View source for Myasthenia gravis physical examination

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{{Myasthenia gravis}}
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==Overview==
Myasthenia can be a difficult diagnosis, as the symptoms can be subtle and hard to distinguish from both normal variants and other neurological disorders.<ref name="Scherer">{{cite journal | author=Scherer K, Bedlack RS, Simel DL. | title=Does this patient have myasthenia gravis? | journal=[[JAMA]] | year=2005 | volume=293 | pages=1906–14 | id=PMID 15840866}}</ref> A thorough [[physical examination]] can reveal easy fatiguability, with the weakness improving after rest and worsening again on repeat of the exertion testing. Applying ice to weak muscle groups characteristically leads to improvement in strength of those muscles.

==Physical Examination==
Muscle fatigability can be tested for many muscles. A thorough examination demonstrates easy fatigability during following movements:
* Looking upward and sidewards for 30 seconds: [[ptosis (eyelid)|ptosis]] and [[diplopia]].
* Looking at the feet while lying on the back for 60 seconds
* Keeping the arms stretched forward for 60 seconds
* 10 deep knee bends
* Walking 30 steps on both the toes and the heels
* 5 situps, lying down and sitting up completely
It has been suggested that ice pack and edrophonium tesst are parts of neurological examination of a suspected patient.<ref name="pmid16793269">{{cite journal |vauthors=Benatar M |title=A systematic review of diagnostic studies in myasthenia gravis |journal=Neuromuscul. Disord. |volume=16 |issue=7 |pages=459–67 |date=July 2006 |pmid=16793269 |doi=10.1016/j.nmd.2006.05.006 |url=}}</ref>

Ice pack test: Based on the fact that this test was designed by the fact that cooling can improve NMJ transmission, it can be used only in patients with ptosis since the eyelid muscle is the most accessible muscle to be cooled. We place the ice pack on closed lid for a couple of minutes and the assess the degree of ptosis in the patient. The sensitivity of this test is almost 80 percent.<ref name="pmid16793269">{{cite journal |vauthors=Benatar M |title=A systematic review of diagnostic studies in myasthenia gravis |journal=Neuromuscul. Disord. |volume=16 |issue=7 |pages=459–67 |date=July 2006 |pmid=16793269 |doi=10.1016/j.nmd.2006.05.006 |url=}}</ref><ref name="pmid10406606">{{cite journal |vauthors=Golnik KC, Pena R, Lee AG, Eggenberger ER |title=An ice test for the diagnosis of myasthenia gravis |journal=Ophthalmology |volume=106 |issue=7 |pages=1282–6 |date=July 1999 |pmid=10406606 |doi=10.1016/S0161-6420(99)00709-5 |url=}}</ref><ref name="pmid15529523">{{cite journal |vauthors=Larner AJ |title=The place of the ice pack test in the diagnosis of myasthenia gravis |journal=Int. J. Clin. Pract. |volume=58 |issue=9 |pages=887–8 |date=September 2004 |pmid=15529523 |doi= |url=}}</ref>

Edrophonium test: This test is used in patients with obvious ptosis or ophthalmoparesis. We begin with 2 mg of edriphonium and add another 2 mg every 60 second to the total dosage of 10 mg. this test can have serious muscarinic side effect so we begin with low dose edrophonium since so many patients will respond to drug in 4 to 6 mg dose and by this way we can reduce the side effects of the drug. The sensitivity of this test is 80 to 90 percent. A positive edrophonium test can be seen in other conditions such as motor neuron disease, brainstem tumors, and compressive cranial neuropathies.<ref name="pmid16793269">{{cite journal |vauthors=Benatar M |title=A systematic review of diagnostic studies in myasthenia gravis |journal=Neuromuscul. Disord. |volume=16 |issue=7 |pages=459–67 |date=July 2006 |pmid=16793269 |doi=10.1016/j.nmd.2006.05.006 |url=}}</ref><ref name="pmid27922503">{{cite journal |vauthors=Nicolle MW |title=Myasthenia Gravis and Lambert-Eaton Myasthenic Syndrome |journal=Continuum (Minneap Minn) |volume=22 |issue=6, Muscle and Neuromuscular Junction Disorders |pages=1978–2005 |date=December 2016 |pmid=27922503 |doi=10.1212/CON.0000000000000415 |url=}}</ref><ref name="pmid12870109">{{cite journal |vauthors=Pascuzzi RM |title=The edrophonium test |journal=Semin Neurol |volume=23 |issue=1 |pages=83–8 |date=March 2003 |pmid=12870109 |doi=10.1055/s-2003-40755 |url=}}</ref>

==References==
{{Reflist|2}}
[[Category:Disease]]
[[Category:Autoimmune diseases]]
[[Category:Neurology]]
[[Category:Rheumatology]]
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