 years old

Causes Unknown. Genetic component. Stress-related. Associated with depression. Most theories deal with neurotransmitters.

Treatment Exercise/Physical Therapy Cognitive-behavioral therapy Stress-Relieving Techniques Antidepressants Anti-seizure Medications Drugs to treat pain symptoms: pain relievers, muscle relaxants, sleep aids

Steroid Usage - What is it? Steroids mimic the shape and effects of the hormone testosterone and stimulate the growth of protein (actin & myosin) in the muscles. More muscle fibers mean bigger muscles.

Risks Kidney problems, liver problems, baldness, sterility, mood swings, acne, testicular atrophy, high cholesterol levels, high blood pressure, cardiovascular issues etc. Treatments: Stop taking steroids…