Ahmad Cannot Run

Anatomy of Foot & Ankle
1. Ankle Joint
  1. ligaments
    1. medial
    2. lateral
  2. blood supply
  3. nerve supply
2. muscles of the sole of the foot
  1. 4 layers
3. arches of the foot
Possible Causes of Muscle Weakness
1. infection
  1. poliomyelitis
  2. lyme disease
2. neurological
  1. Guillain Barre Syndrome
3. Medications
  1. Statin
  2. Amiodarone
4. Electrolyte
  1. Hyperkalemia
5. Metabolic
  1. Acid Maltase deficiency
6. Genetic
  1. Duchenne Muscular Dystrophy
    1. Muscular Dystrophies: are inherited disorders which primarily but not exclusively affect the skeletal muscles
    2. Clinical Characteristics
      1. progressive weakness
      2. intellectual impairment
      3. pseudo hypertrophy of the calves
      4. proliferation of connective tissue in muscle
    3. X linked recessive
      1. genetic defect in Xp21
        deletion
        duplication
        point mutation
    4. Pathogenesis
      1. without dystrophin, sarcolemma becomes fragile, loss of calcium homeostaasis, cell death occurs
        muscle cell degeneration will outpace regeneration
        regeneration capacity is exhausted, fibres are replaced by connective tissue and fat
    5. Clinical Progression
      1. Prognosis
        poor
        100% mortality at mid 20s
        due to one of the complications
        lung failure
        heart failure
        aspirations
        airway obstruction
        Management
        no treatment, only improving quality of life by reducing complications
        Pharmacological approach
        Prednisone
        physical and occupational therapy
    6. Investigations
      1. CK test
      2. muscle biopsy
        to check the myopathic changes
      3. western blot
        to detect and analyze dystrophin
7. Tested by Neurological Examination of the LL
  1. Sensation
  2. Motor Function
    1. To test Muscle strength
      1. Muscle Strength Scale
  3. Coordination
  4. Gait
    1. abnormal gait
      1. due to abnormalities in the
        tip toe gait

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Ahmad Cannot Run

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	Created by Salma Mk about 7 years ago