Kristen - Muscular dystrophy-Facioscapulohumeral dystrophy (England) Posted on September 18, 2012

Name: Kristen   
Sex: Female
Country: England
Age: 20
Diagnosis: Muscular dystrophy-Facioscapulohumeral dystrophy
Admission Date: June 27, 2012
Days Admitted to Hospital: 24

Before treatment:
The patient suffered from muscle strength weakening for 3 years without obvious incentive. This was accompanied with facial and both lower limbs muscle strength weakening. The disease progressed gradually and the right side was more severe. The patient went to a local hospital and did't receive a clear diagnosis at first. She didn't receive special treatment. About 6 months ago, she went to a local hospital for further examination. She was diagnosed with muscular dystrophy- Facioscapulohumeral dystrophy. At that time, the patient had myasthenia and muscle atrophy of four limb' near-end and shoulders and facial muscle. She couldn't stand up from a sitting position. She couldn't sit up from clinostatism. She couldn't turn over by herself and couldn't take the object which was in height.

Admission PE:
There was muscle atrophy in the bilateral supraspinatus, infraspinatus, latissimus dorsi, deltoid muscle, biceps brachii and triceps brachii. The deltoids, biceps brachii and triceps brachii were more severe. There was also muscle atrophy in the bilateral iliopsoas, quadriceps femoris and biceps femoris. There was muscle atrophy in the proximal end of all four limbs and there was pseudohypertrophy.

Nervous System Examination:
Kristen was alert and in good spirits. The speech was clear. The memory, calculation abilities and orientation were normal. Both pupils were equal in size and round, their diameter was 3.0mms, and reacted normally to light stimulus. The eyeballs had flexible movement. The forehead wrinkle pattern was symmetrical. The eye closing ability was strong. The left nasolabial sulcus was shallow. The tongue was centered in the oral cavity. The teeth were averted to the right side. The soft palate could be raised normally. The pharyngeal reflex was normal. The cheeks couldn't be expanded. The muscle strength of the right upper limb's proximal end was level 3+, and the abduction strength of the right upper limb's distal-end was level 4 (and the adduction strength of the right upper limb's distal- end was level 3). The muscle strength of the left upper limb's proximal-end was level 3-, and the muscle strength of the left upper limb's distal-end was level 3+. The adduction strength was level 3-. The holding power was level 5. The muscle strength of the right lower limb's proximal-end was level 4- and the distal-end was level 4. The muscle strength of the left lower limb's proximal-end was level 3- and the distal-end was level 3. The muscle tone of all four limbs was almost normal. The tendon reflexes of all four limbs were slightly low. The bilateral abdominal reflex was elicited slightly. The bilateral palm jaw reflex was negative. The Hoffmann's sign and Rossolimo's sign were negative. The bilateral Babinski's sign was negative. The deep and shallow sensation throughout the body was normal through course measurement. The patient was able to finish the finger-to-nose test, the rapid rotation test and digit opposition test almost normally. She was unable to finish the Heel-knee-shin test. There were no signs of meningeal irritation.

Treatment:
We initially gave Kristen a complete examination. The patient received treatment to improve the blood circulation in order to increase the blood supply to the damaged nerves and to nourish the neurons. She also received treatment to promote nerve regeneration and to nourish the muscles. This was accompanied with physical rehabilitation training.

Post- treatment:
Kristen's condition has improved. The closing ability of the eyes has improved.
There is less white when she closes her eyes. The left nasolabial sulcus is deeper when she presents her teeth. There is slight movement in the upper lip. The cheeks can be expanded for several seconds. The muscle volume of all four limbs' proximal end and in the shoulders has increased. The shrugging strength of the shoulders has increased. The muscle strength of all four limbs now reaches level 4. The muscle strength of the waist and back has increased obviously. At present, the patient can turn over, sit up and stand more easily. The walking gait is more standard. And the patient can walk for extended periods of time.