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Flashcards in Muscle Weakness Deck (17):
1

What are three questions you should ask regarding muscle weakness?

1. Does the patient have true muscle weakness?
2. Where is the weakness?
3. What is the cause of the muscle weakness?

2

How can you identify if a person has true muscle weakness?

They are unable to perform certain activities such as standing from a squat or moving a limb

3

What types of muscle weakness are there?

Primary: involving the muscles themselves
Secondary: involving neuromuscular junctions, peripheral nerves, spinal nerve roots, anterior horn cells or corticospinal tracts

4

What does generalised weakness indicate?

- Myasthenia gravis which affects the neuromuscular junction

5

In non-generalised weakness, what should you find out?

Symmetrical/asymmetrical?

6

What does asymmetric non-generalised weakness indicate?

usually caused by conditions that affect the CNS or PNS

7

In symmetrical non-generalised weakness, what should you determine?

Proximal/distal?

8

What does proximal/distal symmetrical non-generalised weakness indicate?

Proximal: usually caused by primary muscle disorders affecting axial muscle groups that is the deltoids or the muscles responsible for hip flexion
Distal: usually affects the hands of feet and may be caused y peripheral neuropathy or motor neuron disease

9

What are some underlying causes of muscle weakness?

immunological conditions, malignancy, vascular events, drugs, metabolic disorders etc

10

What are some important cardinal features to ask about regarding muscle weakness?

- Site
- Severity
- Time Course
- Context
- R/A Features
- Associated Features

11

What are some considerations with regard to muscle weakness in terms of Site?

Where is the weakness? Which muscle groups? Generalised? Local? Symmetrical? Proximal? Distal?

12

What are some considerations with regard to muscle weakness in terms of Severity?

What type of function is impaired? Can you move against gravity?
Effect on ADLs?

13

What are some considerations with regard to muscle weakness in terms of Time Course?

Onset?
Offset?
Change over time?
Duration?

14

What are some considerations with regard to muscle weakness in terms of Context?

Associations with movement?
Noticed anything at the onset?

15

What are some considerations with regard to muscle weakness in terms of R/A Factors?

Relief? Triggers?

16

What are some considerations with regard to muscle weakness in terms of Associated Features?

Any other neurological symptoms? Sensory changes?

17

What are some of the differential diagnoses for muscle weakness?

MS - visual disturbances, sensory loss, family history Myasthenia Gravis – muscle become fatigued, family history
Stroke - family history, past history of cardiovascular problems, high cholesterol, hypertension, sensorimotor loss
Emotional – depression, lack of motivation
Sarcopaenia – Old, loss of muscle mass
Cancer – Loss of muscle mass, weight loss, fatigue, loss of appetite, family history of cancer, age, fever
Joint Pain – Pain in joint where weakness is, context
Motor neuron Disease/ Neurodegen – context, family history, distal weakness
Nerve compression – possible pain, past trauma
Myasthenia Gravis – Fatiguability, History of Autoimmune conditions, Generalised pattern of motor weakness
Metabolic Disorders – exercise intolerance, myoglobinuria, heart problems
Hypothyroidism - Weight gain, insensitivity to cold, depression, loss of hair, neck enlargement, heavy periods
Addison’s Disease – Fatigue, skin pigmentation, nausea, vomiting, diarrhoea, weight loss, low blood pressure, recurrent infections
Medications- eg statins
Muscle damage/ Muscle overuse – context, pain