The Muscles Long, extensible and therefore return to normal length
after muscular contraction
Neuromuscular junction (NMJ)
Acetylcholine (ACh) – excitatory neurotransmitter
Allows muscle to relax
Normal Structure – Skeletal Muscle
Used in low level activity: aerobic, daily activities
Endurance events (marathon)
Fast twitch – B
Normal Structure – Skeletal Muscle
Can switch from one type to another
Innervation changes
2. Transmission of nerve stimuli depends on binding
of Ach
potassium)
Facts to know
dermatomyositis)
muscle specific enzymes (creatine kinase (CK))
8. Cannot regenerate properly
Tetany- muscle spasm
Myalgia – muscle pain
Paraplegia
Quadraplegia
Terminology
Sprain
Strain
Avulsion
bone
Pathology
Upper motor neuron
Strokes, hemorrhage
Transection of the entire nerve
Poliomyelitis
Impaired nerve impulse transmission
Extraocular muscle and facial muscle weakness
Ptosis and diplopia
Bland facial expression
Thymus enlargement
Speech abnormalities
Inhibition of AChE floods the neuromuscular junction with Ach
Plasmaphoresis
Plan therapy at max energy time
Muscular dystrophy
Primary muscle cell pathology of genetic origin
Progressive course
Muscular dystrophy
Limb-girdle (shoulder, girdle)
Fascioscapulohumeral (face, shoulder)
Differences Between Types of
Death usually in the 20s
Pathogenesis
Muscle cell degeneration and loss
Compensatory hypertrophy of viable fibers
Ingrowth of fibrous tissue, and fat cells which replace lost
fibers
Gower’s sign
Hyperlordotic, wide-based, waddling gait
Contractures (heel cord, ITB, hamstrings, iliopsoas)
Walk on toes due to calf contractures
Myocardial weakness (signs of heart failure)
Adopted from: Jean Flickinger, Childhood Nueromuscular
Disorders, USIP Department of PT, 09/05/06
http://www.dinf.ne.jp/doc/english/global/david/dwe002/dwe002g/dwe00212g01.gif
Nueromuscular Disorders, USIP Department of PT,
09/05/06
Submaximal endurance
Nueromuscular Disorders, USIP Department of PT,
09/05/06
Myopathies
secondary to an identifiable disease of condition
Causes include many metabolic and hormonal
diseases, autoimmune diseases
Characterized by progressive muscle weakness with
pain and tenderness
Often caused by S. aureus and parasites (Taenia solium)
Source: Goodman, CC, Boissonnault, WG, & Fuller: Pathology: Implications for the Physical Therapist. Philadelphia, W.B. Saunders Company, 2002.
Myositis
Immune
Polymyositis
Myositis of SLE
Vessels narrow, cause muscle cell atrophy
Sarcoidosis
Source: Goodman, CC, Boissonnault, WG, & Fuller: Pathology: Implications for the Physical Therapist. Philadelphia, W.B. Saunders Company, 2002.
Myositis
Pathogenesis
conditions
If left untreated, risk of tissue necrosis or muscle tissue
damage
Source: Goodman, CC, Boissonnault, WG, & Fuller: Pathology: Implications for the Physical Therapist. Philadelphia, W.B. Saunders Company, 2002.
Myositis
Pain
Malaise
Fever
Source: Goodman, CC, Boissonnault, WG, & Fuller: Pathology: Implications for the Physical Therapist. Philadelphia, W.B. Saunders Company, 2002.
Myositis
Purple skin rash on eyelids, face, chest, extensor surfaces of
extremities
Source: Goodman, CC, Boissonnault, WG, & Fuller: Pathology: Implications for the Physical Therapist. Philadelphia, W.B. Saunders Company, 2002.
Dermatomyositis
http://www.medical-look.com/diseases_images/dermatomyositis.jpg
Myositis
muscle damage
Submax exercise
Source: Goodman, CC, Boissonnault, WG, & Fuller: Pathology: Implications for the Physical Therapist. Philadelphia, W.B. Saunders Company, 2002.
Tumors
interstitial fibrous tissue
Neurofibromatosis type I, neurofibromas,
rate after surgery
Symptoms
Pain
radiation therapy (XRT)
5 year survival rate: 40%
Tumors
PT
Fibromyalgia
Etiology:
Onset related to trauma
Headache
Fatigue