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MSK 2 > Approach to Muscle Pain and Weakness > Flashcards

Approach to Muscle Pain and Weakness Flashcards

1
Q

Myalgia
Myopathy
Myositis

A

Muscle pain

Muscle fiber disorder with weakness

Muscle inflammation with pain and wekaness

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2
Q

Pathogenesis of muscle pain

A

True muscle pain is from visceral innervation so is a diffuse, dull ,aching or bruning pain

Sensitization can be result of changes to nervous system

Hyperalgesia or allodynia

Muscle pain may be from adjhacent structures

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3
Q

Muscular biochem changes

A

Pain from alt of muscle structure or function due to release of protons or ATP

Damage results in release of these which are detected by nociceptors

Prolonged exercise has production of lactate…does not directly cause pain but does potentiate H ions

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4
Q

Myalgia without weakness

A

Viral infection (flu, cox, EBV, HIV)
Systemic bac/spriochetal infection
Neuroleptic malg syn drome
Malig hyperthermia

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5
Q

Myalgia with weakness

A

Alcohol

Rhabdomyolosis

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6
Q

Weakness without myalgia

A 
Transvese myelitis
Guillan Barre
Botulism
Hypo/hypercalcium
hpo/hpyerkalemia
Hypophos
Hypomag
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7
Q

Rhabdomyolysis patho

A

Muscle necrosis…due to increase in IC Ca which ativates proteases and leads to ROS

Increase in Ca form deletion of ATP leading to Ca ATPase pump dysfunction
OR
Direct injury to plasma membrane

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8
Q

Inflamm, toxic causes of rhabdo

A

POlymyositis, dermatomyosis, IBM

Alcohol, coacine, statins

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9
Q

Infection and injury causes of rhabdo

A

Viral myositis, pyomyositis

Exercise, electrical, crush, hyperthermia, msucle hypoxia

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10
Q

Rhabdo classic sx

A

Diffuse myaglia, muscle weakness, and dark urine

Myoglobin released from muscle damage gives the color of urine

Myoglobin can cause kidney damage by direct tubular toxicity or from obstructed flow

Elevation of CK to over 10,000

Urine positive for blood but negative for RBCs on microscopy

Hyperkalameia

Hyperphosphatemia

Hypocalcemia

Discontinue any contributing drugs

Monnitor acute kindey inijry y

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11
Q

Neuroleptic malginant syndrome

A

Life threating from dopamine antagonists

evolves over 1-3 days

Fever, mental status changes, lead pipe rgiditiy, tachy and labile BP

Evelation of CK to more than 1000

Hypocalcemia, hypomag, hyperkalemia, and metabolic acidosis

Serious complications are rhabdo and acute resp failure

Stop the anti-dopaminergic

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12
Q

Malignant hyperthermia

A

Inherited abnormality of ryanodine receptors

Unregulated passage of calcium causes sustained muscle contraction and rhabdo

Hypercarbia (acute resp failure) and muscle rigidity

Will develop hyperthermia, tachy, tachypnea, myoglobinuria, and hyoperkalemia

Hyperkalemia can lead to arrythmias in ventricular tachy and fibrillation

Discontinue agents

Dantrolene binds ryanodine and blocks Ca passaeg

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13
Q

Inhertied causes of myalgia without weakess

Myalgia with weakness

Weakness without myalgia

A

Mcardle dz (GSD 5)

Mitochondrial myopathy, myotonic dystropy, pompe disease(GSD 3)

DMD and BMD

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14
Q

DMD and BMD

A

Dystrophin mutation leading to myofibril instability and degen of muscle fibers

Located on X chromosome

Gower’s sign when young
Pseudohypertrophy and dilated cardiomyoapthy

Becker presents later but still cardio probs

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15
Q

Mitochondrial myopathy

A

Genetic defect in protein responsible for oxidative phosph

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16
Q

Kearns- Sayre syndrome

A

Adolescne

progressive extenral opthalmoplegia (diplopia and ptsosi)

Cerebellar ataxia, deaf, intellectaul

17
Q

MELAS

A

Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes

Childhood

Progressive muscle weakness and myaglia

Focal or generalized seizures

Episodes of hemipareis, hemianopia, cortical blindenss

18
Q

MERRF

A

Myoclonic epilepsy with ragged red fibers

Childhood and adolescence

Progressive muscle weakkess, myalgia, and spacticity

Myoclonus

Seizures, ataxia, peripheral neuropathy, dementtia

19
Q

Pompe dz

A

Defect in glyocgen synthesis or breakdown

Def of acid maltase

Accumulation of glycogen in lysosomes and cytoplasm

Infantile with hypotonia, muscle weaknes and cardiomyopathy…usually resp distress and feeding difficulties

If onset older or adults…proximal and resp muscle weakness, muscle pain, and cramps

Early involvement of diaphram common so sleep disorder breathing is common

Late onset should be expected if progressive proximal muscle weaknessa nd reduced fixed vital capicty on pulm function testing

20
Q

McArdle dz

A

Def of myophosphorylase which liberate glc-1phos from outer braches of glycogen

Usualy during adolescne or adulthood

Exercise intolerance, fatigue, myalgia and muscle cramps

Exercise leads to CK evleation and myoglobinuria

COntinued exercise may get rhabdo

Second wind phenomeme - due to increased blood flow and activation of FFA metab ofr energy

21
Q

Acquired causes

Myalgia without weakness

Myalgia with weakness

Weakness without myalgia

A

Fibromyalgia, SEID, statin

DM, PM, adrneal insufficiency, hypothyroid, hyperthyroid, statin

Poly rhem, IBM, cushing, MG, alcohol, GCs

22
Q

Fibromylagia

A

Exercise intolernace
unrefreshing sleep
Cong distubance
Psyc disorders

Based on clinical findings

Exercise is key compoennt of tx

Give TCAs (ami and cyclobenzarine), SNRIs (duloxetine), anticonvulstants (pregab and gabapentin)

23
Q

Systemic exertion intolerance dz

A

More likely to have antibodies to virus than control

Early to middle adults andm ore in woemn

Abrupt onset of fatigue after URI

Exercise intolerance
Myalgia
Cog disturbance
Orthostatic infolterance

CBT and exercise…be careful not to overexert

24
Q

Polymyalgia rheymatica

A

Symmetric pain, aching, morning stiffness of shoulders, neck, hips, and thights

Over 50

Modest elevation of ESR

Resolves with low-dose GCs

25
Q

Alcohol myopathy

A

Directly toxic to both skeletal and cardiac muscle

Acute occurs with long stading alcohol abuse who bindge drink…generalized cramps, worse in calves, muscle tenderness and weakness…eelvated CK and rahdbo…discontinue the alcohol

Chronic - gradual onset of proximal weaknes and atrophy

26
Q

Statin myopathy

A

Myalgia is much more common

Decrease cholesterol and inhibit CoQ10 and ubiquinone

Mostly affects proximal muslces and symmetric

Might want ot supplemtn CoQ10

27
Q

GC myopathy

A

Myalgia typically absent and CK normal

Discontnue or reuce

Proximal muscle

MSK 2 (24 decks)

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