The MUSCULAR sYSTEM

 The skeletal system comprises bones, cartilage, ligaments, and other  connective tissues that provide structure, support, and protection for  the body. Its primary functions include facilitating movement,  protecting vital organs, producing blood cells, storing minerals like  calcium and phosphorus, and providing structural support for the body.  Bones are dynamic structures that undergo continual remodeling through  processes such as bone formation (ossification) and resorption.  Additionally, the skeletal system plays a crucial role in maintaining  mineral homeostasis and acid-base balance in the body. Through its  interactions with muscles and joints, the skeletal system enables  mobility and locomotion, allowing humans and other vertebrates to  perform a wide range of activities, from basic movements to complex  tasks. Overall, the skeletal system serves as the framework of the body,  contributing to its shape, stability, and overall function. 

Amputation, Osteoarthritis,Osteopenia, Rheumatoid Arthritis, 

1. Muscular Dystrophy: A group of genetic disorders characterized by progressive muscle weakness and degeneration due to abnormalities in muscle proteins. Duchenne muscular dystrophy is the most common and severe form, typically affecting boys and leading to significant disability and early mortality.
2. Myasthenia Gravis: An autoimmune neuromuscular disorder causing muscle weakness and fatigue, particularly in the face, neck, and limbs. Myasthenia gravis is characterized by antibodies targeting acetylcholine receptors at the neuromuscular junction, impairing nerve signaling to muscles.
3. Muscle Strains and Sprains: Injuries resulting from overstretching or tearing of muscle fibers (strains) or ligaments (sprains) due to sudden movements, trauma, or overexertion. These injuries can cause pain, swelling, and limited mobility.
4. Muscle Cramps: Painful involuntary contractions of skeletal muscles, often occurring during or after exercise, dehydration, or electrolyte imbalances.
5. Muscular Atrophy: Loss of muscle mass and strength due to disuse, aging, injury, or neurological conditions. Disuse atrophy can occur from immobilization or lack of physical activity, leading to muscle wasting.
6. Tendonitis: Inflammation of tendons, the fibrous tissues that connect muscles to bones, commonly occurring from repetitive movements or overuse. Tendonitis can cause pain, swelling, and restricted movement.
7. Rhabdomyolysis: A serious condition characterized by the breakdown of skeletal muscle tissue, releasing myoglobin into the bloodstream, which can lead to kidney damage and other complications.

These disorders can significantly impair muscle function, mobility, and overall quality of life, requiring various treatments and interventions depending on the underlying cause and severity.

1. Muscle Weakness and Fatigue:      Insulin resistance and metabolic syndrome components such as obesity can      lead to decreased muscle strength and endurance, contributing to fatigue      and reduced physical activity levels.
2. Muscle Atrophy:      Insulin resistance and metabolic abnormalities may disrupt protein      synthesis and muscle metabolism, leading to muscle wasting and atrophy,      particularly in individuals with prolonged immobility or sedentary      lifestyles.
3. Impaired Muscle Regeneration:      Insulin resistance and hyperinsulinemia can interfere with the body's      ability to repair and regenerate muscle tissue following injury or      exercise, prolonging recovery times and increasing susceptibility to      muscle damage.
4. Increased Risk of Injuries:      Obesity and insulin resistance are associated with alterations in gait,      posture, and biomechanics, increasing the risk of muscle strains, sprains,      and other injuries during physical activity.
5. Myopathy: Some studies suggest a potential link      between insulin resistance and myopathies, including inflammatory      myopathies and metabolic myopathies, although the exact mechanisms are not      fully understood.

Overall, the dysregulation of insulin and metabolic processes seen in hyperinsulinemia, insulin resistance, and metabolic syndrome can negatively impact muscle health and function, increasing the risk of muscular disorders and impairing overall mobility and physical performance.

  Carrying excess weight strains muscles and joints, leading to conditions like osteoarthritis and muscle fatigue. 

 Diabetes-related neuropathy and reduced insulin sensitivity contribute to muscle weakness, especially in the lower limbs. 

Carpal tunnel syndrome (CTS) is a condition characterized by numbness, tingling, weakness, or pain in the hand and wrist. It occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes compressed or squeezed at the wrist within a structure called the carpal tunnel. The carpal tunnel is a narrow passageway in the wrist formed by bones and ligaments.

CTS primarily affects the musculoskeletal system. However, it also involves the nervous system since it involves compression of the median nerve. Therefore, it can be considered to belong to both the musculoskeletal and nervous systems.

Hyperinsulinemia, insulin resistance, and metabolic syndrome can indirectly contribute to carpal tunnel syndrome (CTS) through various mechanisms:

Inflammation and tissue swelling: Hyperinsulinemia and insulin resistance are associated with chronic low-grade inflammation throughout the body, including in the tissues around the carpal tunnel. This inflammation can lead to swelling of the surrounding tissues, which may compress the median nerve and exacerbate symptoms of CTS.

Fluid retention: Metabolic syndrome often involves fluid retention or edema, which can increase pressure within the carpal tunnel. Elevated pressure within the confined space of the carpal tunnel can compress the median nerve, leading to symptoms of CTS.

Obesity: Metabolic syndrome frequently includes obesity as a component. Excess body weight can increase pressure on the carpal tunnel and median nerve, contributing to the development or worsening of CTS symptoms.

Nerve damage and neuropathy: Insulin resistance and metabolic syndrome can lead to peripheral neuropathy, a condition characterized by nerve damage in the extremities. Damage to the nerves may affect their ability to transmit signals properly, potentially exacerbating symptoms of CTS or making individuals more susceptible to developing the condition.

Underlying medical conditions: Metabolic syndrome is often associated with other medical conditions, such as diabetes and hypothyroidism, which are themselves risk factors for CTS. Poorly managed diabetes, for example, can lead to nerve damage and increase the likelihood of developing CTS.

Overall, while hyperinsulinemia, insulin resistance, and metabolic syndrome may not directly cause CTS, their effects on inflammation, fluid retention, nerve function, and associated medical conditions can contribute to the development or worsening of symptoms in individuals predisposed to or already experiencing carpal tunnel syndrome. It's essential for individuals with metabolic syndrome to manage their condition effectively and seek treatment for any associated symptoms or complications, including CTS 

Objectives: This study aims to investigate whether or not metabolic syndrome (MS) affects recurrence in patients who had undergone surgery for carpal tunnel syndrome (CTS). 

Patients and methods: The study included 86 hands of 78 patients (19 males, 59 females; mean age 52.0±8.2 years; range 36 to 78 years) who underwent CTS surgery. Patients were examined clinically and demographically for the presence of MS. Patients were also evaluated using a visual analog scale and the Boston Carpal Tunnel Syndrome Questionnaire. Diagnoses of recurrence were established using electromyography in patients with clinical CTS and Tinel and/or Phalen test positivity. The effect of MS on recurrent CTS was examined statistically by independent t-test. 

Results: At the end of a mean follow-up period of 36.2±19.2 months (range 12 to 60 months), recurrence was identified in 31 (36%) of the 86 hands. Of these 31 hands, MS was present in 23 (74.2%). In the 55 hands (64%) without recurrence, MS was present in 10 (18.2%). According to these differences, the effect of MS on recurrent CTS was statistically significant (p<0.001). 

Conclusion: Our study indicated that MS affected recurrence in patients who had undergone CTS surgery. 

Objective: To determine the frequency of metabolic syndrome and its components in patients with carpal tunnel syndrome. 

Study design: Case-series. 

Place and duration of study: Department of Neurology, Mayo Hospital, Lahore, from January to June 2012. 

Methodology: Seventy-five (64 females and 11 males) patients with clinically diagnosed and electrodiagnostically confirmed carpal tunnel syndrome were inducted. Their waist circumference, blood pressure, fasting blood glucose, fasting triglycerides and high density lipoprotein cholesterol levels were recorded. Patients were categorized having metabolic syndrome according to Adult Treatment Panel III criteria, if any 3 were present out of hypertension, elevated fasting triglycerides, reduced high density lipoprotein cholesterol, elevated fasting blood glucose, and elevated waist circumference. 

Results: Mean age of the patients was 42.04 ±9.31 years, mean waist circumference was 95.32 ±9.03 cm, mean systolic blood pressure was 134.13 ±13.72 mmHg, mean diastolic blood pressure was 89.13 ±8.83 mmHg, mean fasting blood glucose was 94.35 ±21.81 mg/dl, mean fasting triglycerides was 177.48 ±48.69 mg/dl, and mean high density lipoprotein cholesterol was 41.95 ±11.17 mg/dl. Metabolic syndrome was found in 54 (72%) patients including 9 (16.7%) males and 45 (83.3%) females. Out of 75 patients, 54 (72%) had elevated waist circumference, 52 (69.3%) had elevated blood pressure, 19 (25.3%) had elevated fasting blood glucose, 53 (70.6%) had elevated fasting triglycerides and 54 (72%) had reduced high density lipoprotein cholesterol. Highest frequency of metabolic syndrome was found in age range of 40 - 49 years in both genders. 

Conclusion: Metabolic syndrome is frequently found in the patients with carpal tunnel syndrome

Increased weignt and, more recently, body mass index (BMI), have been suggested as risk factors for carpal tunnel syndrome (CTS). In an effort to determine the relative risk (RR) of obesity in the development of CTS, 949 patients who had an evaluation of the right upper extremity that included motor and sensory conduction studies of the median and ulnar nerves were reviewed. Of these patients, 261 were diagnosed with a median mononeuropathy at the wrist. Those individuals who were classified as obese (BMI > 29) were 2.5 times more likely than slender individuals (BMI < 20) to be diagnosed with CTS. Forty-three percent of obese women and 32% of obese men had the diagnosis of CTS compared to 21% of slender women and 0% of slender men.

" We aimed to evaluate the relation between the severity of carpal tunnel  syndrome and metabolic syndrome. One hundred and fifty patients who had a  clinical and electrophysiologically confirmed diagnosis of carpal  tunnel syndrome (CTS), were included in this study. The patients were  divided into two groups (with or without metabolic syndrome) according  to the criteria of National Cholesterol Education Program. Eighty one  (73.5 %) of the patients with CTS had metabolic syndrome. The patients  with metabolic syndrome the severity of CTS was found 22.2 % had mild  CTS, 56.8 % had moderate CTS, and 21 % had severe CTS. The patients  without metabolic syndrome the severity of CTS was found 44.9 % had mild  CTS, 40.6 % had moderate CTS, and 14.5 % had severe CTS. The severity  of CTS between both groups was found to be statistically significant (p =  0.0009). While a correlation was found between the severity of CTS and  high level of LDL with the presence of metabolic syndrome (correlation  coefficient 0.209). In conclusion metabolic syndrome that appears to be a  risk factor for CTS. At the same time, the presence of metabolic  syndrome increases the severity of the disease.  "    

" Carpal tunnel syndrome (CTS) is one of the most common upper limb  compression neuropathies. In only 50% of cases it is possible to  identify a cause. Our objective was to determine the role of glucose  metabolism abnormalities in idiopathic CTS. We identified 117 patients  with idiopathic moderate or severe CTS and 128 controls. In all we  evaluated glucose and insulin levels at fasting and after 2-h oral  glucose tolerance test (2h-OGTT). In addition we determined insulin  resistance (IR). Following OGTT the prevalence of glucose metabolism  abnormalities was significantly higher in the CTS group (p = 0.001). IR  was documented in 80% of patients, of whom 45% had impaired glucose  tolerance, 14% newly diagnosed diabetes mellitus, and 20% IR only. Waist  circumference and body mass index were also significantly increased in  the CTS group. In this study, we focused on evidence that pre-diabetes  may represent a risk factor for CTS. We proposed to determine IR as a  rule in all patients with idiopathic CTS.   "  

 Mitochondria play a pivotal role in supporting the muscular system,  which includes skeletal muscles, smooth muscles, and cardiac muscles.  Within muscle cells, mitochondria are responsible for producing the  energy necessary for muscle contraction, relaxation, and repair  processes. Additionally, mitochondria regulate cellular processes  critical for muscle function, including calcium signaling, oxidative  stress response, and muscle protein synthesis. Dysfunction in these  cellular powerhouses due to poor dietary choices can lead to impaired  muscle function and compromised muscle integrity, contributing to  conditions such as muscle weakness, fatigue, and muscle wasting  disorders. Nutrient-dense foods support optimal mitochondrial function,  while processed foods may compromise muscular system health.  Prioritizing a diet rich in whole foods is crucial for preserving  mitochondrial health and reducing the risk of muscular system disorders,  emphasizing the importance of dietary choices in supporting muscle  health and overall muscular system function. 

  "Skeletal muscle is a highly adaptable tissue that comprises  approximately 40% of total body mass and is essential for maintaining  limb posture and body movement. Skeletal muscle is also an endocrine  organ that secretes myokines that have an effect on the whole-body  organs [1,2,3]. Skeletal muscle atrophy is closely associated with some conditions such as sedentary, physical inactivity and cachexia [4, 5].  Skeletal muscle atrophy can seriously impact the quality of life of  patients and increase the morbidity and mortality of many diseases.  Muscle atrophy usually leads to the loss of muscle mass and function and  is characterized by a reduction in muscle fiber size and mass, a  conversion of muscle fiber type and an imbalance between protein  synthesis and degradation in the muscle 

 More and more studies have shown that inflammation and oxidative stress  play a crucial triggering role in the process of muscle atrophy "

 Picture taken from taken from 

Sarcopenia is a condition characterized by the loss of skeletal muscle mass, strength, and function that occurs with aging. It is a natural part of the aging process but can be exacerbated by various factors including sedentary lifestyle, poor nutrition, hormonal changes, and chronic diseases.

Insulin resistance, hyperinsulinemia, and metabolic syndrome are all conditions associated with disturbances in glucose metabolism and can have significant impacts on muscle health, potentially exacerbating sarcopenia:

Insulin Resistance: Insulin resistance occurs when cells in the body become less responsive to the effects of insulin, a hormone that regulates blood sugar levels. When cells are resistant to insulin, they may not efficiently take up glucose from the bloodstream, leading to higher blood sugar levels. Insulin resistance has been linked to muscle protein breakdown and impaired muscle function. It can contribute to the progression of sarcopenia by disrupting the normal processes of muscle maintenance and repair.

Hyperinsulinemia: Hyperinsulinemia refers to high levels of insulin in the bloodstream. It often accompanies insulin resistance, as the body produces more insulin in an attempt to overcome the resistance and regulate blood sugar levels. Elevated insulin levels have been associated with increased muscle protein breakdown and decreased muscle synthesis, which can contribute to muscle loss and exacerbate sarcopenia.

Metabolic Syndrome: Metabolic syndrome is a cluster of conditions that occur together, including abdominal obesity, high blood pressure, high blood sugar, and abnormal lipid levels. Individuals with metabolic syndrome are at increased risk of developing cardiovascular disease, type 2 diabetes, and other health problems. Metabolic syndrome has been linked to sarcopenia, possibly due to the combined effects of insulin resistance, inflammation, and hormonal imbalances associated with the syndrome.

Overall, insulin resistance, hyperinsulinemia, and metabolic syndrome can all contribute to the progression of sarcopenia by disrupting muscle metabolism, promoting muscle protein breakdown, and impairing muscle function. Managing these conditions through lifestyle interventions such as regular exercise, healthy diet, and weight management can help mitigate their impact on muscle health and reduce the risk of sarcopenia.

  Sarcopenia in critically ill patients is a highly prevalent comorbidity.  It is associated with a higher mortality rate, length of mechanical  ventilation, and probability of being sent to a nursing home after the  Intensive Care Unit (ICU). Despite the number of calories and proteins  delivered, there is a complex network of signals of hormones and  cytokines that affect muscle metabolism and its protein synthesis and  breakdown in critically ill and chronic patients. To date, it is known  that a higher number of proteins decreases mortality, but the exact  amount needs to be clarified. This complex network of signals affects  protein synthesis and breakdown. Some hormones regulate metabolism, such  as insulin, insulin growth factor glucocorticoids, and growth hormone,  whose secretion is affected by feeding states and inflammation. In  addition, cytokines are involved, such as TNF-alpha and HIF-1. These  hormones and cytokines have common pathways that activate muscle  breakdown effectors, such as the ubiquitin-proteasome system, calpain,  and caspase-3. These effectors are responsible for protein breakdown in  muscles. Many trials have been conducted with hormones with different  results but not with nutritional outcomes. This review examines the  effect of hormones and cytokines on muscles. Knowing all the signals and  pathways that affect protein synthesis and breakdown can be considered  for future therapeutics.      

  Sarcopenic obesity (SO), which refers to the coexistence of sarcopenia  and obesity. The aim of this systematic review and meta-analysis was  first to assess the prevalence of SO in patients with diabetes, and  second, to evaluate possible adverse outcomes. 

The systematic review quantitatively  assessed the available evidence from 20 studies on the prevalence of SO  in patients with diabetes and qualitatively described possible adverse  outcomes. This study reveals that the global prevalence of SO among  patients with diabetes is 27%, with a significantly higher prevalence  observed in female patients compared to male patients. Possibly,  decreased estrogen levels and elevated follicle-stimulating hormone  levels contribute to increased deposition of visceral adipose tissue and  reduced fat-free mass in   

The  prevalence of SO in patients with diabetes was found to be  significantly higher in North America compared to Asia and Europe,  possibly due to dietary habits during feasts and a sedentary lifestyle
]. The latest data show that the prevalence of obesity among adults in the United States is 37%, compared with 31% in Canada
]. Due to the limited sample size of studies conducted in North America, the results need to be interpreted with caution.

 The systematic review and meta-analysis revealed a prevalence of 27% for  SO in patients with diabetes, and it is associated with potential  serious adverse outcomes. Therefore, we should attach importance to the  screening of SO in patients with diabetes and early detection of  susceptible groups, then selecting appropriate interventions to reduce  the occurrence of it and various adverse outcomes in this demographic. 

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Abstract 

Background: Surgeons have historically used age as a preoperative predictor of postoperative outcomes. Sarcopenia, the loss of skeletal muscle mass due to disease or biological age, has been proposed as a more accurate risk predictor. The prognostic value of sarcopenia assessment in surgical patients remains poorly understood. Therefore, the authors aimed to synthesize the available literature and investigate the impact of sarcopenia on perioperative and postoperative outcomes across all surgical specialties. 

Methods: The authors systematic+dies showed that sarcopenia remained a significant predictor of mortality and complication occurrence (all P <0.00001). 

Conclusion: Sarcopenia is a significant predictor of poorer outcomes in surgical patients. Preoperative assessment of sarcopenia can help surgeons identify patients at risk, critically balance eligibility, and refine perioperative management. Large-scale studies are required to further validate the importance of sarcopenia as a prognostic indicator of perioperative risk, especially in surgical subspecialties.