abnormal muscle tone
Introduction
Introduction to abnormal muscle tone Dystonia is a group of symptoms of repetitive involuntary movements and abnormal torsional postures caused by the incompatibility of the synergistic and antagonistic muscles of the skeletal muscles of the body, intermittent intermittent contraction. Therefore, it is also called dystonicsyndrome. The tension change of this disease is not noticed, but the abnormal posture posture and involuntary transformation action are noticeable. It has torsional properties, including chest or waist or torsion of the neck or torso, overextension or overflexion of the foot. This abnormal posture posture often changes involuntarily and slowly. It can be fixed in one position for a while, then it becomes another abnormal posture, and it repeats intermittently. All disappeared after sleep, and twisting and spasmodic torticollis are only two clinical types of dystonia. basic knowledge The proportion of illness: 0.002%-0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: spastic torticollis
Cause
Abnormal cause of muscle tone
Abnormal muscle tone (30%):
It is a group of symptoms of repeated involuntary movements and abnormal torsional postures caused by the incompatibility of the synergistic muscles and antagonistic muscles of the skeletal muscles of the body. Therefore, it is also called abnormal muscle tone syndrome. The tension change of this disease is not noticed, but the abnormal posture posture and involuntary transformation action are noticeable. It has torsional properties, including chest and waist and/or upper limb torsion, over-extension or over-curvature of the neck and/or torso.
Spasmodic torticollis (30%):
Occurs at any age, but is most common in adults. Men and women are equally affected. The onset is very slow. The deep and shallow muscles of the neck can be affected, but the contraction of the sternocleidomastoid muscle, trapezius muscle, scalene muscle and cervical muscle is most likely to show symptoms. When one side of the sternocleidomast muscle contracts, it causes the head to rotate to the opposite side. When the sternocleidomastoid muscles on both sides contract simultaneously, the head flexes forward. When both sides of the trapezius and neck muscles contract simultaneously, the head is stretched backwards.
Symptomatic muscle tone abnormalities (30%):
Metabolic disorders, degeneration, inflammation, tumors, etc. can cause symptomatic muscle tone abnormalities. There are only a few neuropathological studies in this disease, and there is no firm conclusion.
Prevention
Abnormal muscle tension prevention
For patients with abnormal primary dystonia, because the cause is unknown, and considering genetic factors, there is no effective preventive measure for this disease. For patients with symptomatic dystonia, it is necessary to actively treat primary diseases, such as Metabolic disorders, degeneration, inflammation, tumors, etc.
Complication
Abnormal muscle tone complications Complications spastic tortuosity
Abnormal muscle tone can cause spastic torticollis and torsion spasm. If not treated in time, the secondary complications include the following:
(1) radiculopathy.
(2) Muscle hypertrophy.
(3) difficulty in swallowing.
Symptom
Symptoms of abnormal muscle tone Common symptoms Localized dystonia, muscle tension, extrapyramidal damage, torsion, small writing, head tremor, torsion, involuntary movement, spastic torticollis, child dystonia
Typical muscle tension abnormalities such as torsion spasm, spasmodic torticollis, etc. are not difficult to diagnose, but must be distinguished from various muscle tone abnormalities caused by various causes.
Abnormal muscle tone is divided into children's type (before 12 years old), juvenile type (13 to 20 years old) and adult type (after 20 years old). The adult type dystonia is often limited, and the condition is not progressively aggravated. Such as spastic torticollis, children and juvenile type of disease progressively worsened, the lower limbs first involved, and then spread to the whole body, such as twisting sputum.
(1) Spasmodic torticollis occurs at any age, but it is most common in adults. The same is true for men and women. The onset is very slow. The deep and shallow muscles of the neck can be affected, but the breast is locked. The contraction of the spur, trapezius, scalene, and cervical muscles is most likely to show symptoms. When one side of the sternocleidomast muscle contracts, it causes the head to rotate to the opposite side. When the sternocleidomastoid muscles contract at the same time, the head is contracted. The front flexes forward. When both sides of the trapezius and neck muscles contract at the same time, the head is stretched backwards. The muscles can be hypertrophied. When the patient tries to maintain the head position, most of the head tremors.
(2) torsion sparsm (torsion spasm) Most of the slow onset of 5 to 15 years old, the first symptoms are mostly mild dyskinesia of one lower limb, the foot is varus and variegated, the heel can not touch the ground while walking, slowly and continuously Autonomic torsional exercise is the most serious of the trunk and the proximal end of the limb, causing lordosis and pelvic tilt. When the involuntary movement involves the neck and the scapular muscle, the torso-neck affects the facial muscles and the throat muscles, causing hemifacial spasm and Difficulties in articulation, reversal of sputum aggravated during spontaneous exercise or mental stress, disappeared completely after falling asleep, muscle tension increased during torsional movement, and turned to normal or decreased after torsional movement stopped. Recessive hereditary torsion was progressive. Development, poor prognosis, more than a few years after the onset of death, but some patients can not progress for a long time, and even can relieve themselves.
Examine
Examination of abnormal muscle tone
The diagnosis of this disease is not difficult, only need to use auxiliary examination when eliminating the cause and other diseases.
(1) Physical examination: There are sputum in the neck muscles, especially the synergistic muscles (a group of muscles that cause the "slanted neck" together). There is a synchronous sputum phenomenon. The patient can repeat the movement of the torticollis to determine the extent of the affected muscles. The type of neck.
(2) In the auxiliary examination, the electromyogram shows the muscles of the primary and secondary tendons. The CT of the neck can show the affected muscles and hypertrophy. The brain CT of some patients is abnormal. Most of the patients have normal functions and no abnormalities. Neck-related pathological changes.
Diagnosis
Diagnosis and diagnosis of abnormal muscle tone
diagnosis
The diagnosis of this disease is not difficult, only need to use auxiliary examination when eliminating the cause and other diseases.
Differential diagnosis
The disease needs to be distinguished from a disease in which the muscle tension is simply increased or decreased:
First, the muscle tension is reduced
(a) myogenic disease
1. progressive muscular dystrophy: is a group of acute muscle diseases caused by genetic factors, characterized by the weakness and atrophy of progressive and exacerbated skeletal muscle of varying degrees and distribution, and the reduction of muscle tone and muscle Atrophy parallel, often accompanied by decreased muscle tone in the muscle atrophy, due to muscle atrophy, weakness and decreased muscle tone, clinical manifestations of standing and walking special posture, standing anterior and anterior curvature of the lumbar spine when standing, "duck step" "This is due to the reduction of muscle tension and atrophy near the spine, pelvic muscle damage caused by poor pelvic fixation, atrophy of the anterior saw, weak force and reduced tension. When the standing and sitting position, the shoulder blade is displaced to the outside, and the thoracic and spine are separated. With a winged shoulder, the examiner can penetrate the finger between the shoulder blade and the sternum, which is the trapezius muscle, and the muscle tension of the rhomboid muscle is reduced.
2. Myopathy is also associated with muscle atrophy in muscle atrophy, and is associated with muscle atrophy. Laboratory tests are helpful for diagnosis. For example, polymyositis can increase serum CPK and immunoglobulin in the acute phase, in urine. Muscle protein appears, creatine increases, and electromyography can show fibrillation and increased insertion activity.
(two) neurogenic diseases
1. Peripheral neuropathy: The muscle atrophy of polyneuritis is mainly distributed in the distal end of the limb, and has an equal relationship with the decrease of muscle tension. Because the muscle tension reduces the wrist joint, the movement of the finger and the ankle joint increases, and it is overextended and flexed. Abnormal posture, according to the etiology of polyneuritis, the injured muscle also has a choice, such as alcohol-toxic polyneuritis, tibialis anterior muscle paralysis is the most obvious, muscle tension is also the most prominent, it is often manifested as foot drop.
Mononeruopathy is mainly caused by trauma, ischemia, infiltration, physical damage, etc. When the ulnar nerve of the upper extremity and the median nerve damage are obvious, the tension of the flexor muscles of the upper limb is significantly reduced, and the tension of the extensor muscles of the upper extremities (antagonistic muscle) Advantages, thus mastering dorsiflexion, high flexion of the tibial nerve, due to triceps tendon and tension reduction, the elbow joint can not be stretched and the wrist sign, and the forearm is half-spinned due to weak flexor muscle strength and reduced tension. The anterior position cannot flex the elbow joint.
2. Posterior root posterior cord lesions: the posterior root of the spinal cord and the reduction of muscle tone in the posterior cord lesion are one of the prominent symptoms. The side of the spinal cord (tabes dorsalis) is characterized by a decrease in resting muscle tone, accompanied by posture and exercise. The muscle tension is abnormal. When the patient is supine, the tibia can even be attached to the bed. When standing, the knee joint has low tension. The knee joint can not be fixed and the "anti-tensional knee" appears. The lower limb muscle tension is lower than that of the upper limb.
3. Spinal cord disease
1 amgotrophic lateral sclerosis: more common after 40 years of age, spinal cord anterior horn cells (and brainstem motor nucleus) and pyramidal tract are involved, so there are characteristics of upper and lower motor neuron damage coexist The upper limbs have muscle atrophy, weakness, fasciculation and hyperreflexia. When the anterior horn cells of the neck enlargement are severely damaged, the symptoms of pyramidal tract are masked. At this time, muscle atrophy occurs in the upper limbs, muscle tone decreases, and tendon reflexes decrease or disappear. When moving passively, the amplitude of the limb increases.
2Charcot-Marie-Tooth's disease: Early muscle atrophy occurs in the lower third of the thigh, and late muscle atrophy can be extended to the lower third of the forearm of the upper limb, bilaterally symmetric, with muscle tension reduced in the muscle atrophy.
3 acute spinal anterior keratitis: the muscle tension in the muscle atrophy is reduced, because the range of acute spinal anterior horn keratitis and muscle atrophy is small, so the atrophic antagonistic muscle preservation, and its muscle tension predominates, so often accompanied Abnormal position, such as clubfoot, foot drop, etc., the passive movement of the affected limb increases, showing an excessive flexion and extension posture.
4. Cerebellar disorders: Reduced muscle tone is a common symptom of cerebellar lesions. Due to the reduction of muscle tone, the posture of the limb is abnormal. For example, if the muscle is overextended and flexed, the muscle tension is low except at rest, and it is also visible during passive exercise. To the obvious reduction of muscle tension, the main movement begins and ends slowly, consciously weak, easy to fatigue, due to the reduction of muscle tension, tendon reflexes are also reduced or disappeared, can be seen in the bell-swing-like reflex, also due to muscle tension reduction and antagonistic muscle function Insufficient and there is a "counterattack".
5. Cone disease:: In the acute phase of pyramidal tract damage, due to the generation of pyramidal corpuscle, the muscles are reduced during the period of cone beam shock, the muscles of the tendon are relaxed, and there is no impedance during passive movement.
Second, increased muscle tone
(1) Pyramidal tract lesions of the pyramidal tract lesions after the shock period, or the cone-shaped lesions of the insidious onset, increased muscle tone in the temporal side, such as the Wernicke-Mann position expressed in hemiplegia is representative, obvious The cone-shaped bundle damage has triple-buckling, the hip joint of the lower limb, the knee joint and the metacarpal joint flexion, and the increased muscle tension of the pyramidal artery lesion is consistent with the ankle site, and the muscle tension is also increased at rest, and the palpation muscle is more Hard, passive movement has a knife-like impedance.
(2) Extrapyramidal disorders
1. Parkinson's disease: The increase of muscle tension caused by this disease is called muscle stiffness, and the tension of agonist muscle and antagonist muscle is increased. When the joint is passively exercised, the increased muscle tension is always consistent, and the uniform resistance is felt. If the patient has tremor, the uniform resistance will appear intermittently during the flexion and extension of the limb. For example, the gear is rotating, that is, the gear-like rigidity, and the facial expression muscles are stiff and expressionless. Mask face", swallowing muscle muscle stiffness can not be swallowed and swallowed well, eye muscle muscle rigidity shows eye movement slowed down, there is a viscous phenomenon of gaze movement, neck muscle and trunk muscle rigidity to form a flexion state, that is, the head Before the trunk changes, the upper muscles are slightly externally rotated, the elbow joints are flexed, the metacarpophalangeal joints are flexed, the thumb is adducted, the lower limbs are slightly adducted, the knee joints are flexed, and the spine and the spine are slow.
2. Huntington's disease: muscle tension is mostly normal, but a few patients have Porkson's disease-like muscle stiffness, and the dance symptoms are very weak or completely absent. This type is finally posture dystonia, upper limb flexion, both lower limbs Straightening, this progressive, chronic, progressive dance symptom is considered to be the result of globus pallidal damage.
3. Torsion spasm: also known as dystrophic dystonia (dystonia musculorum defoumans) is the driving force of the trunk, a rare basal ganglia lesion, clinically increased muscle tone and limbs and even the body and severe Involuntary torsion is characterized by increased muscle tone when the limb is twisted and normal when the torsion is stopped.
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 neck, head muscle involvement, the most common is tongue and mouth The muscles are involuntarily paralyzed, so that the masticatory muscles contract tightly, the mouth does not open, the speech is difficult to talk, the dysphagia, the facial eccentricity, or the sacral torticollis. This reaction is related to the sensitivity of the individual, and the application of anti-shock palsy , antihistamines or barbiturates are effective.
(2) tardive dykinesia (tardive dykinesia): slow onset, taking neuroprotective agents for several weeks, months or years after the occurrence, even after stopping the drug, showing stereotypes, repeated lips, tongue Involuntary movements, sometimes accompanied by dance-like movements of the limbs or trunks, and axial movements, the application of anti-shock palsy drugs is not only ineffective, but sometimes the symptoms are aggravated, and the muscle tension is low, paralyzed, and may involve the neck muscles. Lumbar muscles, such as the waist can not straight up, bulging abdomen, neck soft, can not look up, can not walk when walking, can not lift the legs, the heel dragged the ground.
(C) When the cerebellar disease has extensive cerebellar lesions on both sides, sometimes the muscle tension is increased, the passive movement of the limb has a sense of impedance, the torso when standing, the limbs are stiff, and the olive cerebellar atrophy sometimes presents Parkinson-type muscle stiffness, suggesting that the brain base Nuclear related structural damage.
(D) brain stem disease caused by brain stem lesions increased muscle tension is most obvious in the midbrain, the midbrain lesions show muscle stiffness, belonging to a kind of brain tonic, the proximal extremities of the limbs, suffering in the extensor group, upper limbs Straighten, wrist flexion and adduction, lower extremity straight, internal rotation adduction, called to the midbrain tonic, diffuse white matter of the cerebral cortex, such as encephalitis, severe brain trauma, cerebral hemorrhage can also appear limb stiffness The difference between going to the midbrain and forcing is the flexion of the forearm. Other manifestations are completely the same as those of the midbrain, which is called "de-cortical rigidity."
(5) Peripheral neurological diseases Peripheral neurological diseases are characterized by lower motor neuron damage, which is characterized by decreased muscle tone, but in the case of facial nerve palsy incomplete recovery, facial muscle tension may increase, that is, facial muscle spasm. In addition, inflammation of the peripheral nerves, tumors and other lesions, when the peripheral nerves are irritating, muscle tension is increased, and this increase in muscle tension is mostly due to increased defensive muscle tone.
(6) Myogenic lesions Although muscle tension can be increased, but the tendon reflex is normal or reduced, there is no hyperreflexia.
1. Congenital myogenicity (congenital paramyotonia): also known as Eulenberg disease, the disease only increased muscle tension in exercise, muscle tension at rest, the muscle tension of the disease increased, muscle tonic contraction at the beginning of exercise, When it is repeated, it will return to normal. When palpating, the muscles have a special toughness, which is like rubbery skin. It is obvious when the muscles contract after mechanical stimulation.
2. Stiff mandy syndrome (stiffmansyndrome): for a cause of unexplained seizures, neck muscles, trunk, back bones, abdominal muscles increased muscle tension, external stimulation, pain, sniper, sound and light, mental stress can induce When the weight is aggravated, the proximal extremities of the extremities begin to develop toward the body, the muscle strength and tendon reflexes are normal, and the stiffness symptoms disappear during sleep.
(7) Others
1. Tetanus: early local muscle tension is increased, the common is the chewing tendon contraction on both sides, accompanied by neck muscle rigidity, followed by facial muscle spasm, mouth angle outward traction, nasal wing contraction, large eye crack It is called "smirking face", and the systemic muscle tension is increased with the development of the disease. For example, when the muscle tension of the trunk stretch muscle is dominant, the angle bow is reversed, and when the flexor muscle tension is dominant, the anterior arch is reversed. The position of the fetus is like the position of the fetus, the head is flexed, the knee and the ankle are close to each other, and the ankle is close to the buttocks. When the muscle tension on the side of the trunk is increased, the body is bent laterally, that is, the lateral arch is reversed, and the head and shoulders are turned to one side. Tilt, the side shoulders droop, and the body bends toward the crescent shape.
2. Tetany: Low blood calcium is the main cause of this disease. The increase of muscle tension is mainly seen in the distal extremities, and even spread to the trunk. Some scholars divide the hand and foot sputum 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 the other fingers, the end finger is often folded under the rest of the finger, or the thumb is folded into the glove, which is called the so-called "midwife hand", the lower limb is the toe flexion, the horseshoe is turned over, the calf is stretched. Straight, free movement can not, there is a sense of impedance when passive movement.
(2) Moderate type: early upper limbs first appear muscle tension, muscle rigidity, break to the trunk, facial muscles and lower limbs, sometimes rectus abdominis, sternocleangepsis, pectoralis major muscles can be strong and straight, face to face When the muscle appears to be muscular, it presents a special face, the external oblique or internal oblique, the jaw is closed, the tongue is stiff, the articulation is poor, and the dysphagia is difficult. For example, the larynx can cause difficulty breathing and suffocation.
(3) Severe type: repeated episodes in a short period of time, showing generalized muscle rigidity, accompanied by laryngeal spasm.
