Muscular Changes

Written by Dr. D. Rao

MUSCULAR CHANGES


After death, the muscles of the body pass through three stages-
  1. Primary relaxation or flaccidity.
  2. Rigor mortis or cadaveric rigidity.
  3. Secondary relaxations(Flacidity).

Primary Flaccidity:
During this stage, death is only somatic and it lasts for one to two hours. All the muscles of the body begin to relax soon after death. the lower jaw falls, eyelids loose tension, and joints are flexible. Body flattens over areas which are in contact with the surface on which it rests. Muscular irritability and response to mechanical or electrical stimuli persists. Peristalsis may occur in the bowel, and ciliary movement and movement of white cells may continue. Anaerobic chemical processes may continue in the tissue cells, e.g., the liver cells may dehydrogenate ethyl alcohol to acetic acid, and complex chemical changes may occur in the muscles. Pupils react to atropine or physostigmine. Muscle protoplasm is slightly alkaline.

RIGOR MORTIS


This is a state of stiffening of muscles, sometimes with slight shortening of the fibres. Individual cell death takes place in this stage.

Mechanism:
A voluntary muscle consists of bundles of long fibres. Each fibre is formed of densely packed myofibrils are the contractile elements, and are made up of protein filaments of two types, actin filaments and myosin filaments which form a loose physico-chemical combination called actomyosin, which is physically shorter than the two substances uncombined. In the relaxed condition, the actin filaments interdigitate with the myosin filaments only to a small extent. Under the influence of the nerve impulse, the arrays of actin filaments are drawn into the arrays of myosin filaments, rather like pistons into cylinders.They are energy dependent(ATP) This causes the muscle to contract.Rigor persists until decomposition(Absence of energy production ATP) of the proteins of the muscle fibres makes them incapable of any further contraction. The muscles then soften and relax.


The order of appearance of rigor:
All muscles of the body, both voluntary and involuntary are affected. It first appears in involuntary muscles; the myocardium becomes rigid in an hour. It begins in the eyelids, neck and lower jaw and passes upwards to the muscles of the face, and downwards to the muscles of the chest, upper limbs, abdomen and lower limbs.  Such a sequence is not constant, symmetrical or regular. In individual limbs, it disappears in the same order in which it has appeared. Rigor mortis always sets in, increases and decreases gradually.


Shapiro [1950] suggests that rigor mortis does not follow the anatomical sequence usually described. He suggests that as rigor mortis is a physico-chemical process, it is most likely to develop simultaneously in all the muscles, although the changes are more easily first detected in the smaller masses than in the larger. The proximo-distal progression is more apparent than real, for the sequence is determined by the bulk and kind of muscle involved. This would explain the fixation of elbow or knee joints at an earlier stage than the shoulder or hip joints, but this does not explain why the small muscles of the fingers and toes should be the last to stiffen.


When rigor is fully developed, the entire body is stiff, the muscles shortened, hard and opaque; knee, hips, shoulders and elbows are slightly flexed and fingers and toes often show a marked degree of flexion. Rigor of erector pilae muscles attached to the hair follicles, may cause roughness, pimpling or goose-flesh appearance of the skin with elevation of the cutaneous hairs, known as cutis anserine or goose skin. the testes may be drown up into the groin; semen may be forced out of the seminal vesicles, and the pupils may be partially contracted. Rarely, if the uterus is in labour at the time of death, the rigor mortis may cause the uterus to contract and expel the foetus.


Rigor is tested by trying to lift the eyelids, depressing the jaw, and gently bending the neck and various joints of the body. Note the degree [complete, partial or absent] and distribution. Before rigor mortis develops, the body can be moved to any posture, and te rigor will fix in that posture. When rigor is developing the extremities can be moved and the rigor, temporarily overcome, develops later and fixes the extremities in their new position, although the rigidity will be less than out symmetrical groups, which have not been disturbed.  If force is applied when rigor is fully developed, stiffness is broken up permanently and the rigid muscles may show post-mortem ruptures. Frequent handling of the body breaks the rigor in certain places, leaving a patchy distribution. The contraction of the heart muscle due to rigor mortis should not be mistaken for myocardial hypertrophy. Secondary muscular flaccidity may result in distension of the atria or ventricles, which should not be mistaken for ante-mortem dilatation of the chambers, or myocardial degeneration. Because of these post-mortem changes, it is not possible to determine at autopsy whether a heart has stopped in systole or diastole. The development of rigor is concerned with muscles only. It is independent of the integrity of the nervous system, though it is said to develop more slowly in paralysed limbs.


Time of onset:
In Jamaica, it begins one to 2 hours after death and takes further one to 2 hours to develop. In temperate countries, it begins in 3 to 6 hours and takes further 2 to 3 hours to develop.


Duration of rigor mortis:
In Jamaica, usually it lasts 18 to 24 hours in winter and 12 to 18 hours in summer. It lasts for 2 to 3 days in temperate regions. When rigor sets in early, it passes off quickly and vice versa.


Conditions altering the onset and duration:

  1. Age: Rigor does not occur in a foetus of less than seven months, but is commonly found in stillborn infants at full term. In healthy adults, it develops slowly but is well-marked, while in children and old people it is feeble and rapid.
  2. Nature of Death: In deaths from diseases causing great exhaustion and wasting, e.g., cholera, typhoid, tuberculosis, cancer, etc. and in violent death as by cut-throat, firearms or by electrocution, the onset of rigor is early and duration is short. In strychnine and other spinal posions, the onset is rapid and the duration longer. In deaths from asphyxia, severe haemorrhage, apoplexy, pneumonia, nervous disease causing paralysis of muscle, and perfusion with normal saline, the onset is delayed. It may disappear very rapidly in case, of widespread bacterial infection, especially in gas gangrene, where putrefaction begins early.
  3. Muscular State: The onset is slow and the duration long in case where muscles are healthy and at rest before death. The onset is rapid, if there is fatigue or exhaustion before death. In persons who run prior to death, rigor may develop rapidly in their legs, compared to other parts. After insulin injection it develops quickly, as the muscle glycogen is reduced.
  4. Atmospheric conditions: The onset is slow and duration long in cold weather. The onset is rapid due to heat, because of the increased breakdown of ATP but the duration is short. If the body is in an extremely hot environment and decomposition begins, rigor mortis may disappear in 12 hours after death. it may persist for 3 to 4 days in refrigerated conditions.

 

Conditions simulating rigor mortis:

  1. Heat stiffening: When a body is exposed to temperatures above 65oC, a rigidity is produced, which is much more marked than that found in rigor mortis.The stiffening remains until the muscles and ligaments soften from decomposition and the normal rigor mortis does not occur.
  2. Cold stiffening: When a body is exposed to freezing temperatures, the tissues becomes frozen and stiff, due to freezing of the body fluids and solidification of subcutaneous fat simulating rigor. It the body is placed in warm atmosphere, the stiffness disappears and after a time, the normal rigor mortis occurs.
  3. Cadaveric spasm or instantaneous rigor: Cadaveric spasm [cataleptic rigidity] is a rare condition. In this, the muscles that were contracted during life bcome stiff and rigid immediately after death without passing into the stage of primary relaxation. As such, the change preserves the exact attitude of the person at the time of death for several hours afterwards. It occurs especially in case of sudden death, excitement, fear, sever pain, exhaustion, cerebral heaemorrhage, injury to the nervous system, firearm wound of the head, etc. the spasm is primarily vital phenomenon, In that it originates by normal nervous stimulation of the muscles. This is usually limited to a single group of muscles and frequently involves the hands. Occasionally, the whole body is affected as seen in soldiers shot in battle, when the body may retain the posture which it assumed at the moment of death. no other condition simulates cadaveric spasm and it cannot be produced by any method after death. very great force is required to overcome stiffness. It passes without interruption into normal rigor mortis and disappears when rigor disappears.

 

The nature of cadaveric spasm is obscure, but like rigor mortis, it may be explained on the basis of diminished or exhausted ATP in the affected muscles. The persistence of contraction after death may be due to the failure of the chemical processes required for active muscular relaxation to occur during molecular death. adrenocortical exhaustion which impairs resynthesis of ATP may be a possible cause. It differs only in the speed of onset and the circumstances in which it occurs.


This condition is of great medico-legal importance. Occasionally, in case of suicide the weapon, e.g. pistol or knife is seen firmly grasped in the victim’s hand which is a strong presumptive evidence of suicide. Attempts may be made to simulate this condition in order to conceal murde3r. but, ordinary rigor does not produce the same firm grip of a weapon, and the weapon may be placed in the had in a way which could not have been used by a suicide. If the deceased dies due to assault, some part of clothing , e.g. button of his assailant or some hair may be firmly grasped in the hands. In case of drowning, material such as grass, weeds or leaves may be found firmly grasped in the hands, which indicates that the victim was alive on the entering the water.


Secondary relaxation: Muscles become soft and flaccid due to breaking down of actomyosin due to putrefaction. The reaction of muscle juice again becomes alkaline.