An 18-year-old patient asks you how to perform a self-breast exam.
Which of the following instructions should you provide?

Choice A rationale

Juvenile Idiopathic Arthritis is a chronic autoimmune inflammatory condition affecting joints in children, often leading to pain, swelling, and stiffness. It does not primarily affect proximal muscle strength or neuromuscular coordination in a way that would manifest as a Gowers sign. The underlying pathology involves synovial inflammation rather than primary muscle weakness.

Choice B rationale

Multiple Sclerosis is a demyelinating disease of the central nervous system, predominantly affecting adults, though rare in children. While it can cause muscle weakness and gait disturbances due to impaired nerve conduction, a positive Gowers sign is not a characteristic or primary indicator of this condition. Its presentation is typically varied and includes sensory deficits, visual disturbances, and ataxia.

Choice C rationale

Osteosarcoma is a malignant bone tumor, primarily affecting long bones, common in adolescents. Its primary manifestations include localized pain, swelling, and sometimes a palpable mass. It causes structural damage to the bone and surrounding tissues but does not directly lead to the proximal muscle weakness and compensatory maneuvers seen with a Gowers sign.

Choice D rationale

Muscular dystrophy, particularly Duchenne muscular dystrophy (DMD), is a genetic disorder characterized by progressive degeneration of muscle fibers, leading to increasing muscle weakness. The Gowers sign is a classic indicator of proximal muscle weakness, where the child uses their hands to "walk up" their legs to stand from a seated position, due to weakness of the gluteal and quadriceps muscles. This sign is highly specific to conditions like DMD where progressive proximal muscle weakness is a hallmark.

Choice A rationale

While wheelchairs offer mobility assistance, their continuous use can lead to muscle atrophy and further deconditioning in individuals with Duchenne Muscular Dystrophy. Promoting some level of independent movement, even with assistive devices, is crucial for maintaining existing muscle function and delaying disease progression. Over-reliance on a wheelchair might prematurely reduce weight-bearing activities vital for bone health and circulation.

Choice B rationale

Regular physical therapy, specifically focusing on strengthening exercises adapted for Duchenne Muscular Dystrophy, is paramount. This helps maintain existing muscle strength, slow the progression of muscle weakness, improve joint flexibility, and enhance overall functional mobility. Tailored exercises can also address compensatory movements and improve balance, thereby reducing the risk of falls and promoting ambulation for as long as possible.

Choice C rationale

While calcium and vitamin D are essential for bone health, their direct impact on improving muscle strength in the context of Duchenne Muscular Dystrophy is limited. DMD is a genetic disorder characterized by the absence of dystrophin, a protein vital for muscle fiber integrity. Supplementation may support bone density, but it does not address the underlying muscular dystrophy pathology or directly enhance muscle contractility.

Choice D rationale

Limiting physical activity excessively in Duchenne Muscular Dystrophy can lead to disuse atrophy, contractures, and a more rapid decline in mobility. A balanced approach is necessary, encouraging appropriate levels of activity to maintain muscle function without causing excessive fatigue or injury. Over-restriction can negatively impact both physical and psychological well-being, accelerating the progression of immobility.