When Things Go Wrong
Muscular System
1. Tetanus
 Tetanus is infection of the nervous system with the potentially deadly
bacteria Clostridium tetani (C. tetani).
 Spores of the bacteria C. tetani live in the soil and are found around
the world.
 In the spore form, C. tetani may remain inactive in the soil, but it can
remain infectious for more than 40 years.
 Infection begins when the spores enter the body through an injury or
wound.
 The spores release bacteria that spread and make a poison called
tetanospasmin.
 This poison blocks nerve signals from the spinal cord to the muscles,
causing severe muscle spasms.
 The spasms can be so powerful that they tear the muscles or cause
fractures of the spine.
 The time between infection and the first sign of symptoms is typically
7 to 21 days.
 Tetanus often begins with mild spasms in the jaw muscles (lockjaw).
 The spasms can also affect the chest, neck, back, and abdominal
muscles.
 Back muscle spasms often cause arching.
 Sometimes the spasms affect muscles that help with breathing,
which can lead to breathing problems.
 Prolonged muscular action causes sudden, powerful, and painful
contractions of muscle groups. This is called tetany. These episodes
can cause fractures and muscle tears.
 No specific lab test is available to determine the diagnosis of
tetanus.
 Treatment may include:
o Antibiotics
o Bedrest with a nonstimulating environment (dim light,
reduced noise, and stable temperature)
o Medicine to reverse the poison (tetanus immune
globulin)
o Muscle relaxers such as diazepam
o Sedatives
o Surgery to clean the wound and remove the source of
the poison
2. Muscular dystrophy
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Muscular dystrophy is a group of inherited disorders that involve
muscle weakness and loss of muscle tissue, which get worse over
time.
There are many different types of muscular dystrophy.
Symptoms vary with the different types of muscular dystrophy.
All of the muscles may be affected. Or, only specific groups of
muscles may be affected, such as those around the pelvis, shoulder,
or face.
Muscular dystrophy can affect adults, but the more severe forms
tend to occur in early childhood.
Symptoms include:
o Muscle weakness that slowly gets worse
 Delayed development of muscle motor skills
 Difficulty using one or more muscle groups
 Drooling
 Eyelid drooping
 Frequent falls
 Loss of strength in a muscle or group of muscles as an
adult
 Loss in muscle size
 Problems walking (delayed walking)
Some types of muscular dystrophy involve the heart muscle, causing
cardiomyopathy or disturbed heart rhythm (arrhythmias).
Often, there is a loss of muscle mass (wasting), which may be hard
to see because some types of muscular dystrophy cause a build-up
of fat and connective tissue that makes the muscle appear larger.
A muscle biopsy may be used to confirm the diagnosis. In some
cases, a DNA blood test may be all that is needed.
There are no known cures for the various muscular dystrophies. The
goal of treatment is to control symptoms.
Physical therapy may help patients maintain muscle strength and
function.
Orthopedic appliances such as braces and wheelchairs can improve
mobility and self-care abilities.
The person should be as active as possible. Complete inactivity
(such as bedrest) can make the disease worse.
All types of muscular dystrophy slowly get worse, but how fast this
happens varies widely.
Some types of muscular dystrophy, such as Duchenne muscular
dystrophy, are deadly. Other types cause little disability and people
with them have a normal lifespan.
3. Myasthenia gravis
 Myasthenia gravis is a neuromuscular disorder.
 Myasthenia gravis causes weakness of the voluntary (skeletal)
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muscles.
Weakness occurs because the nerve that activates a particular
muscle does a poor job of stimulating that muscle.
This problem occurs because immune cells (which normally attack
foreign invaders) target and attack the body's own healthy cells. This
is known as an autoimmune response.
This autoimmune response produces antibodies that block the
muscle cells from receiving messages (neurotransmitters) from the
nerve cell.
Myasthenia gravis can affect people at any age. It is most common
in young women and older men.
The muscle weakness of myasthenia gravis worsens with activity
and improves with rest. Weakness in affected muscles may cause:
o Breathing difficulty because of weakness of the chest wall
muscles
o Chewing or swallowing difficulty, causing frequent gagging,
choking, or drooling
o Difficulty climbing stairs, lifting objects, or rising from a seated
position.
o Difficulty talking
o Drooping head
o Facial paralysis or weakness of the facial muscles
o Fatigue
o Hoarseness or changing voice
o Weakness of the eye muscles, causing:
 Double vision
 Difficulty maintaining steady gaze
 Eyelid drooping
 Lifestyle adjustments usually enable continuation of many activities.
Activity should be planned to allow scheduled rest periods.
 Stress and excessive heat exposure should be avoided because
they can worsen symptoms.
4. ALS
 Amyotrophic lateral sclerosis, or ALS, is a disease of the nerve cells
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in the brain and spinal cord that control voluntary muscle movement.
ALS is also known as Lou Gehrig's disease.
In about 10% of cases, ALS is caused by a genetic defect. In the
remaining cases, the cause is unknown.
In ALS, nerve cells (neurons) waste away or die, and can no longer
send messages to muscles.
This eventually leads to muscle weakening, twitching, and an
inability to move the arms, legs, and body.
The condition slowly gets worse.
When the muscles in the chest area stop working, it becomes hard
or impossible to breathe on one's own.
ALS affects approximately 5 out of every 100,000 people worldwide.
There are no known risk factors, except for having a family member
who has a hereditary form of the disease.
Symptoms usually do not develop until after age 50, but they can
start in younger people.
Symptoms include:
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Difficulty breathing
Difficulty swallowing
Head drop due to weakness of the neck muscles
Muscle cramps
Muscle weakness that slowly gets worse
 Commonly involves one part of the body first, such as
the arm or hand
 Eventually leads to difficulty lifting, climbing stairs, and
walking
o Paralysis
o Speech problems, such as a slow or abnormal speech pattern
(slurring of words)
 There is no known cure for ALS. The first drug treatment for the
disease is a medicine called riluzole. Riluzole slows the disease
progression and prolongs life.