PRE-UNIT

• For easier organization and memorization, I’ve divided this unit into three main categories: muscular disorders, skeletal disorders, and joint disorders. All fascial conditions are grouped under the muscular section. There are also some less rigid classifications, such as disorders caused by physical trauma and genetic conditions like Marfan syndrome. Please use this only as a reference, and make sure to focus on understanding the symptoms, pathology, and treatments for each condition.
• Try to be familiar with the names of commonly encountered bones in areas like the legs and forearms.
• For conditions like spinal deformities and various types of fractures, I recommend using images to aid your comprehension.

1. Diseases of the Muscles and Tendons

1.1 Fibromyalgia

• 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
  • 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
  • exercise: walking, biking, swimming, or water aerobics

1.2 Muscular Dystrophy (MD)

• 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)

• disorder of the myoneural junction in which the nerves fail to transmit an impulse for contraction to the muscles