There are many different types of muscular dystrophy (MD). All types cause muscle weakness, but the areas affected and the severity of the symptoms are different.

Muscular Dystrophy UK provides a dropdown list of specific muscle-weakening conditions.

Duchenne muscular dystrophy

As a result of the way it's inherited (see causes of MD), Duchenne MD mostly affects boys. Girls can occasionally be affected, although the condition tends to be milder.

Children with Duchenne MD usually start to have noticeable symptoms between 1 and 3 years of age. The muscles around their pelvis and thighs tend to be affected first and often appear bulkier than normal.

A child with Duchenne MD may:

• have difficulty walking, running or jumping
• have difficulty standing up
• learn to speak later than usual
• be unable to climb the stairs without support
• have behavioural or learning difficulties

Children with Duchenne MD may need a wheelchair by the time they're 12 years old, as their muscles weaken and they lose the ability to walk. They can also develop scoliosis, where the spine begins to curve sideways. This can lead to one shoulder or hip being higher than the other.

By their mid-teens, some people with Duchenne MD will develop dilated cardiomyopathy. This condition affects the heart muscles, causing the heart's chambers to enlarge and the walls to get thinner.

By their late-teens or early 20s, people with Duchenne MD may start to have breathing problems. The condition can also affect the intercostal muscles (muscle tissue between the ribs) and the diaphragm (the large, thin sheet of muscle between the chest and abdomen). 

Once the heart and respiratory muscles are damaged, Duchenne MD becomes life-threatening. With medical care, most people with Duchenne MD die from heart or respiratory failure before or during their 30s.

Myotonic dystrophy

As with other types of muscular dystrophy, myotonic dystrophy involves progressive muscle weakness and muscle wasting. However, it's often the smaller muscles that are affected first, such as those in the face, jaw and neck.

Myotonic dystrophy can appear at any time between birth and old age. It affects the same number of men and women.

As well as muscle weakness and wasting, symptoms can include:

• muscle stiffness (myotonia)
• clouding of the lens in the eye (cataracts)
• excessive sleeping or sleepiness
• difficulty swallowing
• behavioural and learning problems in children
• a slow and irregular heartbeat (cardiac arrhythmia)

Myotonic dystrophy is highly variable and often gets worse very slowly, with little change over long periods of time. However, it can become more severe as it's passed down through the generations.

Some people with myotonic dystrophy may never have a significant disability, although their heart rate will need to be monitored for abnormalities. This is because there's a risk of the electrical impulses that control the heartbeat travelling too slowly through the heart. In some people, the condition can also cause cataracts to develop at a younger age than usual.

Life expectancy for people with myotonic dystrophy can vary considerably. Many people have a normal life expectancy, but people with the more severe congenital form (present from birth) may die while still a newborn baby, or only survive for a few years.

Some people who first develop symptoms as a child or teenager may also have a shortened life expectancy. Most deaths related to myotonic dystrophy are related to pneumonia, breathing problems or heart problems.

If you have myotonic dystrophy, it's important that you're well informed about your condition, and that you tell any healthcare professionals you see that you have it. Myotonic dystrophy can cause difficulties with general anaesthetics and childbirth.

Facioscapulohumeral muscular dystrophy

Facioscapulohumeral MD can affect both men and women. It tends to affect men slightly more than women, although the reason for this is unclear. Men also tend to be affected earlier and more severely.

About 1 in 3 people with facioscapulohumeral MD are unaware of any symptoms until well into adulthood. Others develop problems in early childhood. The condition tends to progress slowly.

Signs in your child may include:

• sleeping with their eyes slightly open
• an inability to squeeze their eyes tightly shut
• an inability to purse their lips – for example, to blow up balloons

Teenagers or adults may have shoulder aches, rounded shoulders or thin upper arms. As the condition progresses, it usually affects the muscles in the:

• face (facio)
• shoulders (scapula)
• upper arms (humeral)
• upper back
• calves

Around half of all people with facioscapulohumeral MD develop weakness in their leg muscles, and 1 or 2 in every 10 people with the condition will eventually need a wheelchair.

Facioscapulohumeral MD can develop unevenly, so the muscles on one side of the body may be affected more than the other. As the condition progresses slowly, it doesn't usually shorten life expectancy.

Becker muscular dystrophy

Like Duchenne MD, Becker MD mostly affects boys. Becker MD also affects similar areas of the body to Duchenne MD, although the symptoms tend to be less severe.

Symptoms of Becker MD usually begin in childhood, but they're often relatively mild at this point. For example, a child with the condition may:

• learn to walk later than usual
• have muscle cramps when exercising
• struggle with sports at school

During late childhood or early adulthood, people with Becker MD often find they have difficulty running, walking quickly and climbing stairs. As they get older, they may also find lifting objects above waist height difficult. 

Most people with Becker MD will be able to walk into their 40s and 50s but often find they need to use a wheelchair as their condition progresses.

If you have Becker MD, you're also at risk of developing dilated cardiomyopathy and breathing problems. However, Becker MD progresses at a slower rate than Duchenne MD, and those with the condition often have a normal lifespan.

Limb-girdle muscular dystrophy

Limb-girdle MD refers to a number of related conditions that cause weakness in the big muscle groups at the base of the arms and legs (around the shoulders and hips).

The first symptoms are often mobility problems affecting the hip girdle. It then progresses to the shoulder girdle ("girdle" means the bones around the shoulder or hip).

Symptoms of limb-girdle MD usually begin in late childhood or early adulthood, although the condition can affect people younger or older than this, depending on the specific type. Males and females are equally affected.

If you have limb-girdle MD, you may experience:

• muscle weakness in your hips, thighs and arms
• loss of muscle mass in the affected areas
• back pain 
• heart palpitations or irregular heartbeats 

The muscle weakness will create problems such as difficulty lifting objects, running or getting out of a low seat.

How quickly limb-girdle MD progresses depends on the specific type. Many types get worse slowly, whereas others can develop more rapidly.

Oculopharyngeal muscular dystrophy

In oculopharyngeal MD, symptoms aren't usually apparent until a person is around 50 years old. It affects the muscles in the eyes (ocular) and the throat (pharyngeal).

Symptoms of oculopharyngeal MD can include:

• droopy eyelids
• difficulty swallowing (dysphagia)
• progressive restriction of eye movement as the eye muscles become affected
• limb weakness around the shoulders and hips

As the eyelids droop, they can cover the eyes and impair vision. It's also possible to develop double vision.

Dysphagia can eventually make it difficult to swallow solid foods, liquids and even small amounts of saliva. This can lead to chest infections if food and drink is accidentally swallowed the "wrong way" into the lungs. However, with treatment to manage the symptoms, a person's life expectancy isn't usually altered.

Emery-Dreifuss muscular dystrophy

People with Emery-Dreifuss MD often begin to develop symptoms during childhood or adolescence.

In the early stages, people with the condition usually develop muscle contractures (where the muscles and tendons become shortened and tightened, limiting the range of movement at nearby joints).

Areas commonly affected by muscle contractures include the arms, neck and feet. This means that people with Emery-Dreifuss MD may have difficulty straightening their elbows or bending their neck forward, for example.

Like all types of MD, Emery-Dreifuss MD also causes progressive muscle weakness, usually beginning in the shoulders, upper arms and lower legs. This can make it difficult to lift heavy objects or raise your arms above your head, and you may have an increased tendency to trip over things.

Later on, the hip and thigh muscles become weaker, making activities such as walking up stairs difficult. People with Emery-Dreifuss MD will often eventually require a wheelchair, as they become unable to walk.

Emery-Dreifuss MD can also affect the heart's electrical signals, causing heart block. This can result in people with the condition developing an abnormally slow heartbeat and palpitations, which can lead to episodes of lightheadedness or fainting. The slow heartbeat can often be treated successfully with an implanted pacemaker.

Due to the risk of serious heart and respiratory problems, someone with Emery-Dreifuss MD will often have a shortened life expectancy. However, most people with the condition live until at least middle age.

In most cases, muscular dystrophy (MD) runs in families. It usually develops after inheriting a faulty gene from one or both parents.

MD is caused by mutations (alterations) in the genes responsible for healthy muscle structure and function. The mutations mean that the cells that should maintain your muscles can no longer fulfil this role, leading to muscle weakness and progressive disability.

Inheriting muscular dystrophy

You have two copies of every gene (with the exception of the sex chromosomes). You inherit a copy from one parent, and the other copy from the other parent. If one or both of your parents has a mutated gene that causes MD, it can be passed on to you.

Depending on the specific type of MD, the condition can be a:

• recessive inherited disorder
• dominant inherited disorder
• sex-linked (X-linked) disorder

In a few cases, the genetic mutation that causes MD can also develop as a new event in the family. This is known as a spontaneous mutation. Examples include:

A recessive inherited disorder

If you have a recessive inherited disorder, it means you've inherited an altered version of the gene that causes the condition from both of your parents (both your copies of the gene are altered).

If a child only inherits an altered version of the gene from one parent, they'll become a carrier of the condition. This means they're not affected, but there's a chance that any children they have will be if their partner is also a carrier.

If both parents carry an altered version of the gene that causes the condition, there's a:

• 1 in 4 chance their child will have MD
• 1 in 4 chance their child will be healthy but carry the mother's faulty gene
• 1 in 4 chance their child will be healthy but carry the father's faulty gene
• 1 in 4 chance their child will be healthy (won't inherit any mutated genes)

Some types of limb-girdle MD are inherited in this way.

A dominant inherited disorder

A dominant inherited disorder means you only need to inherit the mutated gene from one parent to be affected.

This means that if you have a child with an unaffected partner, there's still a 50% chance of your child developing the condition.

Types of MD inherited in this way include myotonic dystrophy, facioscapulohumeral MD, oculopharyngeal MD and some types of limb-girdle MD.

A sex-linked (X-linked) disorder

Chromosomes are long, threadlike structures of DNA. A male has one X and one Y sex chromosome, and a female has two X chromosomes.

A sex-linked disorder is caused by a mutation in a gene on the X chromosome. As males only have one copy of each gene on the X chromosome, they'll be affected if one of those genes is mutated.

As females have two copies of the X chromosome, they're less likely to develop an X-linked condition, because the normal copy of the chromosome can usually cover for (mask) the altered version. 

Females can still be affected by X-linked disorders, but the condition is usually less severe than when the gene alteration is present in an affected male.

Types of MD inherited in this way include Duchenne MD and Becker MD, which is why these conditions are more common and more severe in males.

Spontaneous gene mutations

Spontaneous gene mutations can occasionally cause MD. This is where the genes mutate for no apparent reason, changing the way the cells function. Spontaneous gene mutations can cause MD to develop in people who don't have a family history of the condition.

Another way a child with no family history can be affected is when the condition is recessive. The gene mutations may have been present on both sides of the family for many generations but may not have affected anyone until a child inherited a copy of the altered gene from both parents.

Genes and chromosomes

Genes are units of DNA that determine many of your body's characteristics, such as the colour of your hair and eyes.

Genes are found on strands called chromosomes. Each cell in the body contains 23 pairs of chromosomes, which carry the genes you inherit from your parents.

One chromosome from each pair is inherited from the mother and one from the father.

Read more about genetics.

Many different methods can be used to diagnose the various types of muscular dystrophy (MD).

The age at which MD is diagnosed will vary, depending on when the symptoms first start to appear.

Diagnosis will involve some or all of the following stages:

• investigating any symptoms
• discussing any family history of MD
• physical examination
• blood tests
• electrical tests on the nerves and muscles
• a muscle biopsy (where a sample of tissue is removed for testing)

In the first instance, visit your GP if you or your child have any symptoms of MD. If necessary, your GP may refer you to a hospital for further tests.

Investigating symptoms

Your GP will need to know about any symptoms of MD that you or your child have noticed and when they began to appear. For example, you or your child may be:

• finding it difficult to climb the stairs
• unable to play sports as you used to
• finding it difficult to lift objects

Identifying when symptoms first appeared and determining which muscles are affected is particularly useful in helping to diagnose different types of MD.

Symptoms in young children

Duchenne MD is the most common type of MD in boys. Symptoms can be present from birth, but this is unusual. Signs usually appear between 12 months and 3 years of age. You may notice that your child has difficulty walking or climbing stairs, or that they fall down more frequently than other children.

Your child may also find it difficult to stand up from sitting on the floor. They may use what's known as Gowers' manoeuvre to do this. This is where a child stands up by:

• facing the floor
• placing their feet wide apart
• lifting their bottom first
• using their hands to "walk up" their legs by first placing their hands on their knees and then on their thighs

Visit your GP if you suspect your child may have MD. Your GP will look at the following when they examine your child:

• the way your child stands
• the way your child walks – children with Duchenne MD often have a "waddling" style of walking; later on, they may tend to stand and walk on the front part of their foot, with their heels off the ground
• whether your child has an exaggerated inward curve of their lower back – the medical term for this is lordosis, although it's sometimes called "sway back"
• whether your child has a sideways curvature of their spine, known as scoliosis
• whether your child's calves and other leg muscles look large compared with other muscles

Family history

If there's a history of MD in your family, it's important to discuss it with your GP. This can help to determine which type of MD you or your child might have.

For example, discussing the family history of limb-girdle MD will help your GP determine whether your type of MD is inherited as a recessive or a dominant condition (see causes of MD for more information).

Blood tests

A sample of blood may be taken from a vein in your or your child's arm to test it for creatine kinase (a protein usually found in muscle fibres).

When muscle fibres are damaged, creatine kinase is released into the blood. The muscle damage caused by some types of MD means that the level of creatine kinase in the blood will often be higher than normal.

A blood sample may also be used for genetic testing, and this can sometimes identify the cause of muscle problems without the need for a muscle biopsy.

Muscle biopsy

A muscle biopsy involves removing a small sample of muscle tissue through a small cut (incision), or using a hollow needle, so it can be examined under a microscope and tested for proteins. The sample will usually be taken from the leg or arm, depending on the type of MD.

Analysing the protein in the muscle can help to determine which gene is causing MD and therefore which type of MD you have. For example, people with Duchenne MD and Becker MD have too little of the protein dystrophin in their muscles and it's usually an altered size.

Examining the muscle tissue under a microscope can also help to diagnose limb-girdle MD. Healthy muscle consists of closely packed, evenly sized fibres. In people with limb-girdle MD, these fibres may be missing, may be different sizes or may have been replaced with fat.

Other tests

A number of other tests can be used to find out more about the spread and extent of any muscle damage. This will help your doctor to identify or confirm which type of MD you have. Treatment can then be directed where it's most needed. Some tests include:

• Nerve conduction studies and electromyography (EMG) – tests used to examine the electrical activity in nerves and muscles at rest and when the muscles are contracting. This can help to determine whether the underlying problem is in the spinal cord, in the muscles themselves, or in the nerves carrying impulses between the spinal cord and the muscles.
• MRI scan – a test that uses a strong magnetic field and radio waves to produce detailed pictures of the inside of your body. This can help to identify the affected muscles and will also show the extent of any muscle damage.
• CT scan – where a series of X-rays are taken to create a detailed image of the inside of your body, which will reveal any muscle damage.
• Chest X-ray – this can be useful for looking for breathing or heart symptoms, as it will show up any abnormal enlargement of the heart, plus any fluid in or around the lungs.
• Electrocardiogram (ECG) – where electrodes (flat metal discs) are attached to the arms, legs and chest to measure the electrical activity of the heart. This is used to check for an irregular heartbeat and reveal any damage.
• Echocardiogram – a scan of the heart using sound waves. It gives a clear picture of the heart muscles and valves, so the heart structure and function can be checked.

Genetic testing

Once the doctor – usually a geneticist or neurologist – has an idea about what type of MD may be affecting you or your child, they may arrange genetic testing to look into this.

Genetic testing is simpler for some types of muscle conditions, so it may be arranged at an early stage if a specific condition is suspected, or after many other tests if it's more difficult to diagnose.

There are many different genes that could potentially be responsible for MD, so it would be expensive and time-consuming to test them all. However, genetic testing can sometimes confirm a diagnosis.

For example, if you're diagnosed with Duchenne MD, tests can be carried out to check for a mutation in the dystrophin gene, because mutations in this gene are directly responsible for the condition.

Genetic testing can also be used to identify carriers of MD and to perform prenatal diagnosis (when a foetus is diagnosed before the baby is born).

There's currently no cure for muscular dystrophy (MD), but a variety of treatments can help to manage the condition.

As different types of MD can cause quite specific problems, the treatment you receive will be tailored to your needs. As your symptoms develop, the healthcare professionals treating you will advise on the options.

New research is investigating possible future treatments. Improved genetic testing can help if you're concerned about passing MD on to your children.

Mobility and breathing assistance

As MD progresses, it weakens your muscles and you gradually begin to lose mobility and strength. These physical problems can be helped with:

• low-impact exercise, such as swimming
• physiotherapy, which can be useful for maintaining muscle strength, preserving flexibility and preventing stiff joints
• physical aids, such as a wheelchair, leg braces or crutches, which can help you stand and stay mobile
• occupational therapy, which can help maximise or improve your independence by using different techniques, changing your environment and providing any necessary assistive equipment

Once the chest muscles become too weak to control breathing properly, you may need machines to assist with your breathing and coughing, particularly while sleeping.

Steroid medication

In people with Duchenne MD, corticosteroid medication (steroids) has been shown to improve muscle strength and function for 6 months to 2 years, and slow down the process of muscle weakening.

Steroid medication for Duchenne MD is available in tablet or liquid form, and current research suggests a daily dose is most effective. However, long-term use of steroids is associated with significant side effects such as weight gain and excessive hair growth.

Ataluren

Ataluren is a newer medicine that has been developed to treat some children with Duchenne MD aged 5 or older who can still walk.

Ataluren comes as granules provided in sachets. The contents of each sachet are mixed into liquids or semi-solid food (such as yoghurt) and then swallowed.

For more information read the NICE guidance on ataluren for treating Duchenne MD.

Creatine supplements

Recent research has also shown that a creatine supplement can improve muscle strength in some people with MD, while causing few side effects.

Creatine is a substance normally found in the body that helps supply energy to muscle and nerve cells. It's often available as a supplement from pharmacies and health food stores.

If you have MD and decide to take creatine supplements, make sure you mention this to your doctors (GP and specialist).

Treating swallowing problems

People with some types of MD find swallowing increasingly difficult as the condition progresses. This is known as dysphagia and it can increase your risk of choking or developing a chest infection, if food and liquid get into the lungs.

Depending on the severity of your swallowing problems, there are a number of treatments that can be used. For example, a dietitian may help you alter the consistency of your food and you may be taught some exercises by a speech and language therapist to improve your swallowing.

If necessary, surgery can also be used to treat swallowing problems. This may involve a minor procedure to cut one of the muscles in your throat, or a small balloon may be inflated in your gullet (oesophagus) to expand it.

If MD progresses to a point where you're unable to get enough nutrition by swallowing, a feeding tube (gastrostomy or PEG) may need to be surgically implanted into your stomach through your abdomen (tummy).

Treating heart complications

Some types of MD can affect the heart muscles and the muscles used for breathing. When the condition has progressed to this stage, it can become life-threatening.

It's important that your heart function is assessed regularly once MD has been diagnosed. For Duchenne and Becker MD, an electrocardiogram (ECG) examination of heart rhythm will be carried out at regular intervals, and you may also have an echocardiogram from time to time. An MRI scan may also be used to check for heart problems.

If any damage to your heart is detected, you may be referred to a cardiologist (heart specialist) for further tests and possibly more frequent monitoring.

You may be prescribed medication to treat your heart problems, such as ACE inhibitors to relax your arteries and make it easier for your heart to pump blood around your body, or beta-blockers to control irregular heartbeats (arrhythmias or dysrhythmias).

In some cases of myotonic or Emery-Dreifuss MD, a pacemaker may be fitted to correct an irregular heartbeat. A pacemaker is a small battery-operated device that can be implanted into your chest to regulate your heartbeat.

Corrective surgery

In some severe cases of MD, surgery may be necessary to correct physical problems that can occur as a result of the condition.

For example, if your child has Duchenne MD, there's a chance they'll develop scoliosis. Surgery can correct the scoliosis or prevent it getting worse, although there haven't been any trials to evaluate its effectiveness.

Other kinds of surgery may be used to treat specific symptoms:

• droopy eyelids can be lifted away from the eyes to improve vision
• tight joints caused by tendon contractures can be loosened to improve movement by lengthening or releasing the tendons
• weak shoulder muscles may be improved by surgically fixing the shoulder blades to the back of the ribs (scapular fixation) – however, there haven't been any trials to evaluate the effectiveness of this treatment

If you or your child may benefit from having surgery, you'll be referred to a specialist to discuss the procedure and the risks involved.

Research into treatments

New ideas for MD treatments are currently being developed.

Speak to your GP or specialist if you're interested in taking part in a clinical trial (a form of research that tests one treatment against another). You can also browse the database of clinical trials for MD.

Your GP or the healthcare professional treating you may know of any recent developments in healthcare that may benefit you.

Some examples of current research ideas include:

Exon skipping

Trials are now in progress in the UK and the Netherlands to see if "exon skipping" may be a useful way of treating Duchenne MD. Exons are sections of DNA that contain information for proteins.

In Duchenne and Becker MD, some of the exons are missing or duplicated, which can interfere with the dystrophin protein being produced.

Researchers are currently investigating ways of "skipping" additional exons in the dystrophin gene. This could mean that more dystrophin would be produced, reducing the severity of MD symptoms.

Current trials are focused on treatment that would apply to Duchenne MD, but it may become applicable to Becker MD in the future.

Stem cell research

Stem cells are cells that are at an early stage of development. This means they have the ability to turn into any type of cell in the body.

Some research is currently focusing on whether stem cells can be turned into muscle cells and used to regenerate damaged muscle tissue.

Support groups

Muscular dystrophy can affect you emotionally as well as physically. Support groups and organisations may help you understand and come to terms with your condition. They can also provide useful advice and support for people who care for those with MD.

There are several national charities that offer support for people affected by MD, such as Muscular Dystrophy UK. You can also ask your GP or other healthcare professional treating you about support groups in your local area.