Generalized weakness resident survival guide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Moises Romo M.D.

Synonyms and Keywords: dystrophy, myasthenia gravis, Guillian-barre syndrome, polymyositis, emg

Overview

Generalized weakness or lack of strength is a direct term for the inability to exert force with ones muscles to the degree that would be expected given the individual's general physical fitness. The weakness may be caused due to affection in the muscle, nerve, or neuromuscular plate. Causes of generalized weakness may be as varied as cardiovascular, chemical, dermatologic, drugs side effects, endocrine, environmental, gastroenterologic, genetic, hematologic, iatrogenic, infectious, musculoskeletal, neurologic, nutritional, oncologic, overdose, psychiatric, and renal. A test of strength is often used during a diagnosis of a muscular disorder before the etiology can be identified. Many times, the cause of weakness may be identified with the history and physical examination; emg may guide into the type of weakness, but other times biopsy or other laboratory test may be necessary.

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Diagnosis

Shown below is an algorithm summarizing the diagnosis of Generalized weakness according to the American Academy of Neurology guidelines:

 
 
 
Generalized weakness symptoms
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
True motor weakness?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
 
 
 
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Evaluate for causes of fatigue or muscle pain
 
Fluctuating
 
 
 
 
 
Constant
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Myasthenia Gravis
Lambert-Eaton syndrome
Periodic paralysis
Metabolic myopathy
 
Acquiered
 
 
 
 
 
Life-long/chronic
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Polymyositis
Dermatomyositis
•Inclusion body myopathy
Amyotrophic lateral sclerosis
Multifocal motor neuropathy
 
Non-progessive
 
 
 
 
 
 
 
Progressive
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Congenital myopathy
Congenital dystrophy
 
Ocular
•Kearns-sayre syndrome
•Oculopharyngeal dystrophy
Ocular dystrophy
 
Facial
•Fascioscapulohumeral dystrophy
Myotonic dystrophy
 
Upper extremities
•Emery-Dreiffus dystrophy
•Hereditary distal myopathy
 
Lower extremities
Duchenne's muscular dystrophy
Becker's muscular dystrophy
Sarcoglycanopathies
Spinal muscular atrophy
•Limb girdle dystrophy


Treatment

Treat the underlying cause.

Do's

Don'ts

References

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  2. Hinshaw DB, Carnahan JM, Johnson DL (August 2002). "Depression, anxiety, and asthenia in advanced illness". J Am Coll Surg. 195 (2): 271–7, discussion 277–8. doi:10.1016/s1072-7515(02)01191-2. PMID 12168975.
  3. 3.0 3.1 Walker HK, Hall WD, Hurst JW, Holbrook JH. PMID 21250168. Missing or empty |title= (help)
  4. 4.0 4.1 Ramroop H, Cruz R. PMID 33085325 Check |pmid= value (help). Missing or empty |title= (help)
  5. Alshekhlee A, Kaminski HJ, Ruff RL (February 2002). "Neuromuscular manifestations of endocrine disorders". Neurol Clin. 20 (1): 35–58, v–vi. doi:10.1016/s0733-8619(03)00053-7. PMID 11754301.
  6. Hannibal L, Lysne V, Bjørke-Monsen AL, Behringer S, Grünert SC, Spiekerkoetter U, Jacobsen DW, Blom HJ (2016). "Biomarkers and Algorithms for the Diagnosis of Vitamin B12 Deficiency". Front Mol Biosci. 3: 27. doi:10.3389/fmolb.2016.00027. PMC 4921487. PMID 27446930.
  7. Grassino A, Macklem PT (1984). "Respiratory muscle fatigue and ventilatory failure". Annu Rev Med. 35: 625–47. doi:10.1146/annurev.me.35.020184.003205. PMID 6372673.
  8. Lim KL, Abdul-Wahab R, Lowe J, Powell RJ (March 1994). "Muscle biopsy abnormalities in systemic lupus erythematosus: correlation with clinical and laboratory parameters". Ann Rheum Dis. 53 (3): 178–82. doi:10.1136/ard.53.3.178. PMC 1005282. PMID 8154935.

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