Humeral muscle atrophy and elbow contracture in person with EDMD The classic triad of EDMD consists of early contractures, muscle weakness, and heart involvement, typically manifesting in adolescence. Contractures often manifest before weakness, and they can be more disabling. They tend to fix the elbow into flexion and ankle into plantarflexion via Achilles tendon shortening. The spine is also affected, with limited neck flexion initially, and eventually the entire spine can become fixed into extension, referred to as a rigid spine. Elbow and neck contractures seldom occur in other diseases. Eventually, orthopedics (walker, cane) may be needed. The weakness is slowly progressive and preferentially involves the muscles that overlie the humerus bone (biceps and triceps muscles) and those situated on the outside of the lower leg (peroneal). Later, the muscles that position the scapula can be weakened, completing a pattern that is termed 'scapulohumeroperoneal'. Weakness of the scapular fixators can cause a winged scapula, which can impair the ability to lift the arms over the head and can be painful. Weakness of the peroneal muscles can result in toe walking, which can present in the first decade of life. Facial, hand, and thigh muscles can be affected, although less often. Calf hypertrophy can occur. Involvement of the heart occurs in almost all cases, presenting as syncope in second or third decades, or as sudden cardiac death. A multitude of cardiac arrhythmias can result, requiring a pacemaker often by age 30 years. Reported arrhythmias include bradycardia, atrial fibrillation/flutter, atrioventricular conduction defect, and atrial paralysis. Later in the disease, cardiomyopathy can occur. Sometimes, cardiac involvement is the predominant manifestation of EDMD, with minimal involvement of the skeletal muscles. EDMD1 Skeletal muscle involvement usually occurs before cardiac involvement. Of female carriers, 10-20% have abnormal heart rhythm or conduction, with increased risk of sudden cardiac death. EDMD2 Disease course of EDMD 2 is more severe than EDMD1. Compared to EDMD1, cardiac symptoms are more likely to be the initial manifestation. EDMD2 can result in a much broader spectrum of disease, and the severity of muscle weakness is less predictable. However, muscle weakness typically is slowly progressive in first three decades, with an increased rate of progression thereafter.
Emery–Dreifuss muscular dystrophy
Limb–girdle muscular dystrophy
Fukuyama congenital muscular dystrophy
Ullrich congenital muscular dystrophy
X-linked spinal muscular atrophy type 2
Jokela type spinal muscular atrophy
Thiel–Behnke dystrophy
Danon disease