Ahmad Cannot Run

Ahmad Cannot Run

1. Causes of Muscle Weakness

   • Infection
     • poliovirus > poliomylitis Lyme disease
   • Neurological
     • Demyelinating disorders: Guillain-Barré syndrome
   • Medications
     • Statin> atorvastatin (Lipitor) Amiodarone (oral route)
   • Electrolyte
     • Hyperkalemia
   • Genetics
   • Metabolic
     • Glycogenoses: Acid maltase deficiency

2. Nutrients and Muscle Development

   • Calcium Iron Vitamin D Vitamin B12 Magnesium Zinc

3. Physical Examination

   • Muscle Strength Scale
   • Introduction & Consent HEPA Inspection SSSP Palpation: Skin Temperature Joints Tendons Ligaments
   • Move
     • Dorsiflexion Plantar Flexion Inversion Eversion Flexion of great toe
   • Special Test
     • Inversion and Eversion stress test Thompson’s test for tendoachillies rupture Tests for Morton’s metatarsalgia
   • pes cavus(high arch)
     • fixed plantar flexion of the foot. A high arch is the opposite of a flat foot and is somewhat less common

4. Gait

   • Gait Cycle
   • abnormal gait
     • Trendelenburg gait
     • waddling (duck) gait.
     • Anterior trunk bending
       • inadequacy of the knee extensors.
     • Posterior trunk bending
       • inadequacy of hip extensors.
     • Swing-out
       • presence of weak hip flexors
     • Steppage gait
       • inadequate dorsiflexion control
     • Vaulting
       • Going up on the toes of the stance phase leg.
     • Antalgic gait
       • as short a time is possible is spent on the painful limb, and a correspondingly longer time is spent on the pain-free side.

5. Duchene Muscular Dystrophy

   • DMD Gene
     • Xp21 2.2 megabases 79 exons 8 promoters
     • mutation
   • dystrophin
     • Dystrophin provides strength to muscle cells by linking the internal cytoskeleton to the surface membrane.
   • Genetic Difference Between DMD & BMD
   • complication
   • X-linked inherited
   • Investigations
     • Serum Creatine Kinase
       • A high CK generally indicates that there has been some recent muscle damage but will not indicate its location or cause.
     • Electromyography
       • EMG results can reveal nerve dysfunction, muscle dysfunction or problems with nerve-to-muscle signal transmission.
     • Thyroid Function Test
     • Western Blot
       • The separation of proteins by electrophoresis, then The binding of specific antibody to the protein of interest.
     • Muscle Biopsy
       • Cross section of muscle shows extensive replacement of muscle fibers by fat cells.
   • MANAGEMENT
     • Physical and occupational therapy
     • PHARAMACOLOGICAL
       • Steroids Prednisone Deflazacort -Creatine monohydrate supplementation
     • -Gene therapy:
     • -Stem cell
   • Prognosis
     • death occurs usually at about 18-20yrs of age.

6. Anatomy of the foot

   • foot and ankle bones
   • foot ligaments
   • arterial supply
   • nerve supply
   • layers of the sole
   • cutaneous nerve supply

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