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Muscle wasting is called atrophy. Atrophy results from inactivity (called disuse), such as when a person is paralyzed. Atrophy can occur unilaterally (one side), or bilaterally (both sides) on one or both arms or legs.

During atrophy, muscle fibers shorten and loose bulk. Ligaments and tendons shorten from disuse. The shortening can result in contractures, a permanent condition where the hand or elbow joint, or foot and knee joint, stiffen and stay in a locked position. Fingers curl in contacture. Range of Motion (ROM) exercises can help prevent or slow down atrophy and contracture, but it the exercises must be done every day. Paralyzed persons need someone to do "Passive ROM" where the healthy person moves each joint through the normal range of motion: flexion and extension. The affected person can try pushing against the healthy person's hand, as a form of resistance exercise.

Atrophied muscles will never return to their pre-atrophied state or condition, especially if the person cannot bear weight (stand), and cannot actively move the limb.

It's important for caregivers to remember two important points:

1. Atrophy means the person has less fat and muscle. Bed sores (or from sitting in a wheelchair) can develop quickly, within hours. Bed sores develop in stages, the first stage being redness of skin but no open skin. The red area must be massaged with lotion to bring blood flow back into the area. As a bed sore develops, the skin goes from pink, to purple... and eventually the skin "breaks down" or opens. Any paralyzed person must be turned on a 2-hour schedule; if sitting, the person must be lifted and re-positioned in the chair on a 2-hour schedule.

2. Atrophy seems like such a non-painful state to observers. But shortening of muscles, tendons, and ligaments can cause deep aching pain and even pain in joints. Repositioning, massage, keeping sheets wrinkle-free, and ROM can help reduce the pain from disuse.

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