I read the recent publication on bedside diagnosis of ripping muscle disease with great interest. Sundblom et al. concluded that "The presence of percussion-induced muscle mounding and percussion-induced rapid contractions seems to be diagnostic at all ages, whereas the absence of hyperCKemia and rippling does not exclude the diagnosis." I have some comments on this work. First, Sundblom et al. studied phenotype and genotype to reach this conclusion. Indeed, the final conclusion requires a proven phenotype and genotype correlation as supporting evidence. It is still unknown whether the genotype can occur without significant correlation with phenotype. Second, there is no evidence for diagnostic performance (sensitivity and specificity) of the proposed new method by Sundblom et al. Third, the proposed system might not be an actual bedside diagnosis-it can only be a "clue" for further investigation.
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