Internal Medicine

0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16

Musculoskeletal Problems Myasthenia Gravis 1025

➣Risk factors

Previous peptic ulcer disease

Age >65

Concomitant use of oral steroids, anticoagulants

➣Protective measures

Misoprostol

Proton pump inhibitor

COX-2 selective NSAID (celecoxib)

■Steroid injections

➣Local soft tissue atrophy, skin pigment changes

➣Rarely local inflammatory reaction

➣Very rarely infection

follow-up

■Most localized syndromes respond eventually over weeks to months

complications & prognosis

■Most conditions respond w/out long-term sequelae

■Mechanical low back pain: for symptoms >6 months continued dis-

ability likely

■Shoulder pain: “frozen shoulder” (adhesive capsulitis) or reflex sym-

pathetic dystrophy (shoulder-hand syndrome)

■Carpal tunnel syndrome: permanent thenar weakness & atrophy

MYASTHENIA GRAVIS

MICHAEL J. AMINOFF, MD, DSc

history & physical

■Variable weakness, leading to ptosis, dysphagia, diplopia, respira-

tory difficulty or limb weakness depending on pattern of muscle

involvement

■Weakness aggravated by activity

■No sensory complaints

■Exam reveals weakness & fatigability of affected muscles, ptosis or

extraocular palsies, aggravated by activity & relieved by rest

■Pattern of involvement varies w/ the pt

tests

■Clinical response to short-acting anticholinesterase (IV edropho-

nium)

■CT scan of chest for thymoma