Evaluation Of The Patient With Muscle Weakness
AARON SAGUIL, CPT , MC, USA, Madigan Army Medical Center, Tacoma, Washington
Am Fam Physician. 2005 Apr 1 71:1327-1336.
The online-only version of this article offers more detailed information on additional selected causes of muscle weakness.
Muscle weakness is a common complaint among patients presenting to the family physicians office. Although the cause of weakness occasionally may be apparent, often it is unclear, puzzling the physician and frustrating the patient. A comprehensive evaluation of these patients includes a thorough examination and coordination of appropriate laboratory, radiologic, electrodiagnostic, and pathologic studies.
It is essential to consider depression as a possible diagnosis several screening tools for depression have been validated for use in outpatient settings.
Primary muscle weakness must be distinguished from the more common conditions of fatigue and asthenia.
If the diagnosis is still inconclusive after the history, physical examination, and laboratory, radiologic, and electromyographic evaluation, a muscle biopsy is required for patients who have a suspected myopathy.
A = consistent, good-quality patient-oriented evidence B = inconsistent or limited-quality patient-oriented evidence C = consensus, disease-oriented evidence, usual practice, opinion, or case series. See page 1245 for more information.
Strength of Recommendations
I Have Muscle Weakness
If you have muscle weakness and visit your doctor, they will first need to know the following:
- How it began and how long you have had it for.
- Whether it is getting worse, getting better or staying the same.
- Whether you are otherwise well, are losing weight or have travelled abroad recently.
- What medicines or other drugs you have been taking and whether there are any muscle problems in your family.
Your doctor will need to examine you to see which muscles are affected and whether you have true or perceived muscle weakness. They will check to see whether your muscles are tender to touch or unusually ‘fatigable’. They may want to watch you walk.
They will then need to test your nerves to see whether the muscles are getting the right signals to act. Your doctor may need to test your central nervous system, including your balance and co-ordination. They may need to perform blood tests to look for abnormalities of hormones, salts and blood cells.
Depending on the results of these tests your doctor may also order the following:
- Nerve studies to make sure the nerves are conducting properly.
- A muscle biopsy to see whether the muscles themselves show signs of inflammation or damage. A biopsy is a procedure where a small sample is taken to look at under the microscope.
- Body scans such as CT or MRI to look for conditions elsewhere in the body which may affect muscle power and function.
What You Can Do
Whether your muscle weakness happens because youre not as active, or its due to age or a health problem, regular exercise may help you regain some strength. Ask your doctor for advice, or consider seeing a physical therapist to help you find a healthy exercise routine. As you get older, regular exercise also can help prevent or slow muscle loss and weakening.
Harvard Health: COVID-19 Basics, Fight back against muscle weakness, Myositis.
American Family Physician: Muscle Weakness in Adults: Evaluation and Differential Diagnosis.
Clinical Cases in Mineral and Bone Metabolism: Clinical definition of sarcopenia.
Mayo Clinic: Diabetic neuropathy, Multiple sclerosis, Muscle Strains, Statin side effects: weight the benefits and risks, Symptoms of pregnancy: What happens first?
UCSF Health: Cold or Flu?
Best Practice & Research: Clinical Rheumatology: Infectious myositis.
UT Southwestern Medical Center: Life after coronavirus: PM& R helps patients beat muscle weakness, brain fog, Physical Medicine and Rehabilitation.
UpToDate: Patient education: Polymyositis, dermatomyositis, and other forms of idiopathic inflammatory myopathy.
National Institute of Neurological Disorders and Stroke: Myasthenia gravis fact sheet.
Circulation: Heart Failure: Mechanisms Underlying Skeletal Muscle Weakness in Human Heart Failure.
University of Rochester Medical Center: Myasthenia Gravis and Pregnancy.
StatPearls: Muscle strength grading.
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Healthwhy Early Coronavirus Cases May Have Been Missed
Since that report, other symptoms related to COVID-19 have emerged.
Many patients who’ve either tested positive for the coronavirus, or have been told by their physicians to assume they have it, also develop a headache and sore throat. Others become sick to their stomach with nausea or diarrhea.
Some patients say they have no interest in eating. Many report they’re losing their senses of taste and smell, the British Rhinological Society said recently.
Just this week, a small study published in JAMA Ophthalmology added another potential COVID-19 warning sign: pink eye, also known as conjunctivitis. A third of the 38 patients in the report had the inflammatory eye condition.
But it’s also becoming more clear that some infected people spreading the virus don’t have any symptoms at all.
Causes Of New Onset Muscle Weakness
- Most causes of new onset muscle weakness are serious. True weakness points to diseases of the spinal cord or its nerves. Nerves carry messages from the spinal cord to the muscles in the arms and legs. Diseases that cause muscle weakness are very rare.
- Most children with new onset weakness need special tests to make the right diagnosis. If the weakness gets worse, most children need to be admitted to the hospital.
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How Rehab Select Can Help You Or Your Loved One Recover From Covid
At Rehab Select, we deliver individualized care plans that are designed specifically to help patients suffering from post-COVID fatigue and weakness or other lingering symptoms of a COVID-19 infection that have lasted four weeks or more. Our Alabama COVID-19 Recovery Program can help you or your loved one regain your strength and get back to normal life after COVID more quickly.
Our team of physicians, nurse practitioners, physical and occupational therapists, pulmonologists, and psychologists will design a comprehensive rehab program that targets all of your post-COVID symptoms. Through our remote telehealth system, we will be able to put you in touch with health practitioners who have developed ample experience in the treatment and rehabilitation of COVID-19 patients. To find out more, please visit our website, or click here to schedule a tour of our facilities.
Lack Of Use And Overuse
According to Dr. Harding, “lack of use” may also be a cause of muscle fatigue. Lack of muscle use, or deconditioning, can happen as a result of a sedentary lifestyle. When muscles go unused, the muscle fibers are partly replaced with fat.
Consequently, muscles lose bulk and tire more easily during physical activity. For example, if your muscles are inactive, you may experience arm fatigue or forearm fatigue when lifting a heavy box or bag that may not have felt as heavy when your muscles were fit.
On the other side of lack of use, there’s overuse. Overusing your muscles during physical activity or over-training, is yet another reason why they may be fatigued. The Mayo Clinic points out that overuse can be caused by errors in training, such as taking on too much physical activity too quickly, or technique errors, which would involve using poor form. You can avoid overuse by pacing yourself, using the proper form and gear, and slowly increasing your level of activity.
Read more:The Dangers of Working Out Too Much
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How Can I Ease Or Relieve Fatigue
If a medical condition isnât causing your fatigue, lifestyle changes may improve your symptoms. To reduce fatigue, you can:
- Practice good sleep habits: Aim for seven to nine hours of sleep every night. Donât drink caffeine, use electronics, or exercise right before bed. Try to go to bed and get up at the same time every day.
- Avoid toxins: Donât use illegal drugs, and drink alcohol in moderation, if at all.
- Eat a healthy diet: A balanced diet and plenty of water will keep your body nourished and hydrated.
- Manage stress: Yoga, mindfulness, meditation and regular exercise can help you relieve stress and gain more energy.
- See your healthcare provider: Make an appointment to rule out infections, disease, illness, vitamin deficiencies and other health conditions. You should also talk to your provider about medications youâre taking to see if they are causing your symptoms.
- Exercise often: Regular exercise is crucial for a healthy lifestyle. Though it might seem counter-intuitive, vigorous exercise can help you feel more energetic once you get used to it. But exercising too much can cause fatigue, so talk to your provider about whatâs best for you.
- Maintain a healthy weight: Talk to your healthcare provider about your ideal weight, and try to stay within that range.
Weakness In Arms And Legs
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Many people are familiar with this feeling: a sudden or growing weakness in the arms and legs, when the legs seem to be “poured with lead,” and the hands can not hold even a cup of tea.
Most often, such a weakness is transient and disappears quickly enough without leaving a trace. But can you breathe a sigh of relief? Experts believe that the periodically arising weakness in the limbs can indicate quite serious problems in the body.
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What Was Underlying This Teens Sudden Fatigue And Muscle Weakness
Diabetes, Lyme disease, a mysterious virus or a rare autoimmune disease with neuromuscular consequences?
In clinic, pediatric neurologist Matt Elrick tests Erics strength, much of which he recovered with immunosuppressant therapy.
A few days after Thanksgiving 2020, Eric Lang suddenly felt muscle weakness and fatigue. He also started losing weight rapidly. A visit to the emergency room uncovered inflammation in his arms but no clear cause. Worse, two weeks later, the 17-year-old had difficulty breathing and was admitted to Johns Hopkins Childrens Center for what would become a four-week stay.
For the first 10 days, he was on a ventilator. He couldnt move, he couldnt breathe, says Erics mother, Sue Lang. This was a pretty wild time when they were trying to figure out what was going on.
Among the suspects were diabetes, Lyme disease, myositis muscle inflammation triggered by an autoimmune disease and an infection or a virus taxing Erics entire body. COVID-19 came up, but tests were negative. Myasthenia gravis , a rare chronic autoimmune disease in which antibodies attack the connections between nerves and voluntary muscles, was also on the list of possible diagnoses.
It was an unusual presentation for myasthenia to begin with, and required a number of people from different disciplines to sort out what was going on, says pediatric neurologist Matthew Elrick. And then a lot of different pieces came together at once.
Problems With Thinking Learning And Planning
Some people with MS have problems with thinking, learning and planning, known as cognitive dysfunction.
This can include:
- getting stuck on words
- problems with understanding and processing visual information, such as reading a map
- difficulty with planning and problem solving people often report that they know what they want to do, but can’t grasp how to do it
- problems with reasoning, such as mathematical laws or solving puzzles
But many of these problems aren’t specific to MS and can be caused by a wide range of other conditions, including depression and anxiety, or even some medicines.
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Weak Left Arm And Leg
Usually, if there is weakness in the left arm and leg, first of all they suspect a stroke – an acute disorder of cerebral circulation. Indeed, a characteristic symptom of this pathology is the numbness of one half of the body, in this case the left one. This is quite probable, but not the only factor that can be expressed in the weakness of the limbs. So what else can cause this condition?
- vegetative vascular dystonia, obliterating endarteritis
- disease of the left kidney, including the tumor process
- disease of the spleen
- obliterating atherosclerosis, or thromboangiitis
- diseases of the spine, including curvature of the spine, protrusion of the disc, hernia, tumor process in the spine.
It is almost impossible to diagnose such diseases without special research methods. Therefore, the doctor must necessarily send the patient to a follow-up examination to pinpoint the possible cause of weakness of the left arm and leg. If you suspect a stroke, you need to see a doctor immediately.
Fatigued & Muscle Weakness In Arms And Legs No Idea Where To Start
I don’t even know where to start other than saying I’m glad I found this site. The level of support from fellow members is very reassuring.
I’m a 37yr old male, not in the best shape but far from out of shape. I’m active, I go to the gym, I race dirt bikes, hike, and you normal every day guy. Since my 20’s I’ve had a left knee that has steadily been getting worse. Last year diagnosed as Patella Pain Syndrome. In 2014 I had a bad skydiving landing and the instructor made us land on our butts, needless to say my tailbone took the weight of both of us and I spent a year going to a chiropractor for lower pack pain and neck pain. I stopped going in fall ’15. In Oct 2015 I did a very rough dirt bike race which left me beat up, my hands were buzzing, sore back and wrists. This wasn’t abnormal and I know I’m getting older so I didn’t think anything of it however over a month later my right wrist was still sore and then at night I started waking up with my hands and feet feeling numbish . I never had the pins and needles feeling, just the numbing type feeling. It extended to my mid forearms and upper calves. I saw my PCP who told me it was probably stress related and gave me some xanax. I hate taking pills so I never took them and instead followed up with a neurologist.
Anyone else experience anything like this?
1 like, 13 replies
I have to ask a really simple question, have you had an MRI?
IM surprised your neurologist hasn’t referred you for a scan?
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My Arms Feel Heavy And Weak What Could Be A Cause Of That
Heaviness in the arms can be an unnerving and scary feeling.
You might not realize that there is something wrong at first. Perhaps you simply felt tired or fatigued. Yet the feeling doesnt seem to be going away.
Luckily, there are treatments for this problem.
You might not have cause to worry at all, or you might want to schedule an appointment with your doctor.
Find out the true meaning to your symptoms
Why Do You Feel Your Arms Heavy And Weak
- Weakness is an absence of physical or muscle strength and the feeling that extra effort is required to move your arms, legs, or other muscles. If muscle weakness is the result of pain, the individual may be able to make muscles work, but it will hurt.
- Fatigue is a feeling of tiredness or fatigue or a need to rest due to the fact that of absence of energy or strength. Tiredness may result from overwork, poor sleep, worry, dullness, or absence of exercise. It is a symptom that may be caused by health problem, medicine, or medical treatment such as chemotherapy. Anxiety or depression can also cause fatigue.
Both weakness and tiredness are symptoms, not illness. Because these symptoms can be caused by numerous other health problems, the significance of weakness and tiredness can be figured out just when other symptoms are examined.
General weakness in arms typically takes place after you have done too much activity at one time, such as by taking an extra-long exercises. You may feel weak and worn out, or your muscles may ache. These sensations normally go away within a few days.
In uncommon cases, generalized muscle weakness might be caused by another health issue, such as:
Arm muscles weakness that is slowly getting worse requires a see to a doctor.
Abrupt muscle weakness and loss of function in one area of the body can indicate a major issue within the brain or spinal cord camera.gif or with a specific nerve in the body.
Essentials For Older People: Weakness
As people age, the amount of muscle tissue and muscle strength tend to decrease. These changes occur partly because older people may become less active but also because the production of the hormones that stimulate muscle development decreases. Thus, for older people, bed rest during an illness can have a devastating effect. Compared with younger people, older people start out with less muscle tissue and strength at the beginning of the illness and lose muscle tissue more quickly during the illness.
Drugs are another common cause of weakness in older people because older people take more drugs and are more susceptible to side effects of drugs .
When evaluating older people who report weakness, doctors also focus on conditions that do not cause weakness but interfere with balance, coordination, vision, or mobility or that make movement painful . Older people may mistakenly describe the effects of such conditions as weakness.
Regardless of what is causing weakness, physical therapy can usually help older people function better.
Trembling In The Hands And Weakness In The Legs
Trembling of the limbs is an involuntary frequent reduction of various groups of muscles in the arms or legs. The condition when hands are shaking and there is weakness in the legs is often and often not the result of any one reason. This condition is physiological, essential, parkinsonian and cerebellar. Let us consider these states in more detail.
- Essential tremor and muscle weakness can be hereditary, or can be associated with age. This pathology increases with motor activity: it is not dangerous, but it significantly affects the quality of life of the patient.
- Parkinsonian tremor and muscle weakness is usually present in Parkinson’s disease and, as a rule, is accompanied by hypokinesia, or without it. Symptoms often occur in a state of rest.
- Cerebellar tremor and muscle weakness are observed in the defeat of the cerebellum, which controls the movements. This may be a manifestation of multiple sclerosis, congenital cerebellar ataxia, etc.
- Physiological trembling of the hands and weakness in the legs is the most common condition. It is associated with nervous overexcitation, anxiety, fear, overfatigue, hypothermia, withdrawal syndrome and certain diseases of the nervous and endocrine systems. Often, trembling in the hands and weakness in the legs appear after taking large doses of caffeine, or with prolonged exposure to the sun.
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