Sandbox Myopathy: Difference between revisions
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| Line 52: | Line 52: | ||
!Electromyogram | !Electromyogram | ||
|- | |- | ||
| rowspan="3" | | | rowspan="3" |Medication−induced | ||
|[[Corticosteroids]]<ref name="pmid24083177">{{cite journal |vauthors=Gupta A, Gupta Y |title=Glucocorticoid-induced myopathy: Pathophysiology, diagnosis, and treatment |journal=Indian J Endocrinol Metab |volume=17 |issue=5 |pages=913–6 |date=September 2013 |pmid=24083177 |pmc=3784879 |doi=10.4103/2230-8210.117215 |url=}}</ref> | |[[Corticosteroids]]<ref name="pmid24083177">{{cite journal |vauthors=Gupta A, Gupta Y |title=Glucocorticoid-induced myopathy: Pathophysiology, diagnosis, and treatment |journal=Indian J Endocrinol Metab |volume=17 |issue=5 |pages=913–6 |date=September 2013 |pmid=24083177 |pmc=3784879 |doi=10.4103/2230-8210.117215 |url=}}</ref> | ||
| | | | ||
| Line 58: | Line 58: | ||
| colspan="2" | | | colspan="2" | | ||
* Proximal | * Proximal | ||
| | |− | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | | − | ||
| | |− | ||
| | | − | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | |− | ||
| | |− | ||
| | | | ||
* [[Central obesity]] | * [[Central obesity]] | ||
| Line 94: | Line 94: | ||
| colspan="2" | | | colspan="2" | | ||
* Proximal | * Proximal | ||
| | |− | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | | − | ||
| | |− | ||
| | | − | ||
| | |− | ||
| | |− | ||
| | | −/+([[Rhabdomyolysis]]) | ||
| | | | ||
* N/A | * N/A | ||
| Line 126: | Line 126: | ||
| colspan="2" | | | colspan="2" | | ||
* Proximal | * Proximal | ||
| | |− | ||
| | |− | ||
| | | − | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | | +/− | ||
| | |− | ||
| | |− | ||
| | |− | ||
| | | | ||
* [[Swelling]] | * [[Swelling]] | ||
| Line 159: | Line 159: | ||
|[[Cushing's disease]]<ref name="pmid25221399">{{cite journal |vauthors=Sharma V, Borah P, Basumatary LJ, Das M, Goswami M, Kayal AK |title=Myopathies of endocrine disorders: A prospective clinical and biochemical study |journal=Ann Indian Acad Neurol |volume=17 |issue=3 |pages=298–302 |date=July 2014 |pmid=25221399 |pmc=4162016 |doi=10.4103/0972-2327.138505 |url=}}</ref> | |[[Cushing's disease]]<ref name="pmid25221399">{{cite journal |vauthors=Sharma V, Borah P, Basumatary LJ, Das M, Goswami M, Kayal AK |title=Myopathies of endocrine disorders: A prospective clinical and biochemical study |journal=Ann Indian Acad Neurol |volume=17 |issue=3 |pages=298–302 |date=July 2014 |pmid=25221399 |pmc=4162016 |doi=10.4103/0972-2327.138505 |url=}}</ref> | ||
| | | | ||
* 25 | * 25 −45 | ||
| colspan="2" | | | colspan="2" | | ||
* Proximal | * Proximal | ||
| | |− | ||
| | |− | ||
| | | − | ||
| | |− | ||
| | |− | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | |− | ||
| | |− | ||
| | | | ||
* Decreased libido | * [[Decreased libido]] | ||
* Obesity/weight gain | * [[Obesity]]/[[weight gain]] | ||
* [[Plethora]] | * [[Plethora]] | ||
* Round face | * Round face | ||
| Line 179: | Line 179: | ||
* [[Hypertension]] | * [[Hypertension]] | ||
* [[Ecchymoses]] | * [[Ecchymoses]] | ||
* Lethargy | * [[Lethargy]] | ||
* [[Depression]] | |||
* Dorsal fat pad | * Dorsal fat pad | ||
* Abnormal glucose tolerance | * Abnormal glucose tolerance | ||
| Line 190: | Line 191: | ||
* [[Moon face]] | * [[Moon face]] | ||
* [[Hypertension|HTN]] | * [[Hypertension|HTN]] | ||
* Hyperpigmentation | * [[Hyperpigmentation]] | ||
| | | | ||
* | * Positive [[ACTH stimulation test]] | ||
* 24-hour urine [[cortisol]] | * 24-hour urine [[cortisol]] | ||
* Low dose [[dexamethasone | * Low dose [[Dexamethasone suppression test|dexamethasone <nowiki/>suppression test]] | ||
| | | | ||
* Normal | * Normal | ||
| Line 203: | Line 204: | ||
|[[Adrenal insufficiency]]<ref name="pmid30656022">{{cite journal |vauthors=Ruff RL, Weissmann J |title=Endocrine myopathies |journal=Neurol Clin |volume=6 |issue=3 |pages=575–92 |date=August 1988 |pmid=3065602 |doi= |url=}}</ref> | |[[Adrenal insufficiency]]<ref name="pmid30656022">{{cite journal |vauthors=Ruff RL, Weissmann J |title=Endocrine myopathies |journal=Neurol Clin |volume=6 |issue=3 |pages=575–92 |date=August 1988 |pmid=3065602 |doi= |url=}}</ref> | ||
| | | | ||
* | * 30−50 years | ||
| colspan="2" | | | colspan="2" | | ||
* Proximal | * Proximal | ||
| | |− | ||
| + | | + | ||
| | | − | ||
| | |− | ||
| | |− | ||
| | |− | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | |− | ||
| | | | ||
* Signs of [[glucocorticoid]], [[mineralocorticoid]], and, androgen deficiency | * Signs of [[glucocorticoid]], [[mineralocorticoid]], and, [[androgen]] deficiency | ||
| | | | ||
* Signs of [[postural hypotension]] | * Signs of [[postural hypotension]] | ||
| Line 226: | Line 227: | ||
* [[Hyperpigmentation]] | * [[Hyperpigmentation]] | ||
* | * Auricular−cartilage calcification | ||
* [[Vitiligo]] | * [[Vitiligo]] | ||
| | | | ||
* Electrolyte abnormalities | * [[Electrolyte abnormalities]] | ||
* [[Hypoglycemia]] | * [[Hypoglycemia]] | ||
| Line 247: | Line 248: | ||
* Distal | * Distal | ||
| | |− | ||
| | |− | ||
| | | − | ||
| | |− | ||
| | |− | ||
| | |− | ||
| | |− | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
Rhabdomyolysis | [[Rhabdomyolysis]] | ||
| | | | ||
* [[Palpitations]] | * [[Palpitations]] | ||
| Line 278: | Line 279: | ||
| colspan="2" | | | colspan="2" | | ||
* Proximal | * Proximal | ||
| | |− | ||
| | |− | ||
| | | − | ||
| | |− | ||
| | |− | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| Line 291: | Line 292: | ||
* H/o of [[weight loss]] | * H/o of [[weight loss]] | ||
| | | | ||
* Sweating | * [[Sweating]] | ||
* Tremor | * [[Tremor]] | ||
* | * Neck swelling | ||
| | | | ||
* Decreased [[TSH]] | * Decreased [[TSH]] | ||
| Line 301: | Line 302: | ||
* Non specific | * Non specific | ||
| | | | ||
* Myotonic | * [[Myotonic]] | ||
|- | |- | ||
|[[Hypothyroidism]]<ref name="pmid6627693">{{cite journal |vauthors=Khaleeli AA, Griffith DG, Edwards RH |title=The clinical presentation of hypothyroid myopathy and its relationship to abnormalities in structure and function of skeletal muscle |journal=Clin. Endocrinol. (Oxf) |volume=19 |issue=3 |pages=365–76 |date=September 1983 |pmid=6627693 |doi= |url=}}</ref> | |[[Hypothyroidism]]<ref name="pmid6627693">{{cite journal |vauthors=Khaleeli AA, Griffith DG, Edwards RH |title=The clinical presentation of hypothyroid myopathy and its relationship to abnormalities in structure and function of skeletal muscle |journal=Clin. Endocrinol. (Oxf) |volume=19 |issue=3 |pages=365–76 |date=September 1983 |pmid=6627693 |doi= |url=}}</ref> | ||
| Line 308: | Line 309: | ||
| colspan="2" | | | colspan="2" | | ||
* Proximal | * Proximal | ||
| | | − | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| + | | + | ||
| | |− | ||
| | |− | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| + | | + | ||
| | | + [[Rhabdomyolysis MRI|Rhabdomyolysis]] | ||
| | | | ||
* Signs of [[hypothyroidism]] | * Signs of [[hypothyroidism]] | ||
| Line 321: | Line 322: | ||
* H/o [[weight gain]] | * H/o [[weight gain]] | ||
| | | | ||
* | * [[Myxedema|Myxoedema]] | ||
* Muscle pseudohypertrophy | * Muscle pseudohypertrophy | ||
| | | | ||
| Line 339: | Line 340: | ||
| + | | + | ||
| + | | + | ||
| | | − | ||
| | | − | ||
| + | | + | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | |− | ||
| | | − | ||
| | | | ||
* [[Cramps]] | * [[Cramps]] | ||
* Sudden onset of pain | * Sudden onset of [[pain]] | ||
* Anterior | * Anterior thigh [[muscles]] are most commonly involved | ||
| | | | ||
* H/O long standing diabetes | * H/O long standing [[diabetes]] | ||
| | | | ||
* Swelling | * [[Swelling]] | ||
* Tenderness | * [[Tenderness]] | ||
| | | | ||
* | * Elevated [[ESR]] | ||
* Leukocytosis | * [[Leukocytosis]] | ||
| | | | ||
* Normal | * Normal | ||
| Line 373: | Line 373: | ||
|[[Dermatomyositis]]<ref name="pmid1658649">{{cite journal| author=Dalakas MC| title=Polymyositis, dermatomyositis and inclusion-body myositis. | journal=N Engl J Med | year= 1991 | volume= 325 | issue= 21 | pages= 1487-98 | pmid=1658649 | doi=10.1056/NEJM199111213252107 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1658649 }}</ref> | |[[Dermatomyositis]]<ref name="pmid1658649">{{cite journal| author=Dalakas MC| title=Polymyositis, dermatomyositis and inclusion-body myositis. | journal=N Engl J Med | year= 1991 | volume= 325 | issue= 21 | pages= 1487-98 | pmid=1658649 | doi=10.1056/NEJM199111213252107 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1658649 }}</ref> | ||
| | | | ||
* | * 40s−50s | ||
* Can affect childreen | * Can affect childreen | ||
| colspan="2" | | | colspan="2" | | ||
| Line 379: | Line 379: | ||
| + | | + | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | | − | ||
| | | − | ||
| | | − | ||
| | |− | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | | − | ||
| | | | ||
* [[Rash]] | * [[Rash]] | ||
| Line 391: | Line 391: | ||
* [[Cough]] | * [[Cough]] | ||
| | | | ||
* Viral infections | * [[Viral infections]] | ||
* [[Cancer]] | * [[Cancer]] | ||
| | | | ||
| Line 399: | Line 399: | ||
* Mechanic's hands | * Mechanic's hands | ||
* [[Gottron's papules|Gottron's sign]] ( violaceous scaly eruption ) | * [[Gottron's papules|Gottron's sign]] ( violaceous scaly eruption ) | ||
| | |||
* '''↑↑''' [[Erythrocyte sedimentation rate|ESR]] | * '''↑↑''' [[Erythrocyte sedimentation rate|ESR]] | ||
* '''↑↑''' [[C-reactive protein|CRP]] | * '''↑↑''' [[C-reactive protein|CRP]] | ||
| Line 407: | Line 407: | ||
* Perimysial mononuclear infiltrate | * Perimysial mononuclear infiltrate | ||
| rowspan="2" | | | rowspan="2" | | ||
* Myopathic | * [[Myopathic]] | ||
|- | |- | ||
|[[Polymyositis]]<ref name="pmid16586492">{{cite journal| author=Dalakas MC| title=Polymyositis, dermatomyositis and inclusion-body myositis. | journal=N Engl J Med | year= 1991 | volume= 325 | issue= 21 | pages= 1487-98 | pmid=1658649 | doi=10.1056/NEJM199111213252107 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1658649 }}</ref> | |[[Polymyositis]]<ref name="pmid16586492">{{cite journal| author=Dalakas MC| title=Polymyositis, dermatomyositis and inclusion-body myositis. | journal=N Engl J Med | year= 1991 | volume= 325 | issue= 21 | pages= 1487-98 | pmid=1658649 | doi=10.1056/NEJM199111213252107 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1658649 }}</ref> | ||
| Line 416: | Line 416: | ||
| + | | + | ||
| + | | + | ||
| | | − | ||
| | | − | ||
| | | − | ||
| | |− | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | | − | ||
| | | | ||
* Similar to [[dermatomyositis]] without [[mucous]] and [[skin]] involvement | * Similar to [[dermatomyositis]] without [[mucous]] and [[skin]] involvement | ||
| Line 428: | Line 428: | ||
| | | | ||
* N/A | * N/A | ||
| | |||
* '''↑↑''' [[Erythrocyte sedimentation rate|ESR]] | |||
* '''↑↑''' [[C-reactive protein|CRP]] | |||
| | | | ||
* '''↑↑''' | * '''↑↑''' | ||
| Line 440: | Line 443: | ||
* Proximal | * Proximal | ||
* Distal | * Distal | ||
| | |− | ||
| | |− | ||
| | | − | ||
| | |− | ||
| | |− | ||
| | |− | ||
| | |− | ||
| | |− | ||
| | | | ||
* [[Dysphagia]] | * [[Dysphagia]] | ||
* Asymmetric weakness | * Asymmetric weakness | ||
| | | | ||
* [[Retrovirus]] most common | * [[Retrovirus]] (most common) | ||
| | | | ||
* N/A | * N/A | ||
| | | | ||
* Antibodies to cytoplasmic 5' | * Antibodies to cytoplasmic 5'−nucleotidase | ||
| | | | ||
* '''↑↑''' | * '''↑↑''' | ||
| | | | ||
* Inflammatory cells | * [[Inflammatory cells]] | ||
* Invading muscle cells | * Invading [[muscle cells]] | ||
* Vacuolar degeneration | * Vacuolar degeneration | ||
* Inclusions or plaques | * Inclusions or plaques | ||
| | | | ||
* Neurogenic | * [[Neurogenic]] | ||
|- | |- | ||
|[[Fibromyalgia]]<ref name="pmid27803417">{{cite journal |vauthors=Ohara N, Katada S, Yamada T, Mezaki N, Suzuki H, Suzuki A, Hanyu O, Yoneoka Y, Kawachi I, Shimohata T, Kakita A, Nishizawa M, Sone H |title=Fibromyalgia in a Patient with Cushing's Disease Accompanied by Central Hypothyroidism |journal=Intern. Med. |volume=55 |issue=21 |pages=3185–3190 |date=2016 |pmid=27803417 |pmc=5140872 |doi=10.2169/internalmedicine.55.5926 |url=}}</ref> | |[[Fibromyalgia]]<ref name="pmid27803417">{{cite journal |vauthors=Ohara N, Katada S, Yamada T, Mezaki N, Suzuki H, Suzuki A, Hanyu O, Yoneoka Y, Kawachi I, Shimohata T, Kakita A, Nishizawa M, Sone H |title=Fibromyalgia in a Patient with Cushing's Disease Accompanied by Central Hypothyroidism |journal=Intern. Med. |volume=55 |issue=21 |pages=3185–3190 |date=2016 |pmid=27803417 |pmc=5140872 |doi=10.2169/internalmedicine.55.5926 |url=}}</ref> | ||
| | | | ||
* | * 40−50s | ||
| colspan="2" | | | colspan="2" | | ||
* Generalized | * Generalized | ||
| | |− | ||
| | | − | ||
| | | − | ||
| | | − | ||
| + | | + | ||
| | |− | ||
| | |− | ||
| | | − | ||
| | | | ||
* [[Anxiety]] or depression features | * [[Anxiety]] or depression features | ||
| Line 487: | Line 490: | ||
* [[Muscle spasms]] | * [[Muscle spasms]] | ||
| | | | ||
* History of | * History of [[depression]] | ||
| | | | ||
* Tenderness in the soft tissue anatomical location | * [[Tenderness]] in the soft tissue anatomical location | ||
| | | | ||
* Normal | * Normal | ||
| Line 506: | Line 509: | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| + | | + | ||
| | | − | ||
| | | − | ||
| | | − | ||
| | |− | ||
| + | | + | ||
| | | − | ||
| | | | ||
* [[Weight loss]] | * [[Weight loss]] | ||
| | | | ||
* History of joints stiffness | * History of joints stiffness, worse in the morning | ||
| | | | ||
* Restricted shoulder motion | * Restricted shoulder motion | ||
| | | | ||
* ''' | * '''↑↑''' [[Erythrocyte sedimentation rate|ESR]] | ||
* '''↑↑''' [[C-reactive protein|CRP]] | |||
| | | | ||
* Normal | * Normal | ||
| Line 536: | Line 539: | ||
* <13yrs | * <13yrs | ||
| colspan="2" |Proximal | | colspan="2" |Proximal | ||
| | |− | ||
| | |− | ||
| + | | + | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | |− | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | |− | ||
| | |− | ||
| | | | ||
* Milder form of [[Duchenne muscular dystrophy|Duchenne]] | * Milder form of [[Duchenne muscular dystrophy|Duchenne]] | ||
| | | | ||
* Growth delay | * [[Growth delay]] | ||
* Age of onset of symptoms is much delayed than duchenne | * Age of onset of symptoms is much delayed than [[Duchenne muscular dystrophy|duchenne]] | ||
| | | | ||
* | * Positive Grower sign | ||
| | | | ||
* Decreased amount of [[dystrophin]]. | * Decreased amount of [[dystrophin]]. | ||
| Line 560: | Line 563: | ||
** Muscle replacement with fat and connective tissue | ** Muscle replacement with fat and connective tissue | ||
| rowspan="2" | | | rowspan="2" | | ||
* Myopathic | * [[Myopathic]] | ||
|- | |- | ||
|[[Duchenne muscular dystrophy]]<ref name="pmid250370842">{{cite journal |vauthors=Flanigan KM |title=Duchenne and Becker muscular dystrophies |journal=Neurol Clin |volume=32 |issue=3 |pages=671–88, viii |date=August 2014 |pmid=25037084 |doi=10.1016/j.ncl.2014.05.002 |url=}}</ref> | |[[Duchenne muscular dystrophy]]<ref name="pmid250370842">{{cite journal |vauthors=Flanigan KM |title=Duchenne and Becker muscular dystrophies |journal=Neurol Clin |volume=32 |issue=3 |pages=671–88, viii |date=August 2014 |pmid=25037084 |doi=10.1016/j.ncl.2014.05.002 |url=}}</ref> | ||
| Line 566: | Line 569: | ||
* <13 yrs | * <13 yrs | ||
| colspan="2" | Proximal | | colspan="2" | Proximal | ||
| | | − | ||
| | | − | ||
| + | | + | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | | − | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | |− | ||
| | | − | ||
| | | | ||
* Calf psedohypertrophy | * Calf psedohypertrophy | ||
| Line 585: | Line 588: | ||
* Early onset | * Early onset | ||
| | | | ||
* | * Positive Grower sign | ||
| | | | ||
* Errors in the Xp21 gene. | * Errors in the Xp21 gene. | ||
| Line 592: | Line 595: | ||
* '''↑↑''' | * '''↑↑''' | ||
|- | |- | ||
|[[Limb-girdle muscular dystrophy| | |[[Limb-girdle muscular dystrophy|Limb−girdle muscular]] dystrophies<ref name="pmid18769252">{{cite journal |vauthors=Guglieri M, Straub V, Bushby K, Lochmüller H |title=Limb-girdle muscular dystrophies |journal=Curr. Opin. Neurol. |volume=21 |issue=5 |pages=576–84 |date=October 2008 |pmid=18769252 |doi=10.1097/WCO.0b013e32830efdc2 |url=}}</ref> | ||
| | | | ||
* <15 yrs | * <15 yrs | ||
| colspan="2" |Proximal | | colspan="2" |Proximal | ||
| | |− | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| + | | + | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | |− | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | |− | ||
| | |− | ||
| | | | ||
* Calf hypertrophy | * Calf hypertrophy | ||
| Line 612: | Line 615: | ||
* Respiratory muscle weakness | * Respiratory muscle weakness | ||
| | | | ||
* Autosomal dominant | * [[Autosomal dominant]] | ||
* Deterioration of ability to run/walk | * Deterioration of ability to run/walk | ||
| | | | ||
*Muscle weakness is generally | *[[Muscle weakness]] is generally symmetric | ||
| | | | ||
* | * [[LMNA]] gene | ||
* CAV3 gene | * CAV3 gene | ||
| | | | ||
* '''↑↑''' | * '''↑↑''' | ||
|− | |||
| | | | ||
* | * [[Myopathic]] | ||
|- | |- | ||
|[[Myotonic dystrophy]]<ref name="pmid22995693">{{cite journal |vauthors=Udd B, Krahe R |title=The myotonic dystrophies: molecular, clinical, and therapeutic challenges |journal=Lancet Neurol |volume=11 |issue=10 |pages=891–905 |date=October 2012 |pmid=22995693 |doi=10.1016/S1474-4422(12)70204-1 |url=}}</ref> | |[[Myotonic dystrophy]]<ref name="pmid22995693">{{cite journal |vauthors=Udd B, Krahe R |title=The myotonic dystrophies: molecular, clinical, and therapeutic challenges |journal=Lancet Neurol |volume=11 |issue=10 |pages=891–905 |date=October 2012 |pmid=22995693 |doi=10.1016/S1474-4422(12)70204-1 |url=}}</ref> | ||
| Line 633: | Line 635: | ||
* Distal | * Distal | ||
| | |− | ||
| | |− | ||
| + | | + | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | |− | ||
| | |− | ||
| + | | + | ||
| | |− | ||
| | | | ||
* [[Myotonia]] | * [[Myotonia]] | ||
| Line 651: | Line 653: | ||
* Eyelid ptosis | * Eyelid ptosis | ||
| | | | ||
* | * Positive family history | ||
| | | | ||
* Muscles often contract and are unable to relax | * Muscles often contract and are unable to relax | ||
| | | | ||
* Mutations in | * Mutations in the [[DMPK]] gene | ||
| | |− | ||
|− | |||
| | |||
| | | | ||
* Myopathic | * [[Myopathic]] | ||
|- | |- | ||
! | ! | ||
| Line 674: | Line 674: | ||
| + | | + | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | | − | ||
| +/ | | +/− | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | |− | ||
| | | − | ||
| | |− | ||
| | | | ||
* Erythema Migrans | * Erythema Migrans | ||
* | * Flu−like symptoms | ||
* [[Lyme arthritis]] | * [[Lyme arthritis]] | ||
* [[Neurological]] manifestations | * [[Neurological]] manifestations | ||
| | | | ||
* | * H/o tick bite | ||
* Hiking | * Hiking trip | ||
| | | | ||
* | * Target−like [[lesions]] | ||
* HSM | * HSM | ||
| | | | ||
| Line 695: | Line 695: | ||
* +Serology | * +Serology | ||
| | | | ||
* | * − | ||
| | | | ||
* | * − | ||
| | | | ||
* | * − | ||
|- | |- | ||
|[[Influenza]]<ref name="pmid6687269">{{cite journal |vauthors=Bove KE, Hilton PK, Partin J, Farrell MK |title=Morphology of acute myopathy associated with influenza B infection |journal=Pediatr Pathol |volume=1 |issue=1 |pages=51–66 |date=1983 |pmid=6687269 |doi= |url=}}</ref> | |[[Influenza]]<ref name="pmid6687269">{{cite journal |vauthors=Bove KE, Hilton PK, Partin J, Farrell MK |title=Morphology of acute myopathy associated with influenza B infection |journal=Pediatr Pathol |volume=1 |issue=1 |pages=51–66 |date=1983 |pmid=6687269 |doi= |url=}}</ref> | ||
| Line 708: | Line 708: | ||
| + | | + | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | | − | ||
| + | | + | ||
| | |− | ||
| | |− | ||
| | |− | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | | | ||
| Line 730: | Line 730: | ||
* '''↑↑''' | * '''↑↑''' | ||
| | | | ||
* | * − | ||
| | | | ||
* | * − | ||
|- | |- | ||
|[[Polio]]<ref name="pmid15933355">{{cite journal |vauthors=Howard RS |title=Poliomyelitis and the postpolio syndrome |journal=BMJ |volume=330 |issue=7503 |pages=1314–8 |date=June 2005 |pmid=15933355 |pmc=558211 |doi=10.1136/bmj.330.7503.1314 |url=}}</ref> | |[[Polio]]<ref name="pmid15933355">{{cite journal |vauthors=Howard RS |title=Poliomyelitis and the postpolio syndrome |journal=BMJ |volume=330 |issue=7503 |pages=1314–8 |date=June 2005 |pmid=15933355 |pmc=558211 |doi=10.1136/bmj.330.7503.1314 |url=}}</ref> | ||
| Line 739: | Line 739: | ||
| colspan="2" | | | colspan="2" | | ||
* Proximal | * Proximal | ||
| | | − | ||
| | |− | ||
| | | − | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | |− | ||
| | |− | ||
| | | | ||
* Asymmetrical [[paralysis]] | * Asymmetrical [[paralysis]] | ||
| Line 763: | Line 763: | ||
* +Serology | * +Serology | ||
| | | | ||
* | * − | ||
| | | | ||
* | * − | ||
| | | | ||
* Neurological pattern | * Neurological pattern | ||
| Line 774: | Line 774: | ||
| colspan="2" | | | colspan="2" | | ||
* Negative | * Negative | ||
| | |− | ||
| | |− | ||
| | | − | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | |− | ||
| | |− | ||
| | |− | ||
| | | | ||
* [[Chancre]] | * [[Chancre]] | ||
| Line 791: | Line 791: | ||
* History of risk factors (MSM, unprotected sex, multiple sex partners) | * History of risk factors (MSM, unprotected sex, multiple sex partners) | ||
| | | | ||
* | * Non−tender [[chancre]] in primary syphilis. | ||
* Followed by [[rash]] | * Followed by [[rash]] | ||
* Generalized [[lymphadenopathy]] in secondary syphilis | * Generalized [[lymphadenopathy]] in secondary syphilis | ||
| Line 798: | Line 798: | ||
* VDRL | * VDRL | ||
* RPR | * RPR | ||
* [[FTA-ABS]] | * [[FTA-ABS|FTA−ABS]] | ||
| | | | ||
* | * − | ||
| | | | ||
* | * − | ||
| | | | ||
* | * − | ||
|- | |- | ||
|[[Pyomyositis]]<ref name="pmid15380499">{{cite journal |vauthors=Crum NF |title=Bacterial pyomyositis in the United States |journal=Am. J. Med. |volume=117 |issue=6 |pages=420–8 |date=September 2004 |pmid=15380499 |doi=10.1016/j.amjmed.2004.03.031 |url=}}</ref> | |[[Pyomyositis]]<ref name="pmid15380499">{{cite journal |vauthors=Crum NF |title=Bacterial pyomyositis in the United States |journal=Am. J. Med. |volume=117 |issue=6 |pages=420–8 |date=September 2004 |pmid=15380499 |doi=10.1016/j.amjmed.2004.03.031 |url=}}</ref> | ||
| Line 814: | Line 814: | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | | − | ||
| | |− | ||
| | |− | ||
| | |− | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | |− | ||
| | | | ||
* [[Fever]] | * [[Fever]] | ||
| Line 833: | Line 833: | ||
* Elevated ESR | * Elevated ESR | ||
| | | | ||
* | * − | ||
| | | | ||
* | * − | ||
| | | | ||
* | * − | ||
|- | |- | ||
! | ! | ||
| Line 849: | Line 849: | ||
* Proximal | * Proximal | ||
* Distal | * Distal | ||
| | |− | ||
| | |− | ||
| | | − | ||
| | |− | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | |− | ||
| | | | ||
* [[Dysphagia]] | * [[Dysphagia]] | ||
| Line 881: | Line 881: | ||
* Proximal | * Proximal | ||
* Distal | * Distal | ||
| | |− | ||
| | |− | ||
| | | − | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | |− | ||
| | |− | ||
| | | | ||
* [[Dysphagia]] | * [[Dysphagia]] | ||
| Line 907: | Line 907: | ||
|[[GBS]]<ref name="pmid23628447">{{cite journal |vauthors=van Doorn PA |title=Diagnosis, treatment and prognosis of Guillain-Barré syndrome (GBS) |journal=Presse Med |volume=42 |issue=6 Pt 2 |pages=e193–201 |date=June 2013 |pmid=23628447 |doi=10.1016/j.lpm.2013.02.328 |url=}}</ref> | |[[GBS]]<ref name="pmid23628447">{{cite journal |vauthors=van Doorn PA |title=Diagnosis, treatment and prognosis of Guillain-Barré syndrome (GBS) |journal=Presse Med |volume=42 |issue=6 Pt 2 |pages=e193–201 |date=June 2013 |pmid=23628447 |doi=10.1016/j.lpm.2013.02.328 |url=}}</ref> | ||
| | | | ||
* 18 | * 18 −350 | ||
| colspan="2" | | | colspan="2" | | ||
* Proximal | * Proximal | ||
| | |− | ||
| | |− | ||
| | | − | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | |− | ||
| | |− | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | |− | ||
| | | | ||
* [[Ascending paralysis]] | * [[Ascending paralysis]] | ||
| Line 939: | Line 939: | ||
* Proximal | * Proximal | ||
* Distal | * Distal | ||
| | |− | ||
| | |− | ||
| | | − | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | |− | ||
| | |− | ||
| | |− | ||
| | | | ||
* Ocular findings | * Ocular findings | ||
| Line 959: | Line 959: | ||
** Increased tone or stiffness | ** Increased tone or stiffness | ||
| | | | ||
* Head CT | * Head CT ologo−clonal bands | ||
| | | | ||
* Normal | * Normal | ||
| Line 968: | Line 968: | ||
|- | |- | ||
! | ! | ||
! colspan="19" | | ! colspan="19" |Neuro−muscular | ||
|- | |- | ||
| rowspan="3" |Botulism | | rowspan="3" |Botulism | ||
| Line 976: | Line 976: | ||
| colspan="2" | | | colspan="2" | | ||
* Distal | * Distal | ||
| | |− | ||
| | |− | ||
| | | − | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | |− | ||
| | |− | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | | − | ||
| | | | ||
* [[Double vision]] | * [[Double vision]] | ||
| Line 1,004: | Line 1,004: | ||
* Myopathic | * Myopathic | ||
|- | |- | ||
|[[Lambert-Eaton syndrome]]<ref name="pmid22094130">{{cite journal |vauthors=Titulaer MJ, Lang B, Verschuuren JJ |title=Lambert-Eaton myasthenic syndrome: from clinical characteristics to therapeutic strategies |journal=Lancet Neurol |volume=10 |issue=12 |pages=1098–107 |date=December 2011 |pmid=22094130 |doi=10.1016/S1474-4422(11)70245-9 |url=}}</ref> | |[[Lambert-Eaton syndrome|Lambert−Eaton syndrome]]<ref name="pmid22094130">{{cite journal |vauthors=Titulaer MJ, Lang B, Verschuuren JJ |title=Lambert-Eaton myasthenic syndrome: from clinical characteristics to therapeutic strategies |journal=Lancet Neurol |volume=10 |issue=12 |pages=1098–107 |date=December 2011 |pmid=22094130 |doi=10.1016/S1474-4422(11)70245-9 |url=}}</ref> | ||
| | | | ||
* Variable | * Variable | ||
| colspan="2" | | | colspan="2" | | ||
* Distal | * Distal | ||
| | |− | ||
| | | − | ||
| + | | + | ||
| + | | + | ||
| | |− | ||
| | |− | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | |− | ||
| | | | ||
* Weakness of the bulbar muscles | * Weakness of the bulbar muscles | ||
| Line 1,024: | Line 1,024: | ||
* Weaknessa is often relieved temporarily after exertion or physical exercise. | * Weaknessa is often relieved temporarily after exertion or physical exercise. | ||
| | | | ||
* Antibodies against | * Antibodies against voltage−gated calcium channels | ||
|- | |- | ||
|[[Myasthenia gravis]]<ref name="pmid23193443">{{cite journal |vauthors=Jayam Trouth A, Dabi A, Solieman N, Kurukumbi M, Kalyanam J |title=Myasthenia gravis: a review |journal=Autoimmune Dis |volume=2012 |issue= |pages=874680 |date=2012 |pmid=23193443 |pmc=3501798 |doi=10.1155/2012/874680 |url=}}</ref> | |[[Myasthenia gravis]]<ref name="pmid23193443">{{cite journal |vauthors=Jayam Trouth A, Dabi A, Solieman N, Kurukumbi M, Kalyanam J |title=Myasthenia gravis: a review |journal=Autoimmune Dis |volume=2012 |issue= |pages=874680 |date=2012 |pmid=23193443 |pmc=3501798 |doi=10.1155/2012/874680 |url=}}</ref> | ||
| Line 1,031: | Line 1,031: | ||
| colspan="2" | | | colspan="2" | | ||
* Proximal | * Proximal | ||
| | |− | ||
| | | − | ||
| + | | + | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | |− | ||
| | |− | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | |− | ||
| | | | ||
* [[Ocular]] | * [[Ocular]] | ||
| Line 1,058: | Line 1,058: | ||
| colspan="2" | | | colspan="2" | | ||
* Proximal | * Proximal | ||
| | |− | ||
| | |− | ||
| | | − | ||
| | |− | ||
| | |− | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
| | |− | ||
| | |− | ||
| | | | ||
* [[Autosomal recessive|AR]] | * [[Autosomal recessive|AR]] | ||
Revision as of 17:02, 9 April 2018
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Flow chart
Approach to muscle weakness[1][2]
| Objective Muscle weakness | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Malignancy Arthralgia Anemia Firbomyalgia | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Generalized | Localized | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Myasthenia gravis Periodic paralysis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Asymmetric | Symmetric | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Cerebrovascular accidents Demyleinating disorders Atrophy Mononeuropathy | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Specific pattern | Specific pattern | Proximal | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hereditary neuropathy Muscular dystrophy | Myoapthy Duchenne muscular dystrophy | Motor neuron disease Peripheral neuropathy | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Differentiating Various Muscle Weakness
| Organ system | Disease | Symptoms | History | Physical
Examination |
Diagnosis | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age of onset | Muscle weakness | Fever | Myalgia | Contractures | Gait abnormality | Neuropathy | Atrophy | Stiffness | Myoglobinuria | Other features | Laboratory Findings | Creatine Kinase | Muscle Biopsy | Electromyogram | |||||
| Medication−induced | Corticosteroids[3] |
|
|
− | + | − | − | − | + | − | − |
|
|
|
|
|
|
| |
| Statins[4] |
|
|
− | + | − | − | − | − | − | −/+(Rhabdomyolysis) |
|
|
|
|
|
|
| ||
| Alcohol[5] |
|
|
− | − | − | + | +/− | − | − | − |
|
|
|
|
|
| |||
| Endocrine | |||||||||||||||||||
| Endocrine | Cushing's disease[6] |
|
|
− | − | − | − | − | + | − | − |
|
|
|
|
|
|
Normal | |
| Adrenal insufficiency[7] |
|
|
− | + | − | − | − | − | + | − |
|
|
|
|
|
| |||
| Hyperaldosteronism with myopathy[8] |
|
|
− | − | − | − | − | − | − | + |
|
|
|
| |||||
| Hyperthyroidism[9] |
|
|
− | − | − | − | − | + | + | + |
|
|
|
|
|
||||
| Hypothyroidism[10] |
|
|
− | + | + | − | − | + | + | + Rhabdomyolysis |
|
|
|
|
|
|
| ||
| Diabetic infraction[11] |
|
|
+ | + | − | − | + | + | − | − |
|
|
|
| |||||
| Inflammatory / Rheumatologic | |||||||||||||||||||
| Inflammatory/ Rheumatologic | Dermatomyositis[12] |
|
|
+ | + | − | − | − | − | + | − |
|
|
|
|||||
| Polymyositis[13] |
|
|
+ | + | − | − | − | − | + | − |
|
|
|
|
| ||||
| Inclusion body myositis[14] |
|
|
− | − | − | − | − | − | − | − |
|
|
|
|
|
|
|||
| Fibromyalgia[15] |
|
|
− | − | − | − | + | − | − | − |
|
|
|
|
|
|
| ||
| Polymyalgia Rheumatica[16] |
|
|
+ | + | − | − | − | − | + | − |
|
|
|
|
| ||||
| Genetic | |||||||||||||||||||
| Genetic | Becker muscular dystrophy[17] |
|
Proximal | − | − | + | + | − | + | − | − |
|
|
|
|
|
|
||
| Duchenne muscular dystrophy[18] |
|
Proximal | − | − | + | + | − | + | − | − |
|
|
|
|
| ||||
| Limb−girdle muscular dystrophies[19] |
|
Proximal | − | + | + | + | − | + | − | − |
|
|
|
|
|
− | |||
| Myotonic dystrophy[20] |
|
|
− | − | + | + | − | − | + | − |
|
|
|
|
− | − | |||
| Infectious | |||||||||||||||||||
| Infectious | Lyme disease[21] |
|
|
+ | + | − | +/− | + | − | − | − |
|
|
|
|
|
|
| |
| Influenza[22] |
|
|
+ | + | − | + | − | − | − | + |
|
|
|
|
|
|
| ||
| Polio[23] |
|
|
− | − | − | + | + | + | − | − |
|
|
|
|
|
|
| ||
| Syphilis[24] |
|
|
− | − | − | + | + | − | − | − |
|
|
|
|
|
|
| ||
| Pyomyositis[25] |
|
|
+ | + | − | − | − | − | + | − |
|
|
|
|
| ||||
| Neurologic | |||||||||||||||||||
| Neurologic | ALS[26] |
|
|
− | − | − | − | + | + | + | − |
|
|
|
|
|
| ||
| Stroke[27] |
|
|
− | − | − | + | + | + | − | − |
|
|
|
|
|
|
| ||
| GBS[28] |
|
|
− | − | − | + | − | − | + | − |
|
|
|
|
|
| |||
| Multiple Sclerosis[29] |
|
|
− | − | − | + | + | − | − | − |
|
|
|
|
|
|
| ||
| Neuro−muscular | |||||||||||||||||||
| Botulism | Botulinum[30] |
|
|
− | − | − | + | − | − | + | − |
|
|
|
|
|
|
| |
| Lambert−Eaton syndrome[31] |
|
|
− | − | + | + | − | − | + | − |
|
|
| ||||||
| Myasthenia gravis[32] |
|
|
− | − | + | + | − | − | + | − |
|
|
| ||||||
| Hereditary | Glycogen storage disease[33] |
|
|
− | − | − | − | − | + | − | − |
|
|
|
| ||||
- ↑ Jackson CE (April 2008). "A clinical approach to muscle diseases". Semin Neurol. 28 (2): 228–40. doi:10.1055/s-2008-1062266. PMID 18351524.
- ↑ LoVecchio F, Jacobson S (August 1997). "Approach to generalized weakness and peripheral neuromuscular disease". Emerg. Med. Clin. North Am. 15 (3): 605–23. PMID 9255135.
- ↑ Gupta A, Gupta Y (September 2013). "Glucocorticoid-induced myopathy: Pathophysiology, diagnosis, and treatment". Indian J Endocrinol Metab. 17 (5): 913–6. doi:10.4103/2230-8210.117215. PMC 3784879. PMID 24083177.
- ↑ Tomaszewski M, Stępień KM, Tomaszewska J, Czuczwar SJ (2011). "Statin-induced myopathies". Pharmacol Rep. 63 (4): 859–66. PMID 22001973.
- ↑ Preedy VR, Adachi J, Ueno Y, Ahmed S, Mantle D, Mullatti N, Rajendram R, Peters TJ (November 2001). "Alcoholic skeletal muscle myopathy: definitions, features, contribution of neuropathy, impact and diagnosis". Eur. J. Neurol. 8 (6): 677–87. PMID 11784353.
- ↑ Sharma V, Borah P, Basumatary LJ, Das M, Goswami M, Kayal AK (July 2014). "Myopathies of endocrine disorders: A prospective clinical and biochemical study". Ann Indian Acad Neurol. 17 (3): 298–302. doi:10.4103/0972-2327.138505. PMC 4162016. PMID 25221399.
- ↑ Ruff RL, Weissmann J (August 1988). "Endocrine myopathies". Neurol Clin. 6 (3): 575–92. PMID 3065602.
- ↑ Sambrook MA, Heron JR, Aber GM (April 1972). "Myopathy in association with primary hyperaldosteronism". J. Neurol. Neurosurg. Psychiatry. 35 (2): 202–7. PMC 494037. PMID 5037033.
- ↑ Li Q, Liu Y, Zhang Q, Tian H, Li J, Li S (July 2017). "Myopathy in hyperthyroidism as a consequence of rapid reduction of thyroid hormone: A case report". Medicine (Baltimore). 96 (30): e7591. doi:10.1097/MD.0000000000007591. PMC 5627834. PMID 28746208.
- ↑ Khaleeli AA, Griffith DG, Edwards RH (September 1983). "The clinical presentation of hypothyroid myopathy and its relationship to abnormalities in structure and function of skeletal muscle". Clin. Endocrinol. (Oxf). 19 (3): 365–76. PMID 6627693.
- ↑ Horton WB, Taylor JS, Ragland TJ, Subauste AR (2015). "Diabetic muscle infarction: a systematic review". BMJ Open Diabetes Res Care. 3 (1): e000082. doi:10.1136/bmjdrc-2015-000082. PMC 4410119. PMID 25932331.
- ↑ Dalakas MC (1991). "Polymyositis, dermatomyositis and inclusion-body myositis". N Engl J Med. 325 (21): 1487–98. doi:10.1056/NEJM199111213252107. PMID 1658649.
- ↑ Dalakas MC (1991). "Polymyositis, dermatomyositis and inclusion-body myositis". N Engl J Med. 325 (21): 1487–98. doi:10.1056/NEJM199111213252107. PMID 1658649.
- ↑ Dalakas MC (1991). "Polymyositis, dermatomyositis and inclusion-body myositis". N Engl J Med. 325 (21): 1487–98. doi:10.1056/NEJM199111213252107. PMID 1658649.
- ↑ Ohara N, Katada S, Yamada T, Mezaki N, Suzuki H, Suzuki A, Hanyu O, Yoneoka Y, Kawachi I, Shimohata T, Kakita A, Nishizawa M, Sone H (2016). "Fibromyalgia in a Patient with Cushing's Disease Accompanied by Central Hypothyroidism". Intern. Med. 55 (21): 3185–3190. doi:10.2169/internalmedicine.55.5926. PMC 5140872. PMID 27803417.
- ↑ Myklebust G, Gran JT (1996). "A prospective study of 287 patients with polymyalgia rheumatica and temporal arteritis: clinical and laboratory manifestations at onset of disease and at the time of diagnosis". Br J Rheumatol. 35 (11): 1161–8. PMID 8948307.
- ↑ Flanigan KM (August 2014). "Duchenne and Becker muscular dystrophies". Neurol Clin. 32 (3): 671–88, viii. doi:10.1016/j.ncl.2014.05.002. PMID 25037084.
- ↑ Flanigan KM (August 2014). "Duchenne and Becker muscular dystrophies". Neurol Clin. 32 (3): 671–88, viii. doi:10.1016/j.ncl.2014.05.002. PMID 25037084.
- ↑ Guglieri M, Straub V, Bushby K, Lochmüller H (October 2008). "Limb-girdle muscular dystrophies". Curr. Opin. Neurol. 21 (5): 576–84. doi:10.1097/WCO.0b013e32830efdc2. PMID 18769252.
- ↑ Udd B, Krahe R (October 2012). "The myotonic dystrophies: molecular, clinical, and therapeutic challenges". Lancet Neurol. 11 (10): 891–905. doi:10.1016/S1474-4422(12)70204-1. PMID 22995693.
- ↑ Schoenen J, Sianard-Gainko J, Carpentier M, Reznik M (August 1989). "Myositis during Borrelia burgdorferi infection (Lyme disease)". J. Neurol. Neurosurg. Psychiatry. 52 (8): 1002–5. PMC 1031843. PMID 2795056.
- ↑ Bove KE, Hilton PK, Partin J, Farrell MK (1983). "Morphology of acute myopathy associated with influenza B infection". Pediatr Pathol. 1 (1): 51–66. PMID 6687269.
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