PRE-UNIT

• 位了方便归纳记忆，这个单元我按照肌肉的疾病，骨骼的疾病，以及关节的疾病三大类进行了整理。所有筋膜的病症也都归纳到肌肉部分了。其余也会有一些不太严谨的部分，例如物理损伤造成的疾病，和遗传性的马方综合征，请大家作为参考，具体还要记忆疾病的症状、病理、和疗法。
• 像是腿部和小臂的几个比较常见的骨头的名字要记清
• 像脊柱变形和各种骨折推荐大家用图片来辅助记忆

1. Diseases of the Muscles and Tendons

1.1 Fibromyalgia 纤维肌痛

• chronic pain condition associated with stiffness and tenderness that affects muscles, tendons, and joints
• restless sleep, depression, fatigue, anxiety, and bowel dysfunction
• signs & symptoms:
  • fatigue
  • diffuse aching or burning in the muscles, stiffness, disturbed sleep patterns, poor concentration, irritability, and depression
  • headaches, jaw pain, and sensitivity to odors, bright lights, and loud noises
  • irritable bowel/ spastic colon: nausea, diarrhea, constipation, abdominal pain with gas and distention
  • urinary symptoms: urinary urgency, frequency brought on by bladder, spasms and irritability
  • wakes up feeling tired
• etiology:
  • ⬆️nerve growth factor and chemical signal: substance P, in the spinal fluid
  • relatively low serotonin 血清素
  • impaired non-rapid eye movement (non-REM) sleep
  • psychological distress, trauma, infection
  • ss aggravated by poor posture, inappropriate exercise, and smoking
• diagnosis:
  • blood testing, physical exam: exclude hypothyroidism, hypoparathyroidism
  • at least 11 of 18 specific tender points
  • usually on both sides, in all four quadrants, widespread pain exist for a mim of 3mth
  • 18 sites: neck, shoulders, chest, hips, knees, and elbows
  • sleep disorders
• treatment:
  • no cure
  • patient education, stress reduction, physical activity, and medications
  • antidepressant amitriptyline (Elavil)
  • pregabalin (Lyrica), duloxetine (Cymbalta), and milnacipran (Savella)
  • for muscle and joint soreness: NSAIDs, muscle relaxants
  • Stress reduction, relaxation techniques, massage therapy, acupressure 针压法
  • exercise: walking, biking, swimming, or water aerobics

1.2 Muscular Dystrophy (MD) 肌肉萎缩症

• etiology:
  • all are hereditary
  • muscle degeneration & physical disability
  • can appear any age, generally ss appear 3~5yr
• most common & serious type: Duchenne’s MD, caused by a sex-linked gene
  • dystrophin is missing: death of muscle fibers, replaced by fat & connective tissue
  • sever form: heart muscle is affected, the calf muscles enlarge as a result of fat deposition, a child becomes weak and thin, and the child does not usually live to adulthood
  • diagnosis:
    • EMG: weak muscle contractions
    • muscle biopsy: abnormal muscle fibers, variations in fiber sizes, fat deposits, absence of dystrophin
    • immunologic & molecular biology techniques can diagnose the disease prenatally & at birth
  • treatment: physical and occupational therapy, exercise, and use of orthopedic appliances
  • no cure, no prevention

1.3 Myasthenia Gravis (MG) 重症肌无力

• disorder of the myoneural junction in which the nerves fail to transmit an impulse for contraction to the muscles
• signs & treatment:
  • fatigue and the inability to use the voluntary muscles
  • respiratory failure
  • enlarged thymus gland