Sandbox Myopathy: Difference between revisions

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Bureaucrats, bureaucrats, nocaptcha, Administrators
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==Differentiating Various Muscle Weakness==
==Differentiating Various Muscle Weakness==
{| class="wikitable"
{| class="wikitable"
! rowspan="3" |
! rowspan="3" |Disease
! colspan="8" |Symptoms
! colspan="9" |Symptoms
! rowspan="3" |History
! rowspan="3" |History
! rowspan="3" |Physical
! rowspan="3" |Physical
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! rowspan="2" |Fatigue
! rowspan="2" |Fatigue
! rowspan="2" |Muscle pain  
! rowspan="2" |Muscle pain  
! rowspan="2" |Gait abnormality
! rowspan="2" |Neuropathy
! rowspan="2" |Neuropathy
! rowspan="2" |Myoglobinuria
! rowspan="2" |Myoglobinuria
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!DIstal
!DIstal
|-
|-
! colspan="16" |Medications
! colspan="17" |Medications
|-
|-
|Corticosteroids
|Corticosteroids
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|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|
| -
| -
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
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| colspan="2" |
| colspan="2" |
* + ACTH Stimulation test
* + ACTH Stimulation test
*  
* 24-hour urine [[cortisol]]
|
* Low dose [[dexamethasone]] suppression test
|
|<nowiki>-</nowiki>
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|-
|Statins
|Statins
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|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|
| -
| -
|<nowiki>-/+(rhabdomyolysis)</nowiki>
|<nowiki>-/+(rhabdomyolysis)</nowiki>
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* Muscle aches
* Muscle aches
| colspan="2" |
| colspan="2" |
|'''↑↑'''
* '''↑↑''' liver enzymes
|
* '''↑↑'''
|
|
* Necrosis
* Necrosis
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|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
|-
|Anti-Thyroid
|Chemotherapeutic
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|-
|Chemotherapeutic
|
|
|
|
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|-
|-
|Organophosphate intoxication
|Organophosphate intoxication
|
|
|
|
|
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|Variable
|Variable
|      '''+'''
|      '''+'''
|
|
|
|
|
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|
|
|-
|-
! colspan="16" |Endocrine  
! colspan="17" |Endocrine  
|-
|-
|Cushing's disease
|Cushing's disease
|
|
|
|
|
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|-
|-
|Adrenal insufficiency
|Adrenal insufficiency
|
|
|
|
|
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|-
|-
|Secondary hyperparathyroidism
|Secondary hyperparathyroidism
|
|
|
|
|
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|-
|-
|Hyperthyroidism
|Hyperthyroidism
|
|
|
|
|
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|-
|-
|Hypothyroidism
|Hypothyroidism
|
|
|
|
|
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|
|
|-
|-
! colspan="16" |Inflammatory / Rheumatologic  
! colspan="17" |Inflammatory / Rheumatologic  
|-
|-
|Dermatomyositis
|Dermatomyositis
|
|
|
|
|
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|-
|-
|Polymyositis
|Polymyositis
|
|
|
|
|
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|-
|-
|Inclusion body myositis
|Inclusion body myositis
|
|
|
|
|
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|-
|-
|Fibomyalgia
|Fibomyalgia
|
|
|
|
|
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|-
|-
|Polymyalgia Rheumatica
|Polymyalgia Rheumatica
|
|
|
|
|
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|-
|-
|Chronic Pain Syndrome
|Chronic Pain Syndrome
|
|
|
|
|
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|
|
|-
|-
! colspan="16" |Genetic
! colspan="17" |Genetic
|-
|-
|Becker muscular dystrophy
|Becker muscular dystrophy
|
|
|
|
|
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|
|
|-
|-
|Limb-girdle muscular dystrophies
|Duchenne muscular dystrophy
|<13 yrs
| +
| -
| -
| +
|
|
| -
| -
|
|
* Calf psedohypertrophy
* Cardiomyopathy
* Kyphoscoliosis
* Cognitive impairment
|
|
| +Grower sign
| colspan="2" |
* Errors in the Xp21 gene.
|
|
* '''↑↑'''
|
|
* Absence of [[dystrophin]].
|
|
* Weakness is caused by destruction of muscle.
|-
|Limb-girdle muscular dystrophies
|<15 yrs
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|
* Calf hypertrophy
* Scapular winging
|
|
|
|
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|-
|-
|Myotonic dystrophy type 1
|Myotonic dystrophy type 1
|
|
|
|
|
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|
|
|-
|-
! colspan="16" |Infectious
! colspan="17" |Infectious
|-
|-
|Lyme disease
|Lyme disease
|Variable
|
|
|
|
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|-
|-
|Infulenza
|Infulenza
|
|
|
|
|
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|-
|-
|Polio
|Polio
|
|
|
|
|
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|-
|-
|Syphilis
|Syphilis
|
|
|
|
|
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|-
|-
|HIV
|HIV
|
|
|
|
|
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|
|
|-
|-
! colspan="16" |Neurologic
! colspan="17" |Neurologic
|-
|-
|ALS
|ALS
|
|
|
|
|
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|-
|-
|Stroke
|Stroke
|
|
|
|
|
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|-
|-
|GBS
|GBS
|
|
|
|
|
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|-
|-
|Multiple Sclerosis
|Multiple Sclerosis
|
|
|
|
|
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|
|
|-
|-
! colspan="16" |Neuro-muscular  
! colspan="17" |Neuro-muscular  
|-
|-
|Botulisim
|Botulisim
|
|
|
|
|
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|-
|-
|Lambert-Eaton myaes
|Lambert-Eaton myaes
|
|
|
|
|
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|-
|-
|Myasthenia gravis
|Myasthenia gravis
|
|
|
|
|
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|
|
|-
|-
! colspan="16" |Paraneoplastic
! colspan="17" |Paraneoplastic
|-
|-
|
|
|
|
|
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|
|
|-
|-
! colspan="16" |Metabolic
! colspan="17" |Metabolic
|-
|-
|Glycogen storage disease
|Glycogen storage disease
|
|
|
|
|
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|-
|-
|Lipid storage disease
|Lipid storage disease
|
|
|
|
|
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|-
|-
|Mitochondrial
|Mitochondrial
|
|
|
|
|

Revision as of 20:25, 28 March 2018


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Differentiating Various Muscle Weakness

Disease Symptoms History Physical

Examination

Diagnosis
Age of onset Muscle weakness Fatigue Muscle pain Gait abnormality Neuropathy Myoglobinuria Other features Laboratory Findings Creatine Kinase Muscle Biopsy Electromyogram
Proximal DIstal
Medications
Corticosteroids Variable + - - + - -
  • + History of medications
  • Facial and sphincter muscles usually are spared
 - - -
Statins 60+ + - - + - -/+(rhabdomyolysis)
  • Positive medication history
  • Tenderness
  • Muscle aches
  • ↑↑ liver enzymes
  • ↑↑
  • Necrosis
  • Degeneration, and regeneration of fibers
  • Phagocytic infiltration
 -
Chemotherapeutic
Organophosphate intoxication
Alcohol Variable +
  • Change in mental status
  • Telangiectasia
  • Peripheral neuropathy
Endocrine
Cushing's disease
Adrenal insufficiency
Secondary hyperparathyroidism
Hyperthyroidism
Hypothyroidism
Inflammatory / Rheumatologic
Dermatomyositis
Polymyositis
Inclusion body myositis
Fibomyalgia
Polymyalgia Rheumatica
Chronic Pain Syndrome
Genetic
Becker muscular dystrophy
Duchenne muscular dystrophy <13 yrs + - - + - -
  • Calf psedohypertrophy
  • Cardiomyopathy
  • Kyphoscoliosis
  • Cognitive impairment
 +Grower sign
  • Errors in the Xp21 gene.
  • ↑↑
  • Weakness is caused by destruction of muscle.
Limb-girdle muscular dystrophies <15 yrs + - - + - -
  • Calf hypertrophy
  • Scapular winging
Myotonic dystrophy type 1
Infectious
Lyme disease Variable
Infulenza
Polio
Syphilis
HIV
Neurologic
ALS
Stroke
GBS
Multiple Sclerosis
Neuro-muscular
Botulisim
Lambert-Eaton myaes
Myasthenia gravis
Paraneoplastic
Metabolic
Glycogen storage disease
Lipid storage disease
Mitochondrial
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