Generalized weakness resident survival guide: Difference between revisions
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==Do's== | ==Do's== | ||
*Verify true weakness in the examination and rule-out muscle pain or fatigue.<ref name="pmid6491629">{{cite journal |vauthors=Sugarman JR, Berg AO |title=Evaluation of fatigue in a family practice |journal=J Fam Pract |volume=19 |issue=5 |pages=643–7 |date=November 1984 |pmid=6491629 |doi= |url=}}</ref><ref name="pmid12168975">{{cite journal |vauthors=Hinshaw DB, Carnahan JM, Johnson DL |title=Depression, anxiety, and asthenia in advanced illness |journal=J Am Coll Surg |volume=195 |issue=2 |pages=271–7; discussion 277–8 |date=August 2002 |pmid=12168975 |doi=10.1016/s1072-7515(02)01191-2 |url=}}</ref> | *Verify true [[weakness]] in the examination and rule-out [[muscle pain]] or [[fatigue]].<ref name="pmid6491629">{{cite journal |vauthors=Sugarman JR, Berg AO |title=Evaluation of fatigue in a family practice |journal=J Fam Pract |volume=19 |issue=5 |pages=643–7 |date=November 1984 |pmid=6491629 |doi= |url=}}</ref><ref name="pmid12168975">{{cite journal |vauthors=Hinshaw DB, Carnahan JM, Johnson DL |title=Depression, anxiety, and asthenia in advanced illness |journal=J Am Coll Surg |volume=195 |issue=2 |pages=271–7; discussion 277–8 |date=August 2002 |pmid=12168975 |doi=10.1016/s1072-7515(02)01191-2 |url=}}</ref> | ||
*Inquiere about social history and family history for genetic disorders.<ref name="pmid21250168">{{cite journal |vauthors=Walker HK, Hall WD, Hurst JW, Holbrook JH |title= |journal= |volume= |issue= |pages= |date= |pmid=21250168 |doi= |url=}}</ref> | *Inquiere about social history and [[family history]] for [[genetic disorders]].<ref name="pmid21250168">{{cite journal |vauthors=Walker HK, Hall WD, Hurst JW, Holbrook JH |title= |journal= |volume= |issue= |pages= |date= |pmid=21250168 |doi= |url=}}</ref> | ||
*Review medications list.<ref name="pmid21250168" /> | *Review [[Medication|medications]] list.<ref name="pmid21250168" /> | ||
*Look for upper motor and lower neuron | *Look for upper motor and [[lower motor neuron]] [[Sign (medical)|signs]].<ref name="pmid33085325">{{cite journal |vauthors=Ramroop H, Cruz R |title= |journal= |volume= |issue= |pages= |date= |pmid=33085325 |doi= |url=}}</ref> | ||
*Evaluate if weakness is symetrical or asymetrical, as well as for exacerbating factors. | *Evaluate if [[weakness]] is symetrical or asymetrical, as well as for exacerbating factors. | ||
*Order TSH testing.<ref name="pmid11754301">{{cite journal |vauthors=Alshekhlee A, Kaminski HJ, Ruff RL |title=Neuromuscular manifestations of endocrine disorders |journal=Neurol Clin |volume=20 |issue=1 |pages=35–58, v–vi |date=February 2002 |pmid=11754301 |doi=10.1016/s0733-8619(03)00053-7 |url=}}</ref> | *Order [[TSH]] testing.<ref name="pmid11754301">{{cite journal |vauthors=Alshekhlee A, Kaminski HJ, Ruff RL |title=Neuromuscular manifestations of endocrine disorders |journal=Neurol Clin |volume=20 |issue=1 |pages=35–58, v–vi |date=February 2002 |pmid=11754301 |doi=10.1016/s0733-8619(03)00053-7 |url=}}</ref> | ||
*Order glucose and vitamin B12 | *Order glucose and [[Vitamin B12 Deficiency|vitamin B12]] when [[deficiency]] is suspected.<ref name="pmid27446930">{{cite journal |vauthors=Hannibal L, Lysne V, Bjørke-Monsen AL, Behringer S, Grünert SC, Spiekerkoetter U, Jacobsen DW, Blom HJ |title=Biomarkers and Algorithms for the Diagnosis of Vitamin B12 Deficiency |journal=Front Mol Biosci |volume=3 |issue= |pages=27 |date=2016 |pmid=27446930 |pmc=4921487 |doi=10.3389/fmolb.2016.00027 |url=}}</ref> | ||
*Order serum and urine testing for drug and toxins exposure. | *Order [[serum]] and [[Urinalysis|urine testing]] for [[drug]] and [[Toxicity|toxins]] exposure. | ||
*Perform electromyogram and nerve conduction test if lab results are inconclusive.<ref name="pmid6372673">{{cite journal |vauthors=Grassino A, Macklem PT |title=Respiratory muscle fatigue and ventilatory failure |journal=Annu Rev Med |volume=35 |issue= |pages=625–47 |date=1984 |pmid=6372673 |doi=10.1146/annurev.me.35.020184.003205 |url=}}</ref><ref name="pmid33085325" /> | *Perform [[electromyogram]] and [[Nerve conduction study|nerve conduction test]] if lab results are inconclusive.<ref name="pmid6372673">{{cite journal |vauthors=Grassino A, Macklem PT |title=Respiratory muscle fatigue and ventilatory failure |journal=Annu Rev Med |volume=35 |issue= |pages=625–47 |date=1984 |pmid=6372673 |doi=10.1146/annurev.me.35.020184.003205 |url=}}</ref><ref name="pmid33085325" /> | ||
==Don'ts== | ==Don'ts== | ||
Revision as of 02:31, 27 October 2020
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.
- Cadmium poisoning
- Dicamba poisoning
- Fluoride poisoning
- Hexane-2,5-dione poisoning
- Temik poisoning
- Benztropine Mesylate overdose
- Hypercalcemia
- Hyperkalaemic periodic paralysis
- Hypermagnesemia
- Hypermethioninemia
- Hypokalemic periodic paralysis
- Hypomagnesemia
- Hypophosphatemia
- Uremia
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.
- To view the treatment of Guillian-Barre syndrome click here.
- To view the treatment of Myasthenia Gravis click here.
- To view the treatment of Polymyositis click here.
- To view the treatment of Lambert-Eaton syndrome click here.
- To view the treatment of Botulism click here.
Do's
- Verify true weakness in the examination and rule-out muscle pain or fatigue.[1][2]
- Inquiere about social history and family history for genetic disorders.[3]
- Review medications list.[3]
- Look for upper motor and lower motor neuron signs.[4]
- Evaluate if weakness is symetrical or asymetrical, as well as for exacerbating factors.
- Order TSH testing.[5]
- Order glucose and vitamin B12 when deficiency is suspected.[6]
- Order serum and urine testing for drug and toxins exposure.
- Perform electromyogram and nerve conduction test if lab results are inconclusive.[7][4]
Don'ts
- Do not use a muscle biopsy as first testing modality; this should usually be reserved after all other diagnostic workup has failed to reveal a cause.[8]
References
- ↑ Sugarman JR, Berg AO (November 1984). "Evaluation of fatigue in a family practice". J Fam Pract. 19 (5): 643–7. PMID 6491629.
- ↑ 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.
- ↑ 3.0 3.1 Walker HK, Hall WD, Hurst JW, Holbrook JH. PMID 21250168. Missing or empty
|title=(help) - ↑ 4.0 4.1 Ramroop H, Cruz R. PMID 33085325 Check
|pmid=value (help). Missing or empty|title=(help) - ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.