Maximus Gage
Muscle wasting, or atrophy, is the thinning or loss of muscle tissue. It can be caused by a variety of factors, including malnutrition, age, genetics, neurogenic conditions, nerve problems, diseases, and a lack of physical activity. As muscle wasting is associated with increased mortality rates, it is important to diagnose and treat it early. Some methods of measuring muscle wasting include dual-energy X-ray absorptiometry (DEXA), gait speed tests, handgrip dynamometry, and bioelectrical impedance analysis (BIA). Imaging techniques such as CT scans, MRIs, and ultrasounds are also used to assess muscle wasting. In addition, girth measurements can be taken using a flexible measuring tape to monitor changes in body dimensions over time.
| Characteristics | Values |
|---|---|
| Muscle wasting measurement techniques | Girth measurement, dual-energy X-ray absorptiometry (DEXA), isometric exercises, gait speed test, handgrip dynamometry, bioelectrical impedance analysis (BIA), ultrasound, magnetic resonance imaging (MRI), computed tomography (CT) scan, blood test, muscle or nerve biopsy, electromyography (EMG), nerve conduction studies |
| Muscle atrophy symptoms | Decrease in muscle mass, one limb being smaller than the other, weakness, numbness, tingling in the limbs, trouble walking or balancing, difficulty swallowing or speaking |
| Muscle atrophy causes | Disuse of muscles, neurogenic conditions, malnutrition, age, genetics, lack of physical activity, certain medical conditions |
| Muscle wasting in ICU patients | Bioelectrical impedance analysis (BIA), magnetic resonance (MR), ultrasound (US) |
| Muscle wasting in cancer patients | Routine cross-sectional imaging, CT scans, skeletal muscle fractional synthetic rate (FSR), bioelectrical impedance analysis (BIA), dual-energy X-ray absorptiometry (DEXA), computerized tomography, magnetic resonance imaging |
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What You'll Learn
Ultrasound imaging
When assessing muscle wasting with ultrasound, clinicians select specific muscles based on clinical relevance and accessibility. Commonly assessed muscles include the quadriceps, rectus femoris, biceps brachii, and gastrocnemius. The rectus femoris is particularly susceptible to wasting during bed rest and illness. The ultrasound probe is positioned over the target muscle, with good skin contact and gel application to optimise image quality.
Ultrasound has several advantages over other imaging techniques, including high spatial resolution, low procedural risks, the absence of ionising radiation, and ease of use. It can be used repeatedly at the bedside and may complement nutritional risk assessments. Serial ultrasound assessments can be performed at regular intervals to track changes in muscle size and quality over time. This information can be integrated with nutritional assessments to evaluate a patient's overall health and nutritional needs.
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Magnetic resonance imaging (MRI)
The MRI scanner is a tube-shaped device that uses strong magnetic fields and radio waves to generate images. The magnetic field temporarily aligns the hydrogen atoms (often called protons) in the body, while short bursts of radio waves continuously break this alignment (as the magnets re-establish alignment between bursts). The computer then uses these signals to create digital images of the scanned area.
The degree of muscle fatty infiltration can be quantified using the Mercuri scale modified by Fischer et al. in 2008, which has been applied to both muscle MRI and CT scans. MRI scans are particularly useful for identifying affected muscles, thereby limiting the risk of false-negative results and the need for multiple biopsies. When measuring SM, a 40 mm interval gap technique is recommended to detect minimum changes of less than 1 kg.
There are two main types of MRI machines: closed bore and open. Closed bore machines produce the highest-quality images, while open machines may be more comfortable for the patient due to the lack of an enclosed space. MRI is generally considered safe, but it is not suitable for everyone. People with metal implants or devices such as pacemakers and insulin pumps should avoid MRI due to the potential for displacement or malfunction. In such cases, alternative imaging techniques like ultrasound or computer tomography (CT) scans may be considered.
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Blood tests
One common blood test is the creatine kinase (CK) test, which measures the level of CK in the blood. CK is a protein usually found in muscle fibres, and when these fibres are damaged, CK is released into the blood. High levels of CK in the blood can indicate muscle damage, but it is not specific to any one disease as CK levels can be elevated in many neuromuscular diseases. However, it is still a useful test, especially when used in conjunction with other tests and examinations.
Another blood test is the aldolase test, which measures the level of aldolase in the blood. Aldolase is an enzyme found in high quantities in the liver and skeletal muscles. When the liver or muscles are damaged, aldolase is released into the bloodstream, indicating muscle damage. This test is particularly useful in differentiating between muscle and nerve problems, as nerve issues do not result in increased aldolase levels.
Sedimentation rate (also called erythrocyte sedimentation rate or ESR) is another blood test that measures swelling and inflammation of the muscles. It is used to monitor the progress of muscle inflammation and the effect of treatment. The results are reported in millimetres, indicating how far red blood cells have fallen in a test tube in one hour.
Genetic testing is also often performed on blood samples to identify the precise nature of the genetic fault causing a muscle-wasting condition. This can help clinicians provide better information about the progression of the condition, access to treatment, and family planning.
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Muscle biopsies
The procedure itself is fairly straightforward and has a low risk of complications. The patient will be asked to remove their clothing and will be given a gown to change into. The skin over the biopsy site will be cleaned with an antiseptic solution, and a local anaesthetic will be administered to numb the area. If a small sample is required, a biopsy needle will be inserted into the muscle to extract the tissue. For larger samples, a small incision will be made in the skin, and sharp scissors may be used to cut sections of the muscle tissue. The patient may experience a mild discomfort during this process. Once the sample is collected, the healthcare provider will apply pressure to the site to stop any bleeding, and close the opening with adhesive strips or stitches. The sample will then be sent to a laboratory for examination.
In the laboratory, the muscle sample is frozen, and thin slices are cut and stained with various dyes to be examined under a microscope. The pathologist will be looking for differences between healthy and affected muscle tissue, such as the size and proportion of type 1 and type 2 muscle fibres.
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Girth measurements
To perform girth measurements, a flexible tape measure is used to record the circumference of the desired body part. It is important to ensure that the tape is not too tight or too loose and that it lies flat and horizontal on the skin. Marking the skin with a pen beforehand can help ensure consistency in tape placement. The subject should stand in an erect posture with their weight evenly distributed on both feet and their muscles relaxed (except when measuring the bicep curl).
When measuring the waist girth, the tape is placed around the midsection of the body, usually at the narrowest point of the torso, to determine fat gain or loss and predict the risk of developing heart disease. The hip girth is measured at the level of the greatest protrusion of the gluteal muscles, with the client standing erect and ensuring they do not tense their gluteal muscles.
The chest girth is measured at the level of the nipples, which usually marks the apex of the chest. The client raises their arms to the side to shoulder level, and the tape is placed around the upper torso under the armpits. They then lower their arms and take the measurement after fully exhaling. For the upper arm or bicep girth, the right elbow is brought up to shoulder level and bent at a 90-degree angle to make a bicep muscle. The tape is then wrapped around the thickest area of the bicep.
The thigh girth can be measured proximally, about 1 cm below the gluteal fold, or at the mid-thigh level, from the inguinal crease to the proximal border of the patella. The distal thigh measurement is taken just proximal to the femoral condyles. The calf girth is measured at the minimum circumference of the lower leg, just proximal to the malleoli.
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Frequently asked questions
Muscle wasting, or atrophy, can be caused by a variety of factors, including malnutrition, age, genetics, and neurogenic conditions. Symptoms include a decrease in muscle mass, weakness, and numbness. If you suspect you have muscle atrophy, consult a healthcare professional for a physical exam.
Muscle wasting can be measured through various techniques, including blood tests, muscle biopsies, and imaging techniques such as CT scans, MRIs, and ultrasounds. Girth measurements using a flexible tape can also be used to monitor changes in body dimensions and muscle wasting over time.
Muscle wasting can lead to decreased muscle strength and endurance, impacting an individual's functionality and quality of life. It is also associated with increased mortality rates, particularly in patients with cancer or other critical illnesses.
Yes, in some cases, muscle wasting can be reversed through regular exercise and an improved diet. Pool-based exercises can be beneficial as they reduce the muscle workload during the recovery process. However, neurogenic atrophy, caused by nerve damage, may be irreversible.
