DISEASES OF THE ORGANS OF MOTION (JOINTS AND MUSCLES) : MYALGIA, MYOSITIS, POLYMYOSITIS (ACUTE FEBRILE ILLNESS, MYOSITIS, POLIMYOSITIS) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Myopathies are caused by different etiological factors. The main ones are infections, rheumatism, disorders of metabolism, defects in performance of the movements, and so on, most of the diseases of the muscles are forms derived from a disorder reduction function. The normal sequence of the contractile process is disturbed under the influence of various exogenous and endogenous factors. This includes primarily due to number of reasons violation of gross motor skills, impaired working movements, congenital and acquired deformation (extension ribs, scoliosis, kyphoscoliosis, flat), effects of operations and inflammatory processes involving robovie by collapsing, acute infections (especially influenza), chronic infections (tuberculosis, syphilis), diseases of metabolism (especially gout and diabetes), disorders of the endocrine glands and violations of the autonomic nervous system.
The resulting disorder of the function of muscles can refer both to the individual fascicles within the muscle (fastsikulyarny discoordinated, microdiscovery determined by touch), and the individual muscles and muscle groups (microdiscovery, visible to the eye). C. S. Marx distinguishes between:
1) simple coordinatory miopatoz impaired coordination between agonists, antagonists and synergists;
2) fastsikulyarny miopatoz impaired coordination not only of the whole muscle, but also bundles of fibers within the muscle.
These two forms have a common etiology and one into the other. Observe them in their pure form have very rarely.
The acute period in most cases. The manifestation of the disease is preceded by precursors fatigue and slight pain, sense information, fleeting spasm, weakness, fingers, hand, forearm during operation, a feeling of heaviness of the limbs. Often patients complain of numbness at night and in the morning, stupid, lomadia pain of an impermanent nature, sometimes unstable shaking limbs. In severe cases the patient is unable to perform certain workers movement. More severe symptoms appear suddenly after a hard work or any disease: increased muscle pain, pressing them increase this pain, which often radiates in different places. Localization of pain is often changing, as the contractile disorders can appear and disappear in different muscles. Localization of pain corresponds to finding fastsikulyarny changes. The disappearance of pain for the most part connected with the disappearance of these changes. * Palpation of muscles detects their overall tension, density, sometimes, on the contrary, dullness, sagging or uneven texture, some spasm of muscle bundles (hypertonus), creating a wavy or bumpy feel the texture of the muscle. Such hypertonus occur in the forearm (long instep and this hands and fingers), deltoid, trapezius, calf, and gluteal muscles. Often contractile changes are located symmetrically on both sides, but they are more pronounced in the muscles involved in the working movements; meet in the Central parts of the muscles, but is especially pronounced in joints muscles tendons at higher voltage.
The final stage fastsikulyarny myomatosis most part is myofascial - layering of the inflammatory process in the muscle fastsikulyarny changes. Myofasical distinguish infectious (acute and chronic) and intoxication (on the basis of gout, diabetes, changes in the endocrine glands, and so on). In these cases, painful process manifests itself first of all in the muscles, are most interested in working movements, but then extends to all muscles of the body. When the process associated with influenza infection, it gets a creeping nature extends to the intermuscular connective tissue layer, ligaments, fascia, tendons swell and razryhlyaya. Tendon movements produce a characteristic crunch, often mistaken for a crunch in joints. Periosteum in places of transition in her tendon is irritated and palpation (with deep survey) felt rough, swollen, painful. Such painful swelling and roughness are most often found on the surface of the clavicles, the styloid processes of the ulnar and radial bones, crests of the iliac bones. With a deep feeling of the spine from all sides (ligaments and small muscles, their attachments) felt thickening in the form of nodules, plaques or diffuse roughness. All this is very painful and difficult movement of the spine. When these tissue changes are localized around the joints, the latter severely painful, sometimes priuchayut, the amount of movement in them is limited. These cases of influenza-like periarthritis easily mixed with infectious arthritis. Soon after the beginning of the pain they are joined by periodically increasing the sensation of numbness, crawling. Affects primarily the muscles of the shoulder girdle and the pelvic girdle and legs, neck and back. In the future, the process often goes on the muscles of the chest, abdomen, head and face. With the spread of the inflammatory process on a particular group of muscles is decreased range of motion, reduced their power.
When differential diagnosis fastsikulyarny myomatosis and infectious myofascial need to be aware of diseases of the nervous system (radiculitis, neuritis, plexitis, neuralgia, diseases of the joints (polyarthritis), and the number of internal diseases accompanied by pain. We must remember that miopatoz and myofascial in most cases of the disease of the whole muscular system, and therefore at pains of unknown origin, when you think about the diseases of internal organs (heart, liver, kidney, female reproductive organs, Appendix, and so on), it is necessary to examine the muscles of the appropriate areas and then often a difficult diagnosis becomes simple and clear. The difference myomatosis and myofascial from neuritis, plexitis and radiculitis is based on the presence in the latter cases, changes in skin sensitivity, trophic, reflexes and spinal fluid. The same symptom pain on pressure and tension occurs when lesions as peripheral nerves and muscles. When moatzah muscle ache from the pressure and tension as well as nerves. Pain when pressure exerted on the nerve plexus (e.g., shoulder) or nerve (e.g. sciatica) may refer to the subcutaneous tissue, the skin, the aponeurosis of the muscle. If the affected muscles, pain when pressure starts much earlier than the finger has reached the nerve plexus or nerve trunk. For a correct differential diagnosis in such cases must be based on thorough research, on the one hand, the nervous system, and on the other muscles of this region both at rest and in motion. Joint diseases diferenciada on the history, current, permanent limitation of motion, atrophy of muscles, swelling, the crunch, the data of x-ray examinations, tactile study of the muscles of the joints and the entire musculoskeletal system and character movements.
Prediction with proper and systematic treatment is favorable.
Major preventive factor is culture movements. The basis of properly organized movement is rhythm, as the physiological ability, inherent in the muscular system. In the basis of appropriate education movement is the law of consistency of abbreviations and stress agonists, antagonists and synergists. When teaching proper movement must develop the ability to think, to feel and then to agree on the degree of tension and muscle tone, directly performing the work, as well as the muscles that facilitate this work.
The treatment includes massage and application of physical agents. The technique sensual massage: the feeling, konturirovany movable elements of the affected muscle, stretching, pressure, which is dosed differently each time, depending on the consistency, configuration, location feel in the muscle changes. Treatment 30 - 40 massages. During the course marked reaction amplification of pain: first, on 5 - 6th session, second by 30 - 35-m session. From physical agents in the first place in terms of reduction of pain is the use of ultraviolet irradiation of the affected muscles. The irradiation is effected areas. Single dose of erythema, the course of treatment 4 to 5 exposures for each segment. Heat is applied in the form of baths, steam showers, mud applications, paraffin. Less favourable operating dry heat (Solux). Galvanization is contraindicated because it increases the tone of the already strained muscle bundles. A definite therapeutic effect is observed when monohalobenzene histamine. In all cases of violation of the contractile function of muscles is an important part of complex therapy is a special culture movements. When gouty myofascial, in addition to the described methods of treatment, recommended warm, saline-alkaline, hydrogen sulfide, radon baths, medication (see Diseases of metabolism, Gout), diet therapy. In endocrine myofasciitis in addition to massage and treatment movements shown organotherapy (see Diseases of the endocrine glands),