1. DISEASES OF THE MUSCLES

2. DISEASES OF THE MUSCLES
MUSCLE DYSTROPHY
CONG. MYOPATHY
MYOTONIC DYSTROPHY
INFLAMMATORY MYOPATHY
METABOLIC MYO.
ENDOCRINE MYO.
ALCOHOLIC MYO.
DRUG-INDUCED MYO.

3. MUSCLE DYSTROPHIES INHERITED DISORDERS
PROGRESSIVE MUS. WEAKNESS&WASTING
SUBDIVIDED BY:-MODE OF INHERITANCE
AGE OF ONSET
DISTRIBUTION OF INVOLVED MUSC.
RATE OF PROGRESSION

4. DUCHENNES MUS. DYSTROPHY
THE MOST COMMON
BEGIN AT FIVE,SEVERE DISABILITY BY ADOLESCENCE,DEATH IN THIRD DECADE
TOE WALK.,WADDLING GAIT,INABILITY TO RUN
LOW. LIMBS >UPP. LIMBS
GOWER SIGN IS POSITIVE
PSEUDOHYPERTROPHY OF CALVES
CARDIOMYOPATHY&MENTAL RETARDATION
CPK IS VERY HIGH
NO DEFINITE THERAPY
STEROIDS 1.5mg/Kg/day
DYSTROPHIN IS ABSENT OR REDUCED

7. BECKER DYSTROPHY SIMILAR TO DUCHENNE ONSET AT 11 –DEATH AT 40s
CARDIAC &COGNITIVE FUNCTION IS NORMAL
CPK IS LESS ELEVATED
DYSTROPHIN STRUCTURE IS ABNORMAL

9. LIMB GIRDLE MUS. DYSTROPHY
AUT. RECESSIVE/CHROM 15
LATE CHILD. TO EARLY ADULTHOOD
SHOULDER&PELVIC GIRDLE MUSCLES
NO PSEUDOHYPERTROPHY
CPK IS LESS ELEVATED

10. FACIOSCAPULOHUMERAL DYSTRO.
AUT. DOMINANT
ONSET AT ADOLESCENCE/// NORMAL LIFE SPAN
WEAKNESS IN FACE, NECK, SHOULDER MUSCLES
WINGING OF SCAPULAE
HEART IS NORMAL
CPK IS NORMAL

12. DISTAL MYOPATHY AD ONSET AFTER 40/// SLOW PROGRESSION
SMALL MUS. OF HANDS &FEET,,WRIST EXT.&FOOT DORSIFLEXORS
MAY BE AR OR SPORADIC

13. OCULAR DYSTROPHY AUTO. DOMINANT COULD BE RECESSIVE ONSET < 40
SLOWLY PROGRESSIVE
PTOSIS , OPHTHALMOPLEGIA,FACIAL WEAKNESS

14. OCULOPHARYNGEAL DYSTROPHY
AUTO.DOMINANT
ONSET: 3rd-5th DECADE
PTOSIS, OPHTHALMOPLEGIA, DYSPHAGIA, FACIAL WEAKNESS &PROX. MUSCLE WEAKNESS
MILD ELEVATION OF CPK

15. PARASPINAL DYSTROPHY
ONSET >40
BACK PAIN &KYPHOSIS

16. MYOTONIA
ABNORMALITY OF MUSCLE FIBRE MEMBRANE LEADING TO MARKED DELAY OF RELAXATION AFTER CONTRACTION CAUSING APPARENT MUSCLE STIFFNESS.
PERCUSSION MYOTONIA THENAR MUSCLES AND TONGUE

18. MYOTONIC DYSTROPHY AUTO. DOMINANT MANIFEST IN 3rd OR 4th DECADE
MAY APPEAR IN EARLY CHILDHOOD
MYOTONIA, WEAKNESS&WASTING OF FACIAL, STERNOCLIEDOMASTOID&DISTAL LIMB MUSCLES WITH PTOSIS.
CATARACT, DM,FRONTAL BALDNESS,TESTICULAR ATROPHY,CARDIAC&INTELLECTUAL DEFECT
MYOTONIA IS TREATED WITH QUININE SULPHATE mg tds OR PROCAINAMIDE gm qds OR PHENYTOIN 100mg tds

20. MYOTONIA CONGENITA AUTO. DOMINANT ,MUTATION IN CHRO.7
GENERALIZED MYOTONIA , NO WEAKNESS
PRESENT FROM BIRTH BUT SYMPTOMS MAY NOT DEVELOP UNTIL EARLY CHILDHOOD
MUS. STIFFNESS IS ENHANCED BY COLD &INACTIVITY RELIEVED BY EXERCISE
MUSCLE HYPERTROPHY SOMETIMES PRONOUNCED
AUTO. RECESSIVE FORM:-
LATER ONSET, SLIGHT WEAKNESS, ATROPHY OF DISTAL MUSCLES
TREATMENT OF MYOTONIA

22. METABOLIC MYOPATHY PERIODIC PARALYSIS SYNDROMES
PROXIMAL MUSCLE WEAKNESS
CHRONIC HYPOKALEMIA
ACUTE HYPOKALEMIA OR HYPERKALEMIA
OSTEOMALACIA WITH BONE PAIN &TENDERNESS,MILD DECREASE IN SERUM Ca , INCREASE ALK. PHOSPHATASE. TREATMENT WITH VIT. D
PERIODIC PARALYSIS SYNDROMES
MAY BE FAMILIAL, AUTO. DOMINANT
EPISODES OF FLACCID WEAKNESS OR PARALYSIS
STRENGTH IS NORMAL BETWEEN THE ATTACKS
HYPOKALEMIC, HYPERKALEMIC, NORMOKALEMIC

23. FPP HYPOKALEMIC ASSOCIATED WITH THYROTOXICOSIS ATTACKS ON AWAKENING,
AFTER EXERCISE OR HEAVY MEAL
MAY LAST FOR SEVERAL DAYS
ACETAZOLAMIDE OR ORAL POTTASIUM FOR PREVENTION
ORAL OR I.V.POTTASIUM FOR TREATMENT
THYROTOXICOSIS SHOULD BE TREATED

24. HYPERKALEMIC NORMOKALEMIC UNRESPONSIVE TO TREATMENT
ATTACKS AFTER EXERCISE
BRIEFER < 1 hr
SOMETIMES ASSOCIATED WITH MYOTONIA
Rx WITH Ca GLUCONATE, I.V. DIURETICS LIKE LASIX OR GLUCOSE
ACETAZOLAMIDE OR CHLOROTHIAZIDE FOR PREVENTION
NORMOKALEMIC
UNRESPONSIVE TO TREATMENT

25. ENDOCRINE MYOPATHY HYPER. OR HYPOTHYROIDISM
HYPER. OR HYPOPARATHYROIDISM
HYPER. OR HYPOADRENALISM
HYPOPITUITARISM
ACROMEGALY

26. DRUG- INDUCED STEROIDS CHLOROQUINE CLOFIBRATE B-BLOCKERS COLCHICINE
EMETINE ZIDOVUDINE

27. INFLAMMATORY MYOPATHY POLYMYOSITIS &DERMATOMYOSITIS للاطلاع
DESTRUCTION OF MUSCLE FIBERS&INFLAMMATORY CELL INFILTRATION
OCCUR AT ANY AGE
FEVER, MUSCLE PAIN, TENDERNESS&WASTING OF PROXIMAL LIMB &GIRDLE MUSCLES
ARTHRALGIA ,MALAISE ,WEIGHT LOSS ,DYSPHAGIA ,RESP.DIFFICULTIES ,RAYNAUD PHENOMENA
VARIABLE PROGRESSION
IN DERMATOMYOSITIS THERE IS ERYTHEMATOUS RASH AROUND THE EYES &EYELIDS
MAY BE ASSOCIAT. AUTOIMMUNE DISEASES
IN ADULTS WITH CANCER

28. CPK IS ELEVATED, IF NORMAL DOESN’T EXCLUDE DIAGNOSIS EMG SHOWS MYOPATHIC CHANGES TREATMENT WITH STEROIDS, PREDNISOLONE mg / day for ? YEARS

30. POLYMYALGIA RHEUMATICA للاطلاع
MORE IN WOMEN ABOVE 60 YEARS
MUSCLE PAIN &STIFFNESS ABOUT THE NECK &GIRDLE MUSCLES
HEADACHE, ANOREXIA , Wt LOSS, LOW GRADE FEVER,
RAISED ESR
ENZYMES, EMG, MUS. BIOPSY ARE NORMAL
Rx PREDNISOLONE mg/ day for ? One year
GIANT CELL ARTERITIS

31. DISEASES OF NEUROMUSCULAR JUNCTION MYASTHENIA GRAVIS
OCCUR AT ANY AGE
MORE IN FEMALES
FLUCTUATING WEAKNESS&EASY FATIGUABILITY OF VOLUNTARY MUSCLES
WEAKNESS IS DUE TO IMMUNE- MEDIATED DECREASE IN THE NUMBER OF AchR LEADING TO BLOCK OF N-M. TRANSMISSION
MAY BE ASSO. WITH THYMIC TUMOR, THYROTOXICOSIS, SLE, Rh. Arthritis

32. CLINICALLY INSIDIOUS ONSET PTOSIS, DIPLOPIA , DIFFICULTY IN CHEWING OR SWALLOWING, NASAL SPEECH RESP. DIFFICULTY &LIMB WEAKNESS SYMPTOMS ARE FLUCTUATING IN SEVERITY ( DIURNAL VARIATION) SPONTANEOUS RELAPSES &REMISSIONS EXACERBATIONS infection, pregnancy, premenstrual &drugs EXAMINATION NO ATROPHY NO REFLEX CHANGES NO SENSORY SIGNS CONFIRM WEAKNESS& FATIGUABILITY SUSTAINED UPGAZE REPEATED KNEE BENDING DIAGNOSIS-----CLINICAL TENSILON TEST EMG AchR ANTIBODIES CXR & CT CHEST TREATMENT ANTICHOLINESTRASE THYMECTOMY STEROIDS AZATHIOPRINE PLASMAPHERESIS I. V. IMMUNOGLOBULIN