Round muscle nutritional disorder

2021-02-05 12:00 AM

Ulcers are most common in diseases of the marrow, especially in the stage of soft paralysis, so taking care of patients with paralysis is an important issue.

Nutritional disorders

Nutritional disorders can be found in the skin, muscles, bones and joints, but muscle nutritional disorders are common.

Skin nutritional disorders

The disease usually manifests itself in dry, smooth, shiny, edematous or overactive horny layers that thicken the skin. Change in skin colour (dark, discoloured skin like albino ...)

Ulcers are severe symptoms usually appear in the protrusion of the bone head where the skin is pressed against the hard bed surface such as the amputation zone, elbow, shoulder blade, heel, outer ankle, and protrusion of the femur. Initially, the red skin is swollen and then it may slough the skin with pus or appear dark necrotic patches underneath with pus. The necrotic skin patches a few days later peeled off, revealing a pus-filled sore. Ulcers that can be visible to the bones can sometimes cause systemic infections. Ulcers are most common in diseases of the marrow, especially in the stage of soft paralysis. Therefore, care for the paralyzed patient is an important issue (special attention is given to patients with comorbid diabetes).

Hair, nail and hair nutritional disorders

It is the phenomenon of hair growth, beard or hair loss, hard hair is easy to break. The nail is hard, thick, not shiny, easily fractured or deformed (cracked, split), changing colour. These disorders are common in medical diseases.

Muscular and joint nutritional disorders

Pain in joints, bones in arms and legs due to calcified cartilage, ligaments or pitting, hypertrophy, bone erosion ...

In which, muscle nutritional disorders are the most common, clinically indicated by muscle atrophy or possibly hypertrophy (pseudo-hypertrophic atrophy)

When the patient has muscle atrophy we must:

Locate muscle atrophy in the base of the limb or apex, name of muscle atrophy, muscle atrophy is symmetrical or not.

Determine the degree of muscle enlargement measured by a tape measure in certain locations such as forearm, arm, lower leg, hind thigh (also to monitor whether muscle atrophy is progressing, how fast or slow progression is). For example, take a fixed landmark on the upper edge of the kneecap, measure from the landmark to a certain distance above the thigh (10cm) and mark the mark, then use a tape measure to measure the circle of the thigh in the correct place to mark and compare the sides. or compare exams.

Physical self-radiation examination: Using a reflex hammer to knock on the muscle itself, the muscle that responds with the naked eye can see the knuckle emerging a crease-like line. This is a valuable reflex to distinguish muscle atrophy caused by myopathy or neuromuscular atrophy.

Distinguishing muscle atrophy caused by myopathy or nerve damage:

Muscle atrophy due to myopathy (myopathy): Common in children or young people, the disease is familial with gradual progression, weakness of the base of the limbs and the back muscles, so when the patient goes to the side people sideways (duck's gait) due to the inability to fold the thighs on the abdomen. While standing and telling the patient to squat down, the patient squatted very quickly (unable to sit slowly due to paralysis of the limb). Sitting asking the patient to stand up will see that the patient has to put his hand on each thigh to stand up gradually (climbing ladder). Body reflexes lose. There are no jerky muscle fibres. No sensory disturbances. Can fake hypertrophy calf muscles. There is no common electrical degradation reaction. Met in progressive muscular dystrophy.

Muscle atrophy is often caused by damage to the anterior marrow horn (polio, myelitis, anterior marrow degeneration ...). Sometimes muscle atrophy accompanied by pyramidal syndrome as in Charcot's disease, hollow spinal cord. Muscle atrophy due to nerve root damage is usually bilateral, there is always feeling disturbances and decreased or loss of bone tendon reflexes but never jerky muscle fibres. If the nerve root is damaged, there is cell protein dissociation in the cerebrospinal fluid.

Table: Distinguishing muscle atrophy caused by myopathy and neuropathy.





Root limbs, shoulder belt, hip belt

Chi when wire damage

Root chi when root damage

Reflex yourself



Sensory disturbances

Are not

Yes (except for anterior medullary keratitis)

Muscle jerking


No (except for chronic anterior medullary keratitis, Charcot)


Small motor unit, short interval <3 milliseconds.

Multi-phase motor unit, high amplitude, long interval.

Round muscle disorder

Round muscle disorder is a common symptom of nerve damage. The only muscles of the round that work at will are the round muscles of the bladder and anus. It works by the control centres of the central nervous system. The cerebral cortex (central parietal lobe), basal nucleus, spheroid and apical nucleus, cerebellar villi, medulla and peripheral nervous system, the centre is S2 - S4 through the activity of the nerves T11, T12, T1, S2, S3, S4.

Bladder circular muscle disorder

The inner sphincter is controlled by the vegetative nervous system, keeping urine as sympathetic L1-2 and causing urination as the parasympathetic S2-5. The outer sphincter is handled by the mid-lobe tower system.

There are the following bladder sphincter disorders:

Urinary incontinence: Urine spontaneously flowed, could not stop on its own without the patient's wishes, often when the patient was in a coma, damaged aneurysm of the lumbar spinal cord, tip and pony tail ...

Difficult urinary retention or urinary retention: A strained bladder bridge to urinate but difficulty or failure to urinate is observed in gradual spinal cord compression, myelitis on L1. It must be differentiated from mechanical urinary tract obstruction such as urethral stones, prostate fibroids, urethral compression or atrophic tumors.

Auto urinary: Urine spontaneously flowed and stopped spontaneously according to the patient's wishes encountered in lesions on the lumbar aneurysm but did not cause much increase in outer tonicity, due to damage to lower brain stitching or middle lobe.

Anal circular muscle disorder

Often associated with bladder sphincter disturbances but less pronounced. There are 2 types:

Stool: The stool is spontaneous but the patient has no feeling, the cause is similar to urination. This type of sphincter disorder as well as urination is prone to ulceration and superinfection. Attention should consider the diagnosis of stools with diarrhoea especially in the elderly.

Stomach secret: Cannot go to the toilet but should be distinguished from constipation.

Disorders of urination can be accompanied by genital disorders such as impotence, impotence, cold air ...

Genital sphincter disorder (sexual dysfunction)

Sexual dysfunction is quite common, but patients are afraid and rarely complain about these disorders. Often when the physician suggests, ask very subtly to exploit it.

Normal sexual activity in both sexes includes four phases: the arousal, the plains, the climax, and the regressive phases. To get the above normal activities must have the participation of the nervous, endocrine and genitourinary systems. The most common symptoms of genital disorders are impotence in men and mood in women.