HSP might lead to changes in muscle tissue
A 55-year-old man with HSP, with only minor spasticity and no significant muscle shortening experienced a complete tear in one of the major muscles at the front of the thigh, first in one leg and then in the other after only minimal trauma, raising the question as to whether chronic spasticity might lead to changes in muscle tissue, or whether the genetic mutation itself might adversely affect muscle tissue making muscle tears more likely and more common.
This case raises questions about the pathophysiology of muscle ruptures in highly functional patients with hereditary spastic paraplegia (HSP) who have only minor spasticity and no significant muscle shortening. Literature on the skeletal muscle changes secondary to spasticity or to the underlying disease, HSP, has been explored and compared with this clinical case. Two theoretical hypotheses are discussed. Firstly, chronic spasticity might be a risk factor for histopathological muscle alterations. Secondly, altered protein synthesis due to the underlying genetic mutation may play a role in the mechanical integrity of muscle tissue.
This is the first case report of a sequential bilateral complete disruption of the rectus femoris muscle after minimal trauma, in a 55 year old man with HSP. Pain was the main complaint, without significant increase in spasticity. Walking ability was not significantly impaired. Conservative treatment resulted in resolution of the complaints.
CLINICAL REHABILITATION IMPACT:
This unique case of a bilateral complete rectus femoris muscle rupture after minimal trauma in a patient with HSP presenting with minor spasticity raises questions on the pathophysiology of the skeletal muscle changes in HSP patients and more generally in spastic patients.
SOURCE: Eur J Phys Rehabil Med. 2017 Mar 6. doi: 10.23736/S1973-9087.17.04513-0. [Epub ahead of print] PMID: 28264543
Sequential bilateral complete rupture of the rectus femoris muscle in a patient with hereditary spastic paraplegia.
Raes L1, Draulans N2, Van Campenhout A3, Ortibus E4, Peers K2, Kiekens C2.
1 Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium – [email protected]
2 Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium.
3 Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium.
4 Department of Paediatrics, University Hospitals Leuven, Leuven, Belgium.