Ahmed Cannot Run

Ahmed Cannot Run

1. Anatomy

   • Joints
     • Ankle Joint
       • Articulations
         • Lower end of tibia
         • Two malleoli
         • Troclear Surface of talus
       • Type
         • Synovial-Hinge
       • Movement
         • Dorsiflextion
         • Plantarflextion
       • Vascular Supply
         • Anterior and posterior tibial arteries
         • Peroneal artery
         • Dorsalis Pedis artery
       • Nerve Supply
         • Sural nerve
         • Saphenous nerve
         • Deep peroneal nerve
         • Lateral and Medial plantar nerves
     • Subtalar
     • Talocalcaneonavicular
   • Muscles
     • 1st Layer
     • 2nd Layer
     • 3rd Layer
     • 4th Layer

2. Causes of Muscle Weakness

   • Infection
     • poliovirus
   • Neurological
     • Guillain-Barré syndrome
   • Medications
     • Amiodarone
   • Electrolyte
     • Hyperkalemia
   • Genetics
   • Metabolic
     • Acid maltase deficiency

3. DMD

   • Mutations
     • 60% are deletions
     • 5-10% duplications
     • 30% point / splice site modifications
   • The DMD gene encodes for the protein dystrophin, found in muscle cells and some neurons.
   • DMD is a sever progressive X-linked inherited disease characterized by progressive degeneration of the skeletal muscle especially those of the shoulder and pelvic griddle.
   • Pathogenesis
     • 1-fragile sarcolemma
       • 2-loss of interaction between the sarcolemma and extracellular matrix
         • 3-separation of the sarcolemma from the basal lamina.
   • Progression
     • (1)Relentless necrosis of muscle fibers
       • (2)Continuous effort of repair and regeneration
         • (3)The progressive fibrosis
           • (4)Degenerative process eventually outstrips the Regenerative capacity of the muscles
             • (5) Muscle fibers + fibrofatty connective tissue
               • (6) End stage: Almost Complete loss of skeletal muscle fibers and sparing of muscle spindles
   • Clinical progression
     • Early
       • Poor head control
     • Transitional
       • Toddler: hip weakness and lordosis
       • 3-9y: Gower sign and HT of calf
     • Loss of Ambulatory
       • Wheel chair
     • Late
       • Respiratory-cardiac-CNS complications
   • Complications
     • Cardiac
       • Arrhythmias
       • Cardiomyopathy
     • Orthopaedic problems
       • Joint contractures
       • Osteopenia
     • Infectious
       • Pulmonary infections
     • Pulmonary
       • Respiratory insufficiency
   • Management
     • Physical and occupational therapy
     • Pharmacological
       • Steroids
         • Prednisone
         • Deflazacort
       • Creatine monohydrate supplementation
     • Gene therapy
     • Stem cell

4. Nutrients for Muscle Development

   • Calcium
   • Iron
   • Vitamin D
   • Vitamin B12
   • Magnesium
   • Zinc

5. Muscle Strength Scale

6. Physical Examination

   • Introduction
     • Confidentiality
     • Consent
     • Privacy
   • Inspection
     • Symmetry
     • Skin
     • Shape
     • Position
     • Gait
   • Palpitation
     • Joints
     • Bony Landmarks
     • Tendons
     • Ligaments
     • Blood Vessels
   • Movement
     • Dorsiflexion
     • Plantar Flexion
     • Inversion
     • Eversion
   • Special Test
     • Inversion and Eversion stress test
     • Thompson’s test
     • Morton’s metatarsalgia

7. Gait Cycle

   • stance phase
   • swing phase
   • Abnormal Gait

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