Sunday, February 5, 2017

Step 2 CK: Differentials of proximal muscle weakness

Hello!

Here's a short post about proximal muscle weakness!

Which groups of muscles are involved in proximal muscle weakness?
Proximal weakness involves the axial muscle groups, deltoids, and hip flexors.

What do patients usually complain of?
They typically complain that they are unable to perform specific tasks, such as climbing stairs or combing hair, or that they have a feeling of “heaviness” or “stiffness” in their limbs.

What are the differentials of proximal muscle weakness?

Inflammatory myopathies:
Dermatomyositis
Polymyositis
Inclusion body myositis
Endocrine disorders:
Hypothyroidism
Hyperthyroidism
Adrenal insufficiency
Drugs:
Steroids
Statins
Cyclosporine
Electrolyte abnormalities (Any electrolyte abnormality can cause it!)
Hypokalemia
Hypocalcemia
Hyonatremia
Neuromuscular disorders:
Myasthenia gravis
Lambert-Eaton myasthenic syndrome
Duchenne muscular dystrophy
Mitochondrial myopathy

(Since this part is loooong to read, I put it in the end.)
How do you check for proximal muscle weakness clinically?
Affected patients may have difficulty flexing or extending the neck against resistance. One way to detect the presence of neck flexor weakness is to observe the patient sitting up from the supine position. In this setting, the head will lag behind as the patient sits up.

Sitting up may be difficult or even impossible in patients with more severe proximal muscle weakness or, at times, may be the only objective evidence of weakness.

Deltoid muscle strength can be assessed by pressing down on the patient's fully abducted arms with the elbows flexed. The examiner should not be able to overcome the patient's resistance if strength is normal.

The patient with quadriceps weakness may be unable to rise from a seated position without the use of the upper extremities and is usually unable to perform a deep knee bend. These individuals may suddenly drop into the chair when trying to sit down slowly.

Patients with proximal leg weakness may rise from sitting on the floor by “climbing up their legs with their hands.” This is termed Gower's sign and is characteristic of, but is not specific for, Duchenne muscular dystrophy.

That's all!
You're never too old to see things in a new way :)
-IkaN

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