DOC WHAT ARE OCCUPATIONAL MUSCULOSKELETAL DISORDERS?

Collage of several of Gray's muscle pictures, by Mikael Häggström (User:Mikael Häggström) (Photo credit: Wikipedia)

Occupational Musculoskeletal Disorders

An occupational Musculoskeletal Disorder is a condition with muscle and skeletal pain and aches with numbness and limited movement which occur frequently in the life of a worker. It is no different from the musculoskeletal pains which occurs in many housewives or people in ordinary life who do not work in factories or offices and look after children and elderly.

The Musculoskeletal disorders occur during repetitive work and are called strain injury or cumulative trauma disorders.

Predisposing Factors are:
1.awkward or static postures
2.repetitive motion
3.carrying of excessive loads
4.forceful movements of the limbs and body
5.overhead work procedures.
6.twisting movements of the wrist or hands

What are the Signs and symptoms of Musculoskeletal disorders?
The appearance of occupational Musculoskeletal disorder may vary from mild presentation of aches and pain to the more severe presentation of disability and weakness of muscles.

1.aches and stiffness of muscles in the neck and interscapular region
2.pain in the shoulder on abduction, elbow and arms on extension or flexion.
3.nerve compression may give rise to numbness, tingling sensation, paresthesia and reduced sensitivity of the fingers and thumb of the hand
4.weakness and wasting of muscles of the hand and fingers such as weakness of hand grasp and thumb pinch or clumsiness of the hand.
5.stiffness and clicking of the finger on extension
6.fingers locked in flexion or extension
7.localized nodule at the base of palmar area of the fingers
8.localized tenderness over the elbow (lateral epicondyle) or wrist (radial styloid)
9.low back pain worse on flexion or extension with sciatica (compression of sciatic nerve due to prolapsed intervertebral disc) down the legs
10.difficulty in sleeping because of pain

Diagnostic Criteria of Work relatedness:
A good occupational history of worker exposure to the trauma or workload is important in diagnosis of an occupational Musculoskeletal Disorders.
He or she must exposed to the work activity such as:
1.poor posture during work (ergometric furniture are important in preventing this)
2.change in work process or practice such handling of excessive loads may aggravate or precipitate the symptoms
3.Overhead work and over reaching may cause strain on the shoulder and neck
4.repetitive movement tend to strain muscles and tendons
5.time relationship of symptoms with work periods(usually there is improvement when resting or on leave from work)
6.The duration of the symptoms must be for at least 1 month and affect the activities of the person’s daily life.

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DOC I HAVE GAS
GANGRENE

What is Gas Gangrene?

Gas Gangrene is a toxic rapidly progressive clostridial infection causing muscle necrosis.

What is the cause of Gas Gangrene?

The known cause is the clostridium perfringens bacteria which are spore forming, anaerobic, gram positive bacilli.Rarely it also can be caused by Group A streptococcus, Staphylococcus aureus and Vibrio vulnificus. 

It normally live a saprophytic existence in intestinal tract of humans and animals and in soil.

There are 4 reasons which predispose to muscle invasion by the bacilli and exotoxin production:
1.impaired local blood supply
2.metallic bodies, clothing or dirt in wound
3.presence of necrotic tissue and hemorrhage
4.growth of aerobic germs in wound or uterine cavity

Under these conditions, the bacilli multiply anaerobically. As the bacteria grows it produces gas in body tissues and releases toxins which can damage tissues .
Toxins diffuse to surrounding muscle and causes tissue death, damage to blood cells and blood vessels resulting in gangrene.

What are the symptoms of Gas Gangrene

The symptoms are:

1. inflammation of the tissue at the site of infection-pale skin color, later becoming dusky and changing to dark red or purple

2.very painful tissue swelling

3.The edges of the infected area expand so quickly that destruction of the involved tissue  can be seen over a few minutes.

4.Air can be felt under the skin

5.Blisters filled with brown-red fluid

6.foul-smelling brown-red or bloody fluid

7.Increased heart rate

8.Moderate fever

9.sweating

10.jaundice

If the condition is not treated, the person can develop shock with decreased blood pressure (hypotension), kidney failure, coma, and finally death.

Prevention of gas gangrene:

1.Always clean the wound thoroughly with hydrogen peroxide

2. watch for signs of infection such as redness, pain or swelling around a wound

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DOC I HAVE DUCHENNE MUSCULAR DYSTROPHY

What is Duchenne muscular dystrophy?

Duchenne muscular dystrophy is a genetic disease which causes rapid weakness and wasting of muscles.

What is the cause of Duchenne muscular dystrophy?

Duchenne muscular dystrophy is believed to occur as a result of a defective gene for dystrophin (a protein in the muscles).

In Duchenne muscular dystrophy males are more likely to develop symptoms than are women.

Inheritance is usually sex-linked and recessive. The sons of women who are carriers of the disease have a 50% chance of having the disease while the daughters have a 50% chance of being carriers.

Duchenne muscular dystrophy occurs in 0.3 per cent of male infants in the population.

What are the symptoms of Duchenne muscular dystrophy?

Symptoms may appear as early as infancy and include:

1.Fatigue
2.Muscle weakness which is worse in the legs

3.waddling gait

4.use of hands to raise self from floor
4.Difficulty in running, jumping
5.Frequent falling

6,climbing stairs difficult

7.Pseudohypertrophy of the infraspinatus, deltoids , triceps and calf muscles

8.Atrophy of muscles occurs with contractures and deformity

9.Progressive difficulty in walking with ability to walk lost by 12 years of age
10.Most patients at age 12 are confined to a wheelchair.

Signs :

A complete physical examination may show:

1.Abnormal heart muscle (cardiomyopathy)
2.Congestive heart failure
3.Deformities of the chest and back (scoliosis)
4.Enlarged calf muscles which are later replaced by fat and connective tissue (pseudohypertrophy)
5.Loss of muscle mass (wasting)
6.Muscle deformities in the heels and legs
7.Respiratory difficulty due to weakness of lung muscles

Investigations:

1.Electromyography (EMG)
2.Genetic tests
3.Muscle biopsy

What is the Treatment of Duchenne muscular dystrophy?

Treatment of Duchenne muscular dystrophy are usually symptomatic to improve the quality of life as there is no cure for the disease.

Gene therapy may be able to cure by removing the defective gene in the future.

1.Physical activity is helpful to maintain muscle strength and function.
Inactivity may worsen the muscle disease.

2.massage and electrical stimulation of muscles
2.Orthopedic appliances (such as braces and wheelchairs) may increase the ability for self help.

What is the prognosis of Duchenne muscular dystrophy?

Duchenne muscular dystrophy usually leads to rapidly worsening muscular condition.
Death can occurs by age 25 typically from respiratory conditions such as pneumonia.

What are the complications of Duchenne muscular dystrophy?

1.heart disease such as cardiopathy and heart failure
2.muscle deformities such as scoliosis
3.mental impairment which is rare
4.permanent, progressive disability
5.pneumonia or other respiratory infections
6.death from respiratory failure

What is the preventive measures of Duchenne muscular dystrophy?

Duchenne muscular dystrophy can be detected with about 95% accuracy by genetic studies performed during pregnancy.
Genetic couseling will therefore be a great help to prevent the disease.

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