Hydroxychloroquine-induced myopathy.

A 70-year-old woman with a history of undifferentiated connective tissue disease was admitted for work-up of shortness of breath and progressive weakness over the course of 1 year. She had been treated with hydroxychloroquine (HCQ) for last 5 years. Her evaluation revealed diffuse muscle weakness and hyperpigmentation of the skin consistent with HCQ deposition, although this did not entirely explain the patient's dyspnea. The patient underwent cardiac evaluation because of occasional substernal chest pain and persistent elevation in serum troponin I, but her ECG and adenosine thallium study did not show any signs of ischemic heart disease. The diagnosis of HCQ-induced myopathy was made with electromyography and muscle biopsy. HCQ was discontinued, with improvement of the patient's signs and symptoms over the course of the next 18 months.We propose that this patient was experiencing myocardial toxicity as a consequence of HCQ deposition disease with her clinical picture of skeletal muscle myopathy and HCQ deposition in the skin. A Medline search yielded several case reports as well as a case series of patients with antimalarial-induced myopathy. HCQ-induced myopathy may be less recognized because of its presentation with signs, symptoms, and laboratory results which suggest other critical diseases. Moreover, this medication is often prescribed to treat illnesses whose clinical manifestations may include myopathy.

Effect of Extracorporeal Shock Wave Therapy on Hamstring Tightness in Healthy Subjects: A Pilot Study.

PURPOSE: To assess the effect of extracorporeal shock wave therapy (ESWT) for healthy participants with hamstring tightness. MATERIALS AND METHODS: This study was performed at a university rehabilitation hospital. Twenty nine healthy adults with hamstring tightness were enrolled and randomly allocated into four groups (ESWT, stretching exercise, ESWT with stretching exercise, and control). The effects of individual treatments were compared by the finger-to-floor test and popliteal angle. RESULTS: The ESWT group, stretching exercise group and ESWT with stretching exercise group had decreased finger-to-floor distances and right popliteal angles immediately after intervention, compared with the control group (p<0.05). At 4 weeks after completion of the interventions, finger-to-floor distances and the right popliteal angle in only the ESWT with stretching exercise group showed a significant improvement, compared with the control group (p=0.008 and 0.023). CONCLUSION: While ESWT and stretching both reduced hamstring tightness immediately after interventions, only ESWT with stretching exercise maintained the significantly improved relief of hamstring tightness significantly after 4 weeks.