A rare genetic neuromuscular disease characterized by proximal muscle weakness with an early involvement of foot and hand muscles following normal motor development . A person who needs to stay in bed due to a medical condition may also experience muscle weakness. Proximal forms of progressive spinal amyotrophy. Patients with vital capacity < 15 mL/kg or inspiratory force < 20 cm H2O are at increased risk. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). The term muscle weakness can be used to describe several different things. Examples of medications that can cause muscle weakness include: Some illicit drugs, such as cocaine, can also cause muscle weakness. You can learn more about how we ensure our content is accurate and current by reading our. 2013 May;39(2):457-79. doi: 10.1016/j.rdc.2013.02.006. Copyright 2023 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. Can J Neurol Sci. Initial tests usually include some combination of a complete blood count (CBC), electrolytes (including calcium and magnesium), glucose, kidney and liver function tests, thyroid-stimulating hormone (TSH), erythrocyte sedimentation rate (ESR), and hepatitis C serologic testing. Regular crack cocaine use can also cause chronically moderately elevated CK levels (mean value, 400 IU/L). Usually, lesions in a given location manifest with similar clinical findings. Glucocorticoid-induced myopathy. If patients have hyperreflexia and increased muscle tone (spasticity), particularly if Babinski reflex is present, suspect an upper motor neuron (eg, corticospinal tract) lesion in the brain or spinal cord; MRI is usually required. Each form of muscular dystrophy is caused by a genetic mutation particular to that type of the disease. Other conditions that may cause muscle weakness include: Muscle weakness can also be caused by complications from certain viruses and infections, including: Botulism, a rare and serious illness caused by Clostridium botulinum bacteria, can also lead to muscle weakness. Distal muscle weakness impairs tasks such as stepping over a curb, holding a cup, writing, buttoning, or using a key; this pattern is typical of polyneuropathies and myotonic dystrophy. This can produce muscle weakness. Muscle weakness is a lack of strength in the muscles. Relative basal myocardial weakness: differentiating dermatomyositis and polymyositis with cardiac involvement from viral myocarditis using speckle-tracking echocardiography and quantification of myocardial work. Accessed Dec. 21, 2019. What are the causes of unexplained muscle aches? The tear causes pain due to irritation of sensory nerves in the disk, and read more ), Spinal cord compression Spinal Cord Compression Various lesions can compress the spinal cord, causing segmental sensory, motor, reflex, and sphincter deficits. History of present illness should begin with open-ended questions, asking patients to describe in detail what they are experiencing as weakness. There is a broad range of underlying causes including drugs, alcohol, thyroid disease, osteomalacia, idiopathic inflammatory myopathies (IIM), hereditary myopathies, malignancy, infections and sarcoidosis. Motor strength is often rated on a 0 to 5 scale: 1: Visible muscle contraction with no limb movement, 3: Movement against gravity but not resistance. Fatigue may persist weeks or read more ), endocrine disorders, renal failure Chronic Kidney Disease Chronic kidney disease (CKD) is long-standing, progressive deterioration of renal function. information is beneficial, we may combine your email and website usage information with You may opt-out of email communications at any time by clicking on However, needlestick artifact can mimic muscle pathology and must be avoided; thus, biopsy should never be done in the same muscle tested by electromyography. Unexplained proximal muscle weakness in patients can occur in some neurologic conditions and can be easily missed during exams that only focus on distal strength. Epub 2020 Oct 29. Cranial nerve examination How to Assess the Cranial Nerves (See also Neuro-ophthalmologic and Cranial Nerve Disorders and Introduction to the Neurologic Examination.) Learn more about the Merck Manuals and our commitment to Global Medical Knowledge. Box 1 Common Causes of Myopathy Acquired Myopathies Inflammatory Myopathy Polymyositis Dermatomyositis Inclusion body myositis Infection Viral infections (HIV, influenza virus, Epstein-Barr virus) Bacterial pyomyositis ( Staphylococcus aureus and streptococci are common organisms) Spirochete (Lyme disease) Parasitic infections such as trichinosis Accessed Dec. 21, 2019. Botulism may occur without infection if toxin is ingested, injected, or inhaled read more , organophosphate poisoning Organophosphate Poisoning and Carbamate Poisoning Organophosphates and carbamates are common insecticide ingredients that inhibit cholinesterase activity, causing acute muscarinic manifestations (eg, salivation, lacrimation, urination, diarrhea read more ). If patients have difficulty climbing stairs, combing hair, and standing up with predominantly proximal muscle weakness and intact sensation, suspect myopathy. It can cause nerve damage that may result in muscle weakness. If deep tendon reflexes appear absent, they may be elicited by augmentation with Jendrassik maneuver (eg, trying to pull the hands apart while they are clasped together). https://www.ninds.nih.gov/Disorders/All-Disorders/Muscular-Dystrophy-Information-Page. HHS Vulnerability Disclosure, Help Management depends on underlying cause, and includes measures, such as removal of offending agent, correction of endocrine or metabolic problem, corticosteroids and immunosuppressive therapy for IIM, and physical therapy, rehabilitation and genetic counselling for muscular dystrophies. Weakness and fatigue tend to cause different symptoms: Weakness: Patients typically complain that they cannot do specific tasks. Specific for facioscapulohumeral dystrophy. Breathing becomes difficult because the muscles of the respiratory system weaken. In: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. Voluntary movement is initiated in the cerebral motor cortex, at the posterior aspect of the frontal lobe. It could be coming from your latissimus dorsi. If myopathy is suspected (suggested by muscle weakness, muscle cramping, and pain), muscle enzymes (eg, creatine kinase [CK], aldolase, lactic dehydrogenase [LDH]) may be measured. of 15 adult cancer patients, 9 developed proximal muscle weakness . Tests done to determine the location and mechanism of weakness depend on clinical findings. Your healthcare provider will also ask about other symptoms and your family medical history. Di Stasi S, et al. Evaluation of the patient with weakness. 8600 Rockville Pike 2022 Jul;12(7):3762-3777. doi: 10.21037/qims-21-1098. The link you have selected will take you to a third-party website. We avoid using tertiary references. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Tapping a muscle (eg, hypothenar) may induce fasciculations in neuropathies or a myotonic contraction in myotonic dystrophy. All rights reserved. Spastic gait is notable for scissoring (legs flexed slightly at the hips and knees, giving the appearance of crouching, with the knees and thighs hitting or crossing in a scissors-like movement) and walking on the toes. Muscle weakness happens when full effort doesnt produce a normal muscle contraction or movement. A cremasteric reflex can test the integrity of the upper lumbar cord and roots in males. Introduction to the Neurologic Examination, Amyotrophic Lateral Sclerosis (ALS) and Other Motor Neuron Diseases (MNDs), Human Immunodeficiency Virus (HIV) Infection, Cervical Spondylosis and Spondylotic Cervical Myelopathy, How to Assess Gait, Stance, and Coordination, Organophosphate Poisoning and Carbamate Poisoning, Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), Findings Related to Weakness Suggesting a Specific Disorder, Brought to you by Merck & Co, Inc., Rahway, NJ, USA (known as MSD outside the US and Canada)dedicated to using leading-edge science to save and improve lives around the world. Many health conditions can cause muscle weakness. Cushing originally. Hyporeflexia may be normal throughout life or occur with aging, but findings should be symmetric and augmentation should elicit reflexes that are otherwise absent. 2009 May;36(3):336-9. doi: 10.1017/s0317167100007083. Diagnosis read more ) and that are immune-mediated (eg, Bell palsy Facial Nerve Palsy Facial nerve (7th cranial nerve) palsy is often idiopathic (formerly called Bell palsy). For example, Weakness accompanied by upper motor signs plus other signs such as aphasia, mental status abnormalities, or other cortical dysfunction: A brain lesion, Unilateral upper motor neuron signs (spasticity, hyperreflexia, extensor plantar response) and weakness involving an arm and a leg on the same side of the body: A contralateral hemispheric lesion, most often a stroke, Upper or lower motor neuron signs (or both) plus loss of sensation below a segmental spinal cord level and loss of bowel or bladder control (or both): A spinal cord lesion. Feel pain across your back? DOI: Muscle weakness (hypotonia) in children. Proximal myopathy presents as symmetrical weakness of proximal upper and/or lower limbs. Childhood/early adult (more frequent phenotype ): myopathy and hypertrophic/dilated cardiomyopathy. Treatment is mainly supportive read more , heart failure Heart Failure (HF) Heart failure (HF) is a syndrome of ventricular dysfunction. NINDS hypotonia information page. An official website of the United States government. You can learn more about how we ensure our content is accurate and current by reading our. Many disorders (eg, chronic inflammatory demyelinating polyneuropathy Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) Chronic inflammatory demyelinating polyneuropathy is an immune-mediated polyneuropathy characterized by symmetric weakness of proximal and distal muscles and by progression continuing > 2 months read more , Guillain-Barr syndrome Guillain-Barr Syndrome (GBS) Guillain-Barr syndrome is an acute, usually rapidly progressive but self-limited inflammatory polyneuropathy characterized by muscular weakness and mild distal sensory loss. Other symptoms may be present depending on the cause. It also detects other causes of paralysis that may mimic myelopathy, including lesions of the cauda equina, spinal roots, and brachial and lumbosacral plexuses. Some infectious diseases can cause muscle weakness. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Created by Dr Jen Wei Ying, Dr Chee Yen Lin and Dr Cheong May Anne. It is more common among read more typically causes fluctuating weakness that worsens with activity and lessens with rest. Enter search terms to find related medical topics, multimedia and more. If a persons muscle weakness is not due to any of the issues above, or if they have particular risk factors, a doctor may consider rare causes when making their diagnosis. CT is used when MRI testing is not possible (eg, in patients with a cardiac pacemaker). 2014 Jan;36(1):84-7. doi: 10.1016/j.braindev.2012.11.014. For example, cardiopulmonary dysfunction or anemia can cause fatigue due to dyspnea or exercise intolerance. Muscle weakness is sneaky. Weakness is loss of muscle strength, although many patients also use the term when they feel generally fatigued or have functional limitations (eg, due to pain or limited joint motion) even though muscle strength is normal. Learn about weakness in legs and when to see a, Muscle stiffness is when the muscles feel tight and difficult to move. The anatomic pattern of weakness is characterized by specific motor tasks that are difficult to do. It is caused by oxygen deprivation to the developing brain. If you are a Mayo Clinic patient, this could If no true weakness is present, other clinical findings (eg, dyspnea, pallor, jaundice, heart murmur), if present, are used to guide testing. The history helps differentiate weakness from fatigue, defines the time course of the illness, and gives clues to the anatomic pattern of weakness. Our website services, content, and products are for informational purposes only. NINDS muscular dystrophy information page. Unauthorized use of these marks is strictly prohibited. Evaluation of weakness should try to distinguish true muscular weakness from fatigue, then check for findings that help establish the location or mechanism (eg, whether weakness is caused by dysfunction of the brain, spinal cord, plexuses, peripheral nerves, neuromuscular junction, or muscles) and, when possible, the cause. But medications and therapy can help manage symptoms and slow the course of the disease. https://www.mda.org/disease/duchenne-muscular-dystrophy. Hepatitis may be acute or chronic (usually defined as lasting > 6 months). This content does not have an Arabic version. Breathing problems in adults with neuromuscular weakness. They are distinguished from other myopathies by the absence of prominent infiltration of the muscle with inflammatory cells in the biopsies. Some decrease in deep tendon reflexes is common with aging, but asymmetry or absence of these reflexes with augmentation is abnormal. Finally, motor nerve dysfunction can manifest as muscle weakness, as motor nerves are responsible for controlling voluntary muscle movement, adds Dr. Mayberry. Brain MRI may show degeneration of the corticospinal tracts when ALS is advanced. If patients have true muscle weakness, first focus on determining whether weakness is caused by dysfunction of the brain, spinal cord, plexuses, peripheral nerves, neuromuscular junction, or muscles. Skip to content Care at Mayo Clinic Care at Mayo Clinic About Mayo Clinic Request Appointment Primary or true muscle weakness Smell, a function of the 1st (olfactory) cranial nerve, is usually evaluated only read more includes inspection of the face for gross asymmetry and ptosis; mild facial asymmetry can be normal. Duchenne muscular dystrophy (DMD). Severe proximal myopathy with remarkable recovery after vitamin D treatment. Careers. Unless the cause is obvious, routine laboratory tests (CBC, electrolytes [including calcium and magnesium], glucose, kidney and liver function tests, TSH, ESR, hepatitis C serologic testing) are usually done. CT myelography may be used when MRI testing is not available. Joint dysfunction (eg, due to arthritis) or muscle pain (eg, due to polymyalgia rheumatica or fibromyalgia) may make doing physical tasks difficult. Many patients report weakness when their problem is fatigue Fatigue Fatigue is difficulty initiating and sustaining activity due to a lack of energy and accompanied by a desire to rest. To provide you with the most relevant and helpful information, and understand which The many causes of muscle weakness are categorized by location of the lesion (see table Some Causes of Muscle Weakness Some Causes of Muscle Weakness ). Clinicians should assess risk factors for possible causes, including those for infection (eg, unprotected sexual intercourse, blood transfusions, exposure to tuberculosis) and stroke (eg, hypertension, atrial fibrillation, atherosclerosis). Specific signs and symptoms begin at different ages and in different muscle groups, depending on the type of muscular dystrophy. . Darras BT. Some tests of large, proximal muscles include standing from a sitting position; squatting and rising; and flexing, extending, and turning the head against resistance. Examples of conditions that cause muscle weakness include: This occurs when a persons adrenal glands do not produce enough of the hormones cortisol and aldosterone. Reflexes How to Assess Reflexes (See also Introduction to the Neurologic Examination) Deep tendon (muscle stretch) reflex testing evaluates afferent nerves, synaptic connections within the spinal cord, motor nerves, and descending read more are tested. These symptoms may get worse with exercise and physical activity. Elevated levels are consistent with myopathy but can also be high in neuropathies (reflecting muscle atrophy) and very high in ischemic rhabdomyolysis. Your treatment plan will depend on the underlying cause of your muscle weakness, as well as the severity of your symptoms. Causes range from, Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. How well you recover from a serious brachial plexus injury depends on a number of factors, including your age and the type, location and severity of the injury. When the brachial or lumbosacral plexus is damaged, motor, sensory, and reflex deficits are often patchy and do not follow any one peripheral nerve pattern. There is a problem with Symptoms generally begin in the teens but might not occur until the mid-20s or later. Muscular dystrophy is a group of diseases that cause progressive weakness and loss of muscle mass. In such cases, testing practices vary widely. Cerebrospinal fluid (CSF) analysis may be unnecessary for some disorders diagnosed during imaging (eg, epidural tumor) and is contraindicated if CSF block (eg, due to epidural spinal cord compression) is suspected. Accessed Dec. 23, 2019. Electrolyte imbalance [Fact sheet]. Make your tax-deductible gift and be a part of the cutting-edge research and care that's changing medicine. JM is known for causing muscle inflammation and skin rashes. Introduction (n.d.). If your brain, nervous system, muscles, or the connections between them are injured or affected by the disease, your muscles may not contract normally. If we combine this information with your protected Use for phrases This results from not using the muscles as regularly as usual. The muscle weakness associated with polymyositis can make it difficult to climb stairs or reach overhead. The .gov means its official. It also remains unclear that weakness results from disease of muscle as opposed to another part of the motor unit. Fatigue: Fatigue reported as weakness tends to have no temporal pattern (eg, tired all of the time) or anatomic pattern (eg, weak everywhere); complaints center more on being tired than on being unable to do specific tasks. Muscle atrophy. Peripheral neuropathy, a result of damage to the nerves located outside of the brain and spinal cord (peripheral nerves), often causes weakness, numbness and pain, usually in the hands and feet. Mood disorders can occur in children and adolescents (see Depressive read more, Past medical history should identify known disorders that can cause weakness or fatigue, including, Thyroid, liver, kidney, or adrenal disorders, Cancer or risk factors for cancer (paraneoplastic syndromes Paraneoplastic Syndromes Paraneoplastic syndromes are symptoms that occur at sites distant from a tumor or its metastasis. If you're still learning, here's how to whistle with, Most armpit lumps arent cause for concern. Complete paralysis accompanied by absent reflexes and severely depressed muscle tone (flaccidity) occurs in sudden, severe spinal cord injury (spinal shock). If tick paralysis is suspected, the skin, particularly the scalp, should be thoroughly inspected for ticks. If patients have hyporeflexia, decreased muscle tone, muscle atrophy, and muscle fasciculations, suspect a lower motor neuron lesion. We link primary sources including studies, scientific references, and statistics within each article and also list them in the resources section at the bottom of our articles. During that time, lack of use may cause the affected muscles to break down. sharing sensitive information, make sure youre on a federal Patients frequently confuse the terms, and the medical literature sometimes uses them interchangeably. Disclaimer. Click here for an email preview. It may cause fever, heart murmurs, petechiae, anemia, embolic read more , mononucleosis Infectious Mononucleosis Infectious mononucleosis is caused by Epstein-Barr virus (EBV, human herpesvirus type 4) and is characterized by fatigue, fever, pharyngitis, and lymphadenopathy. Evaluation should focus on reversible factors. Most cases of acute viral hepatitis read more , endocarditis Infective Endocarditis Infective endocarditis is infection of the endocardium, usually with bacteria (commonly, streptococci or staphylococci) or fungi. Fatigue is normal after physical exertion, prolonged stress, and sleep deprivation read more rather than weakness, history and physical examination focus on identifying subtle manifestations of underlying illness (particularly infections, endocrine and rheumatologic disorders, anemia, and depression) that can be used to guide testing, but testing may be unnecessary. Factors that worsen weakness, such as heat (suggesting multiple sclerosis) or repetitive use of a muscle (suggesting myasthenia gravis), are noted. Mild myopathic changes . Weakness of specific muscle groups can cause disorders of eye movement, dysarthria, dysphagia, or respiratory weakness. Cause is thought read more , myasthenia gravis, radiculopathies, Eaton-Lambert syndrome) cause proximal and distal weakness, but one pattern may be more prominent at first. OPMD may be inherited as an autosomal dominant or recessive trait. Physical and occupational therapy can help people adapt to permanent weakness and minimize loss of function, regardless of the cause. They may not contract or move as easily as before. Possible causes include a muscular dystrophy such as facioscapulohumeral dystrophy. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. and transmitted securely. Occupational therapy can be especially helpful during the stroke rehabilitation process. Having altered levels of electrolytes such as calcium, potassium, sodium, and magnesium can cause muscle weakness. There are several forms of cerebral palsy, but most cause some form of muscular weakness. People with a family history of muscular dystrophy are at higher risk of developing the disease or passing it on to their children. Disorders of the spinal cord may affect tracts from upper motor neurons, lower motor neurons (anterior horn cells), or both. A rectal examination is done to check for heme-positive stool. If patients have no objective motor weakness, the general examination is particularly important; in such patients, nonneuromuscular disorders should be sought. It could be a cyst, infection, bursitis, a lipoma, basal cell carcinoma, or a side effect of your avid tennis, Why some people can whistle easily while others struggle to make the slightest toot is a mystery. SACROILIAC JOINT PROBLEMS? Review/update the Other important findings during inspection include the moon facies of Cushing syndrome and the parotid enlargement, smooth hairless skin, ascites, and vascular spiders of chronic alcohol use. Walking on the heels is particularly difficult when corticospinal tract lesions are the cause of weakness. Review of systems should seek symptoms suggesting possible causes, including the following: Daily fatigue and weakness that increases with heat and humidity: Multiple sclerosis, Rash: Dermatomyositis Autoimmune Myositis Autoimmune myositis is characterized by inflammatory and degenerative changes in the muscles (polymyositis, necrotizing immune-mediated myopathy) or in the skin and muscles (dermatomyositis) read more , Lyme disease Lyme Disease Lyme disease is a tick-transmitted infection caused by the spirochete Borrelia species. Strength testing How to Assess Muscle Strength Patients who report weakness may mean fatigue, clumsiness, or true muscle weakness.
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