Department of Rehabilitation Medicine, Guangzhou First People's Hospital
Zhang Shunxi
(Technician in charge)
Department of Rehabilitation Medicine, Guangzhou First People's Hospital
Muscular atrophy(myotrophy; myophagism) refers to muscle volume reduction caused by striated muscle dystrophy, muscle fiber thinning or even disappearance.It is mostly caused by muscle diseases or nervous system dysfunction. The main causes are: neurogenic muscular atrophy, myogenic muscular atrophy, disuse muscular atrophy and other muscular atrophy.In addition to the pathological changes of muscle tissue itself, muscle nutrition is closely related to the nervous system.Spinal cord diseases often lead to muscular dystrophy and muscular atrophy.Muscle atrophy patients lie in bed for a long time due to muscle atrophy and weakness, and are prone to pneumonia, pressure sore, etc. In addition, most patients have symptoms of bulbar paralysis, which poses a great threat to the lives of patients.
TCM disease name
Muscular atrophy
Foreign name
myatrophy；myophagism
Visiting department
Neurology
Common diseases
muscle
Common causes
Mostly caused by muscle disease or nervous system dysfunction
The common causes were disuse, malnutrition, ischemia and poisoning.The lesions of anterior horn, nerve root, nerve plexus and peripheral nerve can all cause the conduction obstacle of nerve excitation impulse, which will lead to the disuse of some muscle fibers and disuse muscular atrophy.On the other hand, after any part of the motor neuron is damaged, the acetylcholine released from its terminal part is reduced, and the sympathetic neurotrophic effect is weakened, resulting in muscle atrophy.
2. Myogenic muscular atrophy
It is caused by the muscle disease itself, and may also include other factors, such as shoulder belt or facial shoulder humeral muscular dystrophy, which is confirmed to be spinal muscular atrophy by morphological examination.Microelectrode technique was used to examine the animals suffering from muscular dystrophy, showing that functional denervated muscle fibers accounted for about 1/3.
Two main factors can cause "muscular atrophy": nerve damage is called neurogenic muscular atrophy;The disease of muscle itself is called myogenic muscular atrophy.
clinical manifestation
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1. Thigh muscle atrophy
It is mainly caused by quadriceps femoris atrophy. Thigh muscle atrophy is common in patients with femoral head necrosis and lower limb immobilization. All patients with femoral head necrosis in the middle and late stages have thigh muscle atrophy. The severity of muscle atrophy varies. Most useless thigh muscle atrophy can be recovered. A few cases of femoral head necrosis have thigh muscle atrophy that cannot be recovered for life,It seriously affects the walking distance and quality of life of patients.
2. Calf muscle atrophy
It refers to the dystrophy of striated muscle. The muscle volume is smaller than normal, and the muscle fiber becomes thinner or even disappears.
3. Shoulder girdle muscle atrophy
It is the symptom and clinical manifestation of progressive proximal limb muscular atrophy.Progressive proximal muscular atrophy of the extremities is often myogenic atrophy, which is obvious in the proximal extremities and trunk muscles, and is often manifested as atrophy and weakness of shoulder girdle muscles and pelvic girdle muscles.
4. Myogenic facial muscle atrophy
It is caused by the muscle disease itself, and may also include other factors, such as shoulder belt or facial shoulder humeral muscular dystrophy, which is confirmed to be spinal muscular atrophy by morphological examination.On the other hand, after any part of the motor neuron is damaged, the acetylcholine released from its terminal part is reduced, and the sympathetic neurotrophic effect is weakened, resulting in muscle atrophy.
5. Interosseous muscle and thenar muscle atrophy
It usually starts with weakness of small muscles of the hand and gradual atrophy of muscles, which can affect one or both sides, or from one side to the other.The palms are flat due to atrophy of thenar muscles and hypothenar muscles, and the interosseous muscles are atrophied, resulting in claw like hands.The muscular atrophy extends upward and gradually invades the forearm, upper arm and shoulder belt.Muscle bundle fibrillation is common and can be limited to some muscle groups or widely existed. It is easier to induce by tapping with hands.A few atrophic muscle weakness can start from the tibialis anterior and peroneus muscles of the lower limbs or from the extensor muscles of the neck, and some can also start from the proximal muscles of the upper and lower limbs.
6. Muscle strength grading of muscle atrophy
(1) Level 0: completely paralyzed, unable to do anything free and powerless.
(2) Grade I: complete paralysis, slight muscle atrophy can be seen during limb movement, but the body cannot move.
(3) Grade II: limbs can move in parallel on the bed, but cannot be lifted off the bed surface.
(4) Level III: limbs can overcome the gravity and lift off the table.
(5) Level IV: The limbs can move against external resistance.
(6) Grade V: normal muscle strength, free movement.
Muscle atrophy example[1]
Example[1]
inspect
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1. Electromyography (EMG).
2. Nerve conduction velocity, including motor nerve conduction velocity, sensory nerve conduction velocity, F wave and H reflex.
3. Evoked potential, including brainstem auditory evoked potential, visual evoked potential and upper and lower limb somatosensory evoked potential.
4. Free hand muscle strength inspection.
5. Muscle tension test.
6. Muscle circumference measurement.
treatment
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1. Standardize rehabilitation exercise therapy
Patients with limb dyskinesia caused by muscle atrophy can significantly reduce or alleviate the sequelae of paralysis after regular exercise treatment.
Some people mistakenly regard sports therapy as particularly simple, even equating it with "exercise". They are eager for success and often get half the result with twice the effort, which also leads to problems such as joint muscle injury, fracture, shoulder and hip pain, spasticity aggravation, abnormal spasticity patterns and abnormal gait, foot drop, varus, etc., namely "misuse syndrome".
The coordinated rehabilitation treatment of patients' joint range of motion, muscle tension and antagonism should not be ignored, so as to prevent patients' muscle strength from returning to normal, but leaving behind abnormal movement patterns.
2. Emphasize muscle coordination training
Improper muscle strength training can aggravate spasticity, and proper rehabilitation training can alleviate spasticity, so as to make limb movements tend to be coordinated.Once the wrong training method is used, such as repeatedly practicing grasping with the affected hand, the coordination of the affected upper limb's flexors will be strengthened, which will aggravate the spasm of the muscles responsible for joint flexion, resulting in elbow flexion, wrist flexion and pronation, and finger flexion deformity, making it more difficult to recover the function of the hand.In fact, muscle atrophy is not only a problem of muscle weakness, but also an important reason for motor dysfunction.Therefore, we should not mistake rehabilitation training for strength training.
3. Other treatments
Low or medium frequency electric stimulation, neurotrophic drugs, combined with acupuncture/electroacupuncture and massage.
Self regulation
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In addition to having a doctor treat patients with muscular atrophy, self adjustment is very important:
1. Keep optimistic and happy
Intense long-term or repeated emotional changes such as nervousness, anxiety, irritability and pessimism can lead to imbalance of the excitation and inhibition process of the cerebral cortex and promote the development of muscle atrophy.
2. Reasonably allocate the diet structure
Muscle atrophy patients need high protein and high energy diet supplements to provide the materials necessary for the reconstruction of nerve cells and skeletal muscle cells to enhance muscle strength and muscle growth. They should adopt foods with high protein, rich in vitamins, phospholipids and trace elements in the early stage, and actively cooperate with the herbal diet for invigorating qi and spleen, such as yam, astragalus, white lotus, tangerine peel, pseudostellaria, lily, etc., and fast from spicy food,Give up smoking and drinking.The patients in the middle and late stages mainly take semi liquid food and liquid food with high protein, high nutrition and energy, and adopt the method of eating less and more meals to maintain the nutrition and water electrolyte balance of patients.
3. Combination of work and rest
Forced functional exercise is not allowed, because it will be harmful to the recovery of skeletal muscle function and the regeneration and repair of muscle cells due to skeletal muscle fatigue.
4. Prevent colds and gastroenteritis
Due to low autoimmune function or some kind of immune deficiency in patients with muscular atrophy, once they catch a cold, their condition will worsen, the course of disease will be prolonged, muscle weakness and muscle jumping will be aggravated, especially in patients with bulbar paralysis, they are prone to be complicated with lung infection. If they are not prevented and treated in time, their prognosis will be poor, and even their lives will be endangered.Gastroenteritis can lead to functional disorder of intestinal bacteria, especially viral gastroenteritis can damage spinal cord anterior horn cells to varying degrees, thus making the condition of muscular atrophy repeated or aggravated.The maintenance of normal digestive function in patients with muscular atrophy is the basis of rehabilitation.
