Shoulder girdle muscle atrophy

Introduction The scapular muscle atrophy is a symptom and clinical manifestation of progressive proximal extremity muscle atrophy. Progressive extremity proximal muscular atrophy is often myogenic atrophy, with proximal and trunk muscles of the extremities, often showing atrophy and weakness of the scapular and pelvic girdle muscles. If the neck muscles are weak, some patients need to support them by hand to lift the head. The muscle atrophy of the shoulder blades constitutes a winged shoulder blade.

Cause

Common causes are disuse, nutritional disorders, ischemia and poisoning. Anterior horn lesions, nerve roots, nerve plexus, peripheral nerve lesions, etc. can cause conduction disturbances of nerve excitation impulses, thereby making some muscle fibers waste, resulting in disuse muscle atrophy.

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Progressive extremity proximal muscular atrophy is often myogenic atrophy, with proximal and trunk muscles of the extremities, often showing atrophy and weakness of the scapular and pelvic girdle muscles. If the neck muscles are weak, some patients need to support them by hand to lift the head. The muscle atrophy of the shoulder blades constitutes a winged shoulder blade. The atrophy of the pelvic girdle muscles is unable to form a specific 'duck step' gait. Common diseases are progressive muscular dystrophy, polymyositis, diabetic muscular atrophy, and hormonal myopathy. Disease is a genetic disease found in young people with muscle atrophy in the proximal extremities and limbs, gastrocnemius Even pseudo-hypertrophy. Muscle fibrillation is sometimes seen in this disease and can be induced with neostigmine. No duck steps and winged shoulders.

Differential diagnosis

First, acute or subacute muscle atrophy

It is generally neurogenic atrophy, and its rate of occurrence is related to the speed and extent of nerve damage. The more acute and severe the nerve damage and interruption, the faster and more obvious the muscle atrophy occurs. After acute onset, muscle atrophy occurs after sputum, and the clinical manifestations are sputum, such as poliomyelitis, peripheral neuritis, Guillain-Barré syndrome, and alcoholism. Early neuropathic muscle atrophy is characterized by severe pain near the scapula, followed by a rapid decrease in muscle tone, tendon and muscle atrophy near the scapula, and a single atrophy in some muscle groups, inlaid.

Second, progressive distal extremity muscle atrophy

Often neurogenic muscle atrophy, mainly in the distal extremities, upper limbs in the interosseous muscle of the hand, large and small intermuscular muscles are obvious, while the lower extremity atrophy in the tibialis anterior muscle is more obvious. The sides are basically symmetrical, often occurring before the sputum, as a single symptom. Common diseases include amyotrophic lateral sclerosis and progressive spinal muscular atrophy of motor neuron disease, and weakness and muscle atrophy of the distal extremity caused by cervical spondylosis. Gastrocnemius atrophy is characterized by muscle atrophy of the lower third of the thigh of the lower extremity, accompanied by deep sensory disturbance and sensory ataxia. In addition, syringomyelia, spinal vascular malformations, leprosy, and chronic anterior polio can cause progressive muscular atrophy at the distal extremities. Muscular atrophic myotonia and distal progressive muscular dystrophy also manifest as muscle atrophy at the distal extremities.

Third, progressive extremity muscle atrophy

Often myogenic atrophy, with the proximal and trunk muscles of the extremities, often manifested as atrophy and weakness of the scapular and pelvic girdle muscles. If the neck muscles are weak, some patients need to support them by hand to lift the head. The muscle atrophy of the shoulder blades constitutes a winged shoulder blade. The atrophy of the pelvic girdle muscles is unable to form a specific 'duck step' gait. Common diseases are progressive muscular dystrophy, polymyositis, diabetic muscular atrophy, and hormonal myopathy. Disease is a genetic disease. It is seen in young people. It shows muscle atrophy in the proximal and limbs of the extremities, and pseudo-hypertrophy in the gastrocnemius. Muscle fibrillation is sometimes seen in this disease and can be induced with neostigmine. No duck steps and winged shoulders.

Fourth, localized muscle atrophy

Atrophy, which is mainly caused by local muscles or muscle groups, is often caused by various types of single neuritis or injury. It is usually accompanied by the corresponding sensory area disorder. The lesion can be located according to its anatomy. The common cause is single nerve. Inflammation (such as phrenic nerve, phrenic nerve, sciatic nerve injury, etc.), carpal tunnel syndrome, brachial plexus injury, neurofibromatosis, etc. Others are:

1. The softening of the gray matter of the spinal cord can be manifested as distal progressive amyotrophic, or confined to the hand, does not invade the forearm and upper arm, and stops when the atrophy reaches a certain level. It is accompanied by sensory disturbances, which occur in the elderly and are often caused by syphilitic vascular lesions.

2. On the side of the young man with upper limb muscle atrophy, the onset of 14 to 24 years old, more common in men, insidious onset, manifested as thinning below the midpoint of the forearm, large and small inter-crop and bone atrophy, often single On the side, the atrophy boundary is clear and there is no sensory disturbance, but the autonomic nerve disorder is more obvious. The disease will stop on its own within 1 to 3 years.

3. Reflex muscle atrophy refers to a kind of disuse atrophy caused by local lesions such as joint lesions. Found in traumatic, infectious, rheumatoid arthritis. Rheumatoid arthritis can cause systemic muscle atrophy.

Five, partial body shrinkage

1. Topal lobe lesions Some patients with parietal lobe tumors may have contralateral muscle atrophy and are considered to have diagnostic value. This muscle atrophy is mostly limited to the upper limb. In the proximal part of the upper limb, there is often a dislocation of the shoulder joint. It is also associated with cortical sensory disturbances, autonomic disorders in the upper limbs and hands, and even subcutaneous tissue and skeletal abnormalities. It has been suggested that flaccid monoterpene or hemiplegia, cortical sensory disturbance, and muscular atrophy are triads of parietal lesions.

2. Cerebrovascular disease hemiplegia can also appear muscle atrophy, seen in two cases, early in the early days usually appear within a few weeks after the onset, the other case is late, occurs several months after the onset. Often manifested in the muscle atrophy of the distal extremity, and sometimes limited to the scapula, especially in the deltoid muscle, so there is often shoulder dislocation. Lower extremity muscle atrophy is rare and often belongs to disuse atrophy.

3. Congenital eccentric muscle atrophy is characterized by uniform muscle atrophy, no obvious muscle loss and sacral reflex changes, often associated with congenital parietal dysplasia.

4. Progressive partial muscle atrophy is characterized by hyperreflexia, partial dysfunction, and deep lesions in the contralateral cerebral hemisphere or cerebral hemisphere, especially in the space-occupying lesions of the thalamus.

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