Duchenne muscular dystrophy physical examination: Difference between revisions
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===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
*[[Patients]] with Duchenne [[muscular dystrophy]] usually have waddling or [[Trendelenburg gait]] | *[[Patients]] with Duchenne [[muscular dystrophy]] usually have waddling or [[Trendelenburg gait]]<ref name="D’AngeloBerti2009">{{cite journal|last1=D’Angelo|first1=Maria Grazia|last2=Berti|first2=Matteo|last3=Piccinini|first3=Luigi|last4=Romei|first4=Marianna|last5=Guglieri|first5=Michela|last6=Bonato|first6=Sara|last7=Degrate|first7=Alessandro|last8=Turconi|first8=Anna Carla|last9=Bresolin|first9=Nereo|title=Gait pattern in Duchenne muscular dystrophy|journal=Gait & Posture|volume=29|issue=1|year=2009|pages=36–41|issn=09666362|doi=10.1016/j.gaitpost.2008.06.002}}</ref> | ||
===Vital Signs=== | ===Vital Signs=== | ||
*[[Hyperthermia]] may be present mostly due to [[respiratory infections]] | *[[Hyperthermia]] may be present mostly due to [[respiratory infections]]<ref name="ChenardBecane1993">{{cite journal|last1=Chenard|first1=A.A.|last2=Becane|first2=H.M.|last3=Tertrain|first3=F.|last4=de Kermadec|first4=J.M.|last5=Weiss|first5=Y.A.|title=Ventricular arrhythmia in Duchenne muscular dystrophy: Prevalence, significance and prognosis|journal=Neuromuscular Disorders|volume=3|issue=3|year=1993|pages=201–206|issn=09608966|doi=10.1016/0960-8966(93)90060-W}}</ref><ref name="SimondsMuntoni1998">{{cite journal|last1=Simonds|first1=A K|last2=Muntoni|first2=F|last3=Heather|first3=S|last4=Fielding|first4=S|title=Impact of nasal ventilation on survival in hypercapnic Duchenne muscular dystrophy|journal=Thorax|volume=53|issue=11|year=1998|pages=949–952|issn=0040-6376|doi=10.1136/thx.53.11.949}}</ref> | ||
*Irregularly [[pulse]] may be present | *Irregularly [[pulse]] may be present | ||
*[[Tachypnea]] at first due to hypercapnea and [[bradypnea]] after [[respiratory]] [[muscle]] [[exhaustion]] | *[[Tachypnea]] at first due to hypercapnea and [[bradypnea]] after [[respiratory]] [[muscle]] [[exhaustion]] | ||
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* [[Neck]] deviation may be present | * [[Neck]] deviation may be present | ||
===Lungs=== | ===Lungs=== | ||
* Decreased [[chest expansion]] | * Decreased [[chest expansion]]<ref name="Gozal2000">{{cite journal|last1=Gozal|first1=David|title=Pulmonary manifestations of neuromuscular disease with special reference to Duchenne muscular dystrophy and spinal muscular atrophy|journal=Pediatric Pulmonology|volume=29|issue=2|year=2000|pages=141–150|issn=8755-6863|doi=10.1002/(SICI)1099-0496(200002)29:2<141::AID-PPUL9>3.0.CO;2-Y}}</ref> | ||
* Use of accessory breath [[muscles]] | * Use of accessory breath [[muscles]] | ||
* Decreased [[breath sounds]] may be seen in case of [[pneumonia]] | * Decreased [[breath sounds]] may be seen in case of [[pneumonia]] | ||
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===Heart=== | ===Heart=== | ||
* [[Arrythmia]] may be present. | * [[Arrythmia]] may be present.<ref name="ChenardBecane1993">{{cite journal|last1=Chenard|first1=A.A.|last2=Becane|first2=H.M.|last3=Tertrain|first3=F.|last4=de Kermadec|first4=J.M.|last5=Weiss|first5=Y.A.|title=Ventricular arrhythmia in Duchenne muscular dystrophy: Prevalence, significance and prognosis|journal=Neuromuscular Disorders|volume=3|issue=3|year=1993|pages=201–206|issn=09608966|doi=10.1016/0960-8966(93)90060-W}}</ref> | ||
===Abdomen=== | ===Abdomen=== | ||
*[[Abdomen]] sticks out because of the [[lordosis]] | *[[Abdomen]] sticks out because of the [[lordosis]] <ref name="KerrLin2008">{{cite journal|last1=Kerr|first1=Tim P.|last2=Lin|first2=Jean-Pierre|last3=Gresty|first3=Michael A.|last4=Morley|first4=Tim|last5=Robb|first5=Stephanie A.|title=Spinal stability is improved by inducing a lumbar lordosis in boys with Duchenne Muscular Dystrophy: A pilot study|journal=Gait & Posture|volume=28|issue=1|year=2008|pages=108–112|issn=09666362|doi=10.1016/j.gaitpost.2007.10.008}}</ref> | ||
===Back=== | ===Back=== | ||
* [[Scoliosis]] | * [[Scoliosis]]<ref name="KerrLin2008">{{cite journal|last1=Kerr|first1=Tim P.|last2=Lin|first2=Jean-Pierre|last3=Gresty|first3=Michael A.|last4=Morley|first4=Tim|last5=Robb|first5=Stephanie A.|title=Spinal stability is improved by inducing a lumbar lordosis in boys with Duchenne Muscular Dystrophy: A pilot study|journal=Gait & Posture|volume=28|issue=1|year=2008|pages=108–112|issn=09666362|doi=10.1016/j.gaitpost.2007.10.008}}</ref><ref name="pmid2760082">{{cite journal |vauthors=Smith AD, Koreska J, Moseley CF |title=Progression of scoliosis in Duchenne muscular dystrophy |journal=J Bone Joint Surg Am |volume=71 |issue=7 |pages=1066–74 |date=August 1989 |pmid=2760082 |doi= |url=}}</ref> | ||
* Abnormal spinal curves (specially [[lordosis]]) | * Abnormal spinal curves (specially [[lordosis]]) | ||
===Genitourinary=== | ===Genitourinary=== | ||
* Urinary dysfunction may be present | * Urinary dysfunction may be present <ref name="CaressKothari1996">{{cite journal|last1=Caress|first1=James B.|last2=Kothari|first2=Milind J.|last3=Bauer|first3=Stuart B.|last4=Shefner|first4=Jeremy M.|title=Urinary dysfunction in Duchenne muscular dystrophy|journal=Muscle & Nerve|volume=19|issue=7|year=1996|pages=819–822|issn=0148-639X|doi=10.1002/(SICI)1097-4598(199607)19:7<819::AID-MUS2>3.0.CO;2-C}}</ref> | ||
===Neuromuscular=== | ===Neuromuscular=== | ||
*[[Patient]] is usually oriented to persons, place, and time | *[[Patient]] is usually oriented to persons, place, and time | ||
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===Extremities=== | ===Extremities=== | ||
*[[Calf muscle]] [[hypertrophy]] | *[[Calf muscle]] [[hypertrophy]]<ref name="SackleyDisler2009">{{cite journal|last1=Sackley|first1=Catherine|last2=Disler|first2=Peter B|last3=Turner-Stokes|first3=Lynne|last4=Wade|first4=Derick T|last5=Brittle|first5=Nicola|last6=Hoppitt|first6=Thomas|last7=Sackley|first7=Catherine|title=Rehabilitation interventions for foot drop in neuromuscular disease|year=2009|doi=10.1002/14651858.CD003908.pub3}}</ref><ref name="CrosHarnden1989">{{cite journal|last1=Cros|first1=D.|last2=Harnden|first2=P.|last3=Pellissier|first3=J. F.|last4=Serratrice|first4=G.|title=Muscle hypertrophy in Duchenne muscular dystrophy|journal=Journal of Neurology|volume=236|issue=1|year=1989|pages=43–47|issn=0340-5354|doi=10.1007/BF00314217}}</ref> | ||
*[[Foot drop]] | *[[Foot drop]] | ||
*Tight heel cord | *Tight heel cord | ||
Revision as of 14:35, 15 May 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.
Overview
Physical examination of patients with Duchenne muscular dystrophy is usually remarkable for waddling gait, Tachypnea or bradypnea, decreased chest expansion, lordosis, scoliosis, calf muscle hypertrophy, foot drop, tight heel cord, backward bending of the knee, and muscle atrophy in thighs and buttock.
Physical Examination
Physical examination of patients with Duchenne muscular dystrophy is usually remarkable for waddling gait, Tachypnea or bradypnea, decreased chest expansion, lordosis, scoliosis, calf muscle hypertrophy, foot drop, tight heel cord, backward bending of the knee, and muscle atrophy in thighs and buttock.
Appearance of the Patient
- Patients with Duchenne muscular dystrophy usually have waddling or Trendelenburg gait[1]
Vital Signs
- Hyperthermia may be present mostly due to respiratory infections[2][3]
- Irregularly pulse may be present
- Tachypnea at first due to hypercapnea and bradypnea after respiratory muscle exhaustion
Skin
- Skin examination of patients with Duchenne muscular dystrophy is usually normal
HEENT
- HEENT examination of patients with Duchenne muscular dystrophy is usually normal
Neck
- Neck deviation may be present
Lungs
- Decreased chest expansion[4]
- Use of accessory breath muscles
- Decreased breath sounds may be seen in case of pneumonia
- Fine/coarse crackles upon auscultation of the lung may be present in case of pneumonia
Heart
Abdomen
Back
Genitourinary
- Urinary dysfunction may be present [7]
Neuromuscular
- Patient is usually oriented to persons, place, and time
- Hyporeflexia / areflexia may be present
- Muscle weakness specially in the lower limbs
- Waddling gait
- Gowers sign
Extremities
- Calf muscle hypertrophy[8][9]
- Foot drop
- Tight heel cord
- Backward bending of the knee
- Muscle atrophy in thighs and buttock
References
- ↑ D’Angelo, Maria Grazia; Berti, Matteo; Piccinini, Luigi; Romei, Marianna; Guglieri, Michela; Bonato, Sara; Degrate, Alessandro; Turconi, Anna Carla; Bresolin, Nereo (2009). "Gait pattern in Duchenne muscular dystrophy". Gait & Posture. 29 (1): 36–41. doi:10.1016/j.gaitpost.2008.06.002. ISSN 0966-6362.
- ↑ 2.0 2.1 Chenard, A.A.; Becane, H.M.; Tertrain, F.; de Kermadec, J.M.; Weiss, Y.A. (1993). "Ventricular arrhythmia in Duchenne muscular dystrophy: Prevalence, significance and prognosis". Neuromuscular Disorders. 3 (3): 201–206. doi:10.1016/0960-8966(93)90060-W. ISSN 0960-8966.
- ↑ Simonds, A K; Muntoni, F; Heather, S; Fielding, S (1998). "Impact of nasal ventilation on survival in hypercapnic Duchenne muscular dystrophy". Thorax. 53 (11): 949–952. doi:10.1136/thx.53.11.949. ISSN 0040-6376.
- ↑ Gozal, David (2000). "Pulmonary manifestations of neuromuscular disease with special reference to Duchenne muscular dystrophy and spinal muscular atrophy". Pediatric Pulmonology. 29 (2): 141–150. doi:10.1002/(SICI)1099-0496(200002)29:2<141::AID-PPUL9>3.0.CO;2-Y. ISSN 8755-6863.
- ↑ 5.0 5.1 Kerr, Tim P.; Lin, Jean-Pierre; Gresty, Michael A.; Morley, Tim; Robb, Stephanie A. (2008). "Spinal stability is improved by inducing a lumbar lordosis in boys with Duchenne Muscular Dystrophy: A pilot study". Gait & Posture. 28 (1): 108–112. doi:10.1016/j.gaitpost.2007.10.008. ISSN 0966-6362.
- ↑ Smith AD, Koreska J, Moseley CF (August 1989). "Progression of scoliosis in Duchenne muscular dystrophy". J Bone Joint Surg Am. 71 (7): 1066–74. PMID 2760082.
- ↑ Caress, James B.; Kothari, Milind J.; Bauer, Stuart B.; Shefner, Jeremy M. (1996). "Urinary dysfunction in Duchenne muscular dystrophy". Muscle & Nerve. 19 (7): 819–822. doi:10.1002/(SICI)1097-4598(199607)19:7<819::AID-MUS2>3.0.CO;2-C. ISSN 0148-639X.
- ↑ Sackley, Catherine; Disler, Peter B; Turner-Stokes, Lynne; Wade, Derick T; Brittle, Nicola; Hoppitt, Thomas; Sackley, Catherine (2009). "Rehabilitation interventions for foot drop in neuromuscular disease". doi:10.1002/14651858.CD003908.pub3.
- ↑ Cros, D.; Harnden, P.; Pellissier, J. F.; Serratrice, G. (1989). "Muscle hypertrophy in Duchenne muscular dystrophy". Journal of Neurology. 236 (1): 43–47. doi:10.1007/BF00314217. ISSN 0340-5354.