sitting here with my hands in my hear. I have a patient (good for me, I would say :) ) and she has problems with strenghten her muscles. What I mean is when I give her excersises she can built up her force but when she stops her excersises for one week (even just a few days is enough) she loose everything, she really have to start again from zero (meaning musle vibration by doing her excersise). Also the same for doing sport activity. Some of the excersises she do allready 1 year.
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I have asked for a bloodanalysis but everything was OK.
Hoping for someone who can help me out.
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Re: Inability to maintain musle strength
My first reaction would be some sort of metabolic myopathy or something like that, but they generally can get stronger in the first place.
Everyone loose muscle strength when not maintaining it. The average amount lost over a certain time period would be on a bell shaped curce --- maybe your patient is just at one end of that bell shaped curve. Nothing abnormal, but maybe a couple of standard deviation away from the mean ???
(BTW - have you still got that photo that the wife is not supposed to see :eek::eek::eek: ) -
Re: Inability to maintain musle strength
Kerstin:
You first have to determine what this problem with this woman's muscle strength is from. Is it congenital, metabolic, neurological, poor diet, or simply because she is not doing the exercises correctly or as much as she says she is. How severe is her weakness, or is it more that she wants to be stronger but isn't making progress as rapidly as she expects?
Or maybe she just likes to watch you showing her how to do the exercises every office visit.:confused:;) -
Re: Inability to maintain musle strength
Kerstin:
You first have to determine what the problem with this woman's muscle strength is from. Is it congenital, metabolic, neurological, nutritional, psychological, or simply because she is not doing the exercises correctly or as much as she says she is. How severe is her weakness, or is it more that she wants to be stronger but isn't making progress as rapidly as she expects?
Or maybe she just likes to watch you showing her how to do the exercises every office visit.:confused:;) -
Hello Craig and Kevin,
aha, can think about that, yes she is a great patiënt ;-).
Serious, I follow her for more then a year. She came with knee pain bilateral (chondromalacie +, patella tendon+, pes anserinus pain), sorness pain lateral right feet, lumbar and cervical pain. She is 39 years old, weight 57kg. and lenght 1m.71. She underwent a surgery when she was 18 years old (transposition of the tuberositas tibia right) and after that she got sudec atrofie (duration 15 months).
Bloodanalysis: normal. EMG: interruption as well as lumbar as cervical (don't have the exact details here).
I have give her excersise for her back and knee (and orthotics for asymmetry), and I know for sure that she do them every day 30 min. But she feels when she don't do them that her strenght goes very fast downward (after two day it is hard to do her excersise).
Note: she had a knee trauma and she had to rest for one week and some excersise were very very difficult (every excersise was difficult) she couldn't left her leg without vibration, it is for sure not normal. Every day she go to her work by bicycle (6 km.) and it is just the same after the weekend, her work is much further away (by speaking).
Could it be just neurological?? But why didn't do the specialist who have done the EMG notting?? Or can it be hormonal?? HELP
Yes Craigh I have the "not accessible for publication" picture (whistle smilley :)) )
Thanks,
kerstin -
Maybe a neuro consult for your patient is warranted to rule things out.
Another option is to get her onto a physio who is using vibration platforms. They seem to affect muscle strength in a different kind of way. Check this thread and the couple linked from it (I tried it whne I could not strengthen my quads post op and it workd wonders).Last edited: Sep 30, 2007 -
Yes I promise I will send him as quick as I can (just have so much on my head right now).
Yes, I thought that too, that a neuro would sort that out but no, so??? Yes, solution a surgery for a hernia but that is not the problem. I forgot to mention that her uterus is removed too, so therefor my thought of hormonal??
Maybe I can try a physio because I am sure that muscle strenght is important to get her painfree. But I am sure that there is more going on because it is not just one muscle group.
Thanks,
Kerstin -
My first thought is myasthenia gravis
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This is a good idea, Steve. I think Kerstin should pursue this idea since myasthenia gravis most commonly affects young women. However, the droopy eyelids (ptosis) are generally the first thing that one notices in these patients which I don't remember her mentioning. Kerstin.....are there any other signs/symptoms of myasthenia gravis in this patient? http://womenshealth.gov/faq/mgravis.htm -
Here is my lecture notes on MG
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The first of these that I had seen was a young man, an instructor at my local health club - about 25 years ago! Knowing I was a doctor he complained to me of becoming weaker and weaker - although physically he looked as pumped as ever. I do not recall that he had any other complaints or physical signs that were obvious to me in casual conversations with him.
After three or four weeks of this "complaining" I persuaded him to see his primary care physician who, after some lengthy work up, finally Dx MG. He responded to treatment.
As far as our present "case" - feeling weak between work outs or not improving strength wise with continued workouts is certainly not, in itself, a "symptom". This purported weakness has not been quantitated; so we'd have to take her word for it.
We have all have patients who state they work out "hours" per day and can't lose weight! Well, what can you say? No you don’t? You eat more than you burn? You’re work outs are not intense enough? An hour on a bike isn’t going to make it for you? There are many many intangibles at work.
The patient in this discussion may be mal nurished or have some type of mal absorptive syndrome. Perhaps she doesn't work out properly in order to gain "strength" or is one of those who needs more time to recover than normal. Perhaps she expects too much or is just a poor historian.
It's tough to say.....
but...
"all things being equal" - if in fact her case presentation can be taken as factual, MG may be a possible cause.
Have fun..I'm headed out for a drink with my lady!
Steve -
Thanks for helping me out!
But no she don't have any of this symptoms. When she rest it is getting worser, she needs her excersise, she feels when she don't do them that her pain increase and her muscles force goes very quick downward. She even don't get them as strong we want them to be (this is not qauntitative been measured). And believe me she do her excersise every day (30 min. in the morning and 30 min. in the evening, have rechecked it) plus bicycling and swimming (3 times a week).
Patients story: she went for bicycling with her girl friend who never sit on her bicycle and she had it very difficult to follow her (especially when there is resistance, like a hill). And yes indeed I believe her and I take her on her word, because I follow her for more then a year and in the first stage I was thinking the same, it can't be she don't do them right, or not enough or... but I couldn't ignore it, it was really a fact when she couldn't do the excersise for several reasons (even a few days), the story came back, so???
And she don't have psychological problems, she is a very possitive person, even she is never without pain.
Best regards,
Kerstin -
http://www.cerebralpalsysource.com/Types_of_CP/ataxic_cp/index.html .
Test the reflexes, ask about early baby/childhood milestones. Try searching for myopathies. If blood test is negative, perhaps link up with a physio involved in paediatric assessment.Sometimes if mild , these conditions are not detected in early childhood. -
perform a neurologic exam including dtr's,vibratory exam,temperature,muscle tone/strength exam,balance/toe/heel walking,monofilament protective sensation test,muscle/nerve biopsy,clonus exam,plantar stroking of foot,consult with a neurologist.
dlbdpm@yahoo.com -
Press Release; 26 October 2007:
Heavy drinkers face increased muscle weakness: study
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