How Long Does it Take to Muscle Wasting to Appear After Lower Motor Neuron Lesion?

Muscle wasting is a significant feature of lower motor neuron lesion. But, muscle wasting takes time. It takes about 2-3 weeks to appear. Muscle wasting can also appear in upper motor neuron lesion but, it is due to disuse atrophy.

Diseases of the Nipple

1.      Absence of nipple with or without amazia (Congenital absence of breast)

2.      Supernumerary nipples

3.      Nipple Retraction

4.      Cracked Nipple

·         This usually occurs during lactation and if it occur the breast should be rested for at least 24-48 hours. It should b emptied and breast feeding should be resumed as soon as possible.

5.      Papilloma of nipple

6.      Retraction cysts of the gland of Montgomary

7.      Eczema

8.      Paget’s Disease

9.      Discharge from nipple

                                                              i.      Clear serous discharge –This is can be physiological, due to ductal papilloma or due to mammary dysplasia

                                                            ii.      Blood stained – due to duct ectasia, duct papilloma or carcinoma

                                                          iii.      Black/green – due to duct ectasia

                                                           iv.      Purulent – infection

Treatment – Microdochectomy or cone excision of the major ducts

ANATOMY OF THE BREAST
EXAMINATION OF THE BREAST
INVESTIGATION OF BREAST SYMPTOMS

Investigation of Breast Symptoms

1.      Mammography

a.      Sensitivity of mammography increases with age as the density of the breasts reduces with age.

b.      Digital mammography and tomo mammography are now available with more sensitivity.

2.      Ultrasound

a.      Used in young women with dense breasts

b.      Can be used to identify cysts from solid lesions

c.       Can also be used to impalpable areas of pathology

d.      Used to scan axillary tissues

e.      Useful in guided percutaneous biopsy

3.      MRI (Magnetic Resonant Imaging)

a.      Used to distinguish scar from recurrence

b.       Best modality to investigate women with implants

c.       Useful as screening tool for high risk women

4.      Needle biopsy/Cytology

a.      Biopsy is taken under local anaesthesia

b.      Histology – By taking a spring loaded core needle biopsy device – Core cut biopsy of the Breast

c.       Fine Needle Aspiration Cytology – 21G or 23G needle with 10 ml syringe, sample is taken by passing the needle several times through the lump with negative pressure. Then it is smeared on to slide and air dried or fixed.  

5.      Large needle biopsy with vacuum system

a.      8G or 11G needles are used

b.      Useful in the management of the micro calcification or complete excision of fibroadenomas

Triple Assessment of Breast Symptoms

1.      Clinical Assessment

a.      Age

b.      Examination

2.      Radiological Imaging

a.      Ultrasound Scan

b.      Mammography

3.      Cytology or Histology

a.      Fine Needle Aspiration Cytology

b.      Core cut

ANATOMY OF BREAST

EXAMINATION OF BREAST

Examination of the Breast

·         Inspection

o   Patient sitting

§  Assess – asymmetry

§  Visible masses

§  Distortion or skin tethering

§  Nipple discharge

§  Ulceration

§  Oedema and erythema of skin (Paeu d’orange)

·         Palpation

o   Patient lying in near supine position, or in semi recumbent position if the breast are large

§  Arms raised

§  Hand behind the head

o   Palpate the four quadrants including the axillary tail.

o   If a mass is detected examine it further with the thumb and the forefinger

§  Site

§  Size

§  Surface

§  Shape

§  Mobility

§  Consistency

§  Tenderness

§  Transilluminating or not

§   Enlargement of the lymph nodes

·         Examine axillary and cervical draining nodes

·         Examine abdominal organs for metastatic involvement 

 ANATOMY OF THE BREASTS

The Breast

The Anatomy

General borders-

·         Upper border – second rib

·         Lower border – sixth rib

·         Medial border – lateral border of the sternum

·         Lateral border – anterior axillary line

Actual borders –

o   Upper border – clavicle

o   Lower border – seventh or eighth rib

o   Medial border – midline

o   Lateral border – edge of latissimus dorsi

Important parts of the breasts

·         Breast lobe

·         Ductile

·         Lactiferous duct and ampulla

·         Areola

·         Cooper ligament

·         Axillary tail

·         Lobule – structural unit of the mammary gland

1.      Lobule à Ductules à lactiferous duct à terminal papilla

·         Ligaments of Cooper

o   Apices are attached to the superficial facial

o   Account for the dimpling of skin overlying carcinoma

·         Areola

o   Contain involuntary muscles

o   Epithelium contains sweat glands and sebaceous glands

o   Sebaceous glands enlarge during lactation. Then it is called “Montgomary tubercle”

·         Nipple

o   An erectile structure pointing upwards

·         Lymphatics

o   To axillary and internal mammary lymph nodes

o   Axillary lymph nodes have six groups

1.      Lateral – along the axillary vein

2.      Anterior – along lateral thoracic vessels

3.      Posterior – along the sub capsular vessels

4.      Central

5.      Interpectoral

6.      Apical à Supraclavicular nodes à Subclavian lymph trunk à Thoracic duct or Jugular trunk

·         Sentinel node is the first node draining the tumour bearing area of the breast

EXAMINATION OF BREAST