Symptom >> Internal Medicine >> Neurology

Increased myotonia

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction The resistance encountered when passively moving a patient's limb is generally smaller than that of a sputum, but it has nothing to do with the length of the muscle at that time, ie, the contraction morphology. There is no difference between the extensor and the flexor. Regardless of the speed, amplitude, and direction of the action, the same resistance is encountered. This increase in muscle tone is called lead-like tonic, such as alternating loose and tight changes due to tremor, called gear-like rigidity. Increased tonic muscle tone is seen in some extrapyramidal lesions with special tension changes, which are selective for increased muscle tone. The upper limbs are mainly adductor, flexor and pronator, and the lower extremities are superior to extensor muscle tension.

Cause

Cause

Seen in some extrapyramidal lesions, the special tension changes, the muscle tension is increased and selective, the upper limbs are mainly adductor, flexor and pronator, and the lower extremities are superior to the extensor muscles.

1. Parkinson's disease: The increase in muscle tone caused by this disease is called stiff muscle. The tension of the agonist muscle and the antagonist muscle are increased. When the joint is passively moved, the increased muscle tension is always consistent, and the uniform resistance is felt and the "lead tube-like rigidity" is present. If the patient has tremor, the limb is flexed and stretched. When you feel the uniform resistance, there is an intermittent pause, such as the gear is rotating, that is: "the gear is strong." Facial expression muscle muscle stiffness is an expressionless "mask face", swallowing muscle muscle stiffness can not be swallowed and swallowed well, eye muscle muscle rigidity shows eye movement slowed, there is a viscous phenomenon of gaze movement. The neck muscles and the trunk muscles are stiffened to form a flexion state, that is, the head and torso are forward, the upper muscles are slightly externally rotated, the elbow joint is flexed, the metacarpophalangeal joint is flexed, the thumb is adducted, the lower limbs are slightly adducted, and the knee is flexed. The neck and the spine move slowly.

2. Huntington's disease: Muscle tone is mostly normal, but a few patients have Porkson's disease-like muscle stiffness, and the dance symptoms are mostly or completely absent. This type is finally posture dystonia, upper limb flexion, and both lower limbs straight. This chronic, progressive dance symptom of muscle stiffness is thought to be the result of globus pallidal damage.

3. Torsion spasm: Also known as deformity dystonia (dystonia musculorum defoumans) is a torso of the trunk, a rare basal ganglia lesion. Clinically, it is characterized by increased muscle tone and severe involuntary torsion of the limbs and even the whole body. Muscle tone increases when the limb is twisted, and normal when the twist stops.

4. Drug-induced muscle tone abnormalities:

(1) acute dystonia (acute dystonia): acute onset, appear shortly after medication, more common in young people, characterized by strange tendons. Mainly the neck and head muscles are involved, the most common is the involuntary paralysis of the tongue and oral muscles, so that the masticatory muscles contract tightly, the mouth does not open, speech, difficulty swallowing, facial eccentricity, or accompanied by spasmodic torticollis This response is related to the sensitivity of the individual and is effective with anti-shock palsy, antihistamines or barbiturates.

(2) tardive dykinesia: slow onset, occurring after several weeks, months or years of taking neuroleptics, even after stopping the drug. It is characterized by a rigid, repetitive lip, involuntary movement of the tongue, sometimes accompanied by a dance-like movement of the limb or trunk, and a body-axis movement. The use of anti-shock palsy drugs is not only ineffective, but sometimes worsens the symptoms. It may also have low muscle tone and paralysis. It may involve the neck muscles, the lumbar muscles, etc., such as the waist can not straight up, the bulge, the neck is soft, can not look up, can not walk when walking, can not lift the legs, heel dragging the ground .

Muscle tone measurement: Children with young age often do the following tests:

1 Hardness: When the muscle tension is increased, the muscle hardness is increased, and the passive activity is a feeling of tightness and firmness. When the muscle tension is low, the muscles that are touched are soft, and when passive, there is no resistance.

2 Swing degree: Fix the proximal end of the limb, make the distal joint and limb swing, observe the swing amplitude, the swing is small when the muscle tension is increased, the resistance is low when the muscle tension is low, and the swing is large.

3 joint extension: observe the extension and flexion angle when passively flexing and flexing the joint. When the muscle tension is elevated, the joint extension and flexion are limited, and when the muscle tension is low, the joint is overextended.

Examine

an examination

Related inspection

Muscle tone test

Increased tonic muscle tone is seen in some extrapyramidal lesions with special tension changes, which are selective for increased muscle tone. The upper limbs are mainly adductor, flexor and pronator, and the lower extremities are superior to extensor muscle tension. The resistance encountered when passively moving a patient's limb is generally smaller than that of a sputum, but it has nothing to do with the length of the muscle at that time, ie, the contraction morphology. There is no difference between the extensor and the flexor. Regardless of the speed, amplitude, and direction of the action, the same resistance is encountered. This increase in muscle tone is called lead tube-like rigidity.

Older children can also use the modified Ashworth assessment:

Grade 0 has no increase in muscle tone.

Grade I muscle tension is slightly increased, and when the affected part is passively flexed, there is minimal resistance or sudden jamming and release at the end of the ROM.

I+ grade muscle tension increased slightly, suddenly caught within 50% of the ROM, and then showed minimal resistance in the last 50% ROM.

Grade II muscle tension increased significantly, and most of the muscle tension through ROM increased significantly, but the affected part could still be moved more easily.

Grade III muscle tension is severely increased and passive exercise is difficult.

Grade IV stiffness, the affected part of the passive flexion is stiff and unable to move.

Diagnosis

Differential diagnosis

Differential diagnosis of ankylosing muscle tone:

1. Congenital myogenicity (congenital paramyotonia): also known as Eulenberg disease. The disease only shows an increase in muscle tone during exercise and a normal muscle tension at rest. The muscle tension of this disease is increased, and the muscle tonic contraction is seen at the beginning of exercise, and it returns to normal after repeated exercise. At the time of palpation, the muscles have a special toughness, which is hard like a rubbery skin. It is obvious when the muscles are contracted after mechanical stimulation.

2. Stiff mandy syndrome (stiffmansyndrome): an epileptic seizure with unknown etiology. The muscle tension of the neck muscles, trunk, back bones, and abdominal muscles is obvious, and the pain is stimulated by the outside world. Sniper, sound and light, mental stress, etc. can be induced and aggravated. The common proximal extremities begin to develop toward the body, and the muscle strength and tendon reflexes are normal. The symptoms of stiffness disappear during sleep.

3. Tetany: Low blood calcium is the main cause of this disease. Increased muscle tone is mainly seen in the distal extremities, and even spread to the trunk. Some scholars divide the hand, foot and ankle syndrome into three types:

(1) benign type: mainly occurs in the distal extremity of the toe, the thumb is strongly adducted and semi-flexible, and the other fingers are close together, the middle finger of the finger is flexed obviously, and the lateral edge of the hand is close to the lateral edge. Sometimes the end finger is more pronounced than other fingers, and the last finger is often folded under the rest of the finger, or the thumb is folded into the glove, which is called the "midwife hand". The lower limbs are toe flexion, which is a horseshoe inversion, the calf is straight, free to move, and there is a sense of impedance during passive movement.

(2) Moderate type: early upper limbs first appear muscle tension, muscle rigidity, break to the trunk, facial muscles and lower limbs, sometimes the rectus abdominis, sternocleangepsis, pectoralis major muscles can be strong and straight. When the facial muscles appear to be myotonic, they have a special face: extraocular oblique or internal oblique, closed jaw, tongue stiff, poorly structured, difficult to swallow, such as dyspnea and asphyxia when the larynx is sore.

(3) Severe type: repeated episodes in a short period of time, showing generalized muscle rigidity, accompanied by laryngeal spasm.

4. Myogenic lesions: Although muscle disorders may have increased muscle tone, but the tendon reflexes are normal or reduced, and there is no hyperreflexia.

5. Increased muscle tension: The tension in the static state of muscle relaxation is called muscle tension. Muscle tone is the basis for maintaining various postures and normal movements of the body and is manifested in various forms. When passively moving a patient's joint, a sense of impedance occurs in the case of increased muscle tone, which is related to the speed of being exercised. When the muscles in the shortened state are quickly drawn, they immediately cause contraction and feel paralyzed state. When the force is stretched to a certain extent, the resistance suddenly disappears, that is, the so-called knives-like muscle tension is increased. Increased spastic muscle tension is not related to "sputum", which refers to an involuntary muscle contraction.

Other differential diagnosis