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rhabdomyolysis
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rhabdomyolysis - November 20, 2006 8:59:00 AM
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AYAJ
Posts: 5
Joined: March 20, 2005
From: Greece
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My patient is a 20 years boy with rhabdomyolysis, after drug abuse (heroin and pills). I first saw him 4 months after his "crush". He has spent 3 months in hospital (including I.C.U. ).Generally looks like low paraplegic. He can perform some leg flexion in the supine (his quads contract with 50Hz), but more distally shows foot drop (both feet).
Well, I need some help here : What do we know about the prognosis of rhabdomyolysis? Any physical therapy modalities that could be helpful? Modalities contraindicated? and what about the amount of exercise?
Anything you know could be grand!
ThanX
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Re: rhabdomyolysis - November 20, 2006 1:36:00 PM
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jma
Posts: 2312
Joined: August 24, 2000
From: NY
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Here is an article I saw once before. This was the only one I remember seeing but the cause is different from what you describe. I hope this can help you out in some way though. See if you can get the full text or know someone who subscribes to the JOSPT. See below:
" Diagnosis and Treatment of Acute Exertional Rhabdomyolysis
Richard E. Baxter, PT, DSc, OCS, ATC, Physical Therapist, US Army; Student, Command and General Staff College, Combined Arms Center, Fort Leavenworth, KS
Josef H. Moore, PT, PhD, SCS, ATC, Director, US Military-Baylor University Postgraduate Sports Medicine Residency, US Military Academy, West Point, NY; Chief, Physical Therapy, Keller Army Community Hospital, US Military Academy, West Point, NY
JOSPT March 2003 Vol.33 No.3
This case report involving a 20-year-old male in the military serves as a reminder that not every individual presenting with musculoskeletal dysfunction has a simple uncomplicated musculoskeletal problem. Always consider acute exertional rhabdomyolysis (AER) as a differential diagnosis in patients who have performed intense exercise recently and are now complaining of muscle pain and weakness, especially if they have any of the AER risk factors discussed in this report (poor physical condition, exercising in a hot, humid environment, and poor fluid intake). These patients have an excellent prognosis if AER is caught early and treated aggressively. However, serious complications can occur if AER is overlooked or dismissed as delayed onset muscle soreness."
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Re: rhabdomyolysis - November 20, 2006 4:57:00 PM
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Synergy
Posts: 589
Joined: March 11, 2004
From: Forney, TX
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AYAJ,
Send me an email and I'll send you the above article.
cdadams@cebridge.net
_____________________________
Chris Adams, PT, MPT
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Re: rhabdomyolysis - November 22, 2006 9:32:00 AM
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AYAJ
Posts: 5
Joined: March 20, 2005
From: Greece
Status: offline
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The article was very helpful.
Thank U.
I owe U a report of how my patient will do.
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Re: rhabdomyolysis - November 22, 2006 10:07:00 AM
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Dr.Wagner
Posts: 1237
Joined: January 24, 2003
From: Indianapolis
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Please feel free to post these types of questions on the "Medical Complexity" area.
Rhabdomyolysis, is not an uncommon complication of drug use. It consists of the muscular breakdown and kidney failure from filtering the myoglobin via the urine.
In extreme cases it causes death, organ failure, or muscular pain and atrophy.
In mild cases it causes generalized "ache".
It is diagnoses when CK/CPK reaches levels 5x normal in the serum.
No PT modality will significantly raise levels when used properly (ie avoiding gross malpractice such as turning on an ultrasound and walking away or setting a patient up on E stim and locking him in the clinic overnight).
Treat the patient as any other patient with atrophy.
_____________________________
Dr. Wagner DO
Moderator of Medical Complexity Forum
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Re: rhabdomyolysis - November 23, 2006 4:48:00 AM
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AYAJ
Posts: 5
Joined: March 20, 2005
From: Greece
Status: offline
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Well, I 've found really many things about it, but concerning physical therapy many little. My initial worry was not to magnify rhabdomyolysis with exercise, massage, Electrcal stim etc. So, DrWagner, what U just sent is precious support.
ThanX
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Re: rhabdomyolysis - November 23, 2006 2:55:00 PM
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tr6454
Posts: 60
Joined: March 6, 2004
Status: offline
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AYAJ
I've also seen/rehabed soldiers with the exertional type in the military (search Military Medicine). Exercise within limits of pain is generally OK. Since the underlying pathology relates to the cell wall integrity being broken down by depletion of ATP, be sure not to over fatigue the muscle as they gradually recover.
_____________________________
Terry
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