Duchenne muscular dystrophy physical examination: Difference between revisions
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==Overview== | ==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 [[Buttocks|buttock]]. | |||
==Physical Examination== | ==Physical Examination== | ||
Physical examination of patients with [ | [[Physical examination]] of [[Patient|patients]] with Duchenne [[muscular dystrophy]] is usually remarkable for waddling [[gait]], [[Tachypnea]] or [[bradypnea]], decreased [[chest expansion]], [[lordosis]], [[scoliosis]], calf [[muscle]] [[Hypertrophy (medical)|hypertrophy]], [[foot drop]], tight heel cord, backward bending of the [[knee]], and [[muscle atrophy]] in [[thighs]] and [[buttock]]. | ||
===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]] | ||
===Skin=== | ===Skin=== | ||
* Skin examination of patients with Duchenne muscular dystrophy is usually normal | * [[Skin]] examination of patients with Duchenne [[muscular dystrophy]] is usually normal | ||
===HEENT=== | ===HEENT=== | ||
* HEENT examination of patients with Duchenne muscular dystrophy is usually normal | * HEENT examination of patients with Duchenne [[muscular dystrophy]] is usually normal | ||
===Neck=== | ===Neck=== | ||
* 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]] | ||
*Fine/coarse [[crackles]] upon auscultation of the lung may be present in case of pneumonia | *Fine/coarse [[crackles]] upon [[auscultation]] of the [[lung]] may be present in case of [[pneumonia]] | ||
===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<ref name="D’AngeloBerti2009" /><ref name="Pradhan1994">{{cite journal|last1=Pradhan|first1=Sunil|title=New clinical sign in Duchenne muscular dystrophy|journal=Pediatric Neurology|volume=11|issue=4|year=1994|pages=298–300|issn=08878994|doi=10.1016/0887-8994(94)90005-1}}</ref> | ||
* Hyporeflexia / areflexia may be present | * [[Hyporeflexia]] / [[areflexia]] may be present | ||
* Muscle weakness specially in the lower limbs | * [[Muscle weakness]] specially in the [[lower limbs]] | ||
*Waddling gait | *Waddling [[gait]] | ||
*[[Gowers' sign|Gowers sign]] | |||
===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 | ||
*Backward bending of the knee | *Backward bending of the [[knee]] | ||
*Muscle atrophy in thighs and buttock | *[[Muscle atrophy]] in [[thighs]] and [[buttock]] | ||
==References== | ==References== | ||
Latest revision as of 14:37, 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[1][8]
- Hyporeflexia / areflexia may be present
- Muscle weakness specially in the lower limbs
- Waddling gait
- Gowers sign
Extremities
- Calf muscle hypertrophy[9][10]
- Foot drop
- Tight heel cord
- Backward bending of the knee
- Muscle atrophy in thighs and buttock
References
- ↑ 1.0 1.1 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.
- ↑ Pradhan, Sunil (1994). "New clinical sign in Duchenne muscular dystrophy". Pediatric Neurology. 11 (4): 298–300. doi:10.1016/0887-8994(94)90005-1. ISSN 0887-8994.
- ↑ 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.