Proximal muscle weakness
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Differential Diagnosis of Proximal Muscle Weakness
Organ system | Disease | Symptoms | History | Physical
Examination |
Diagnosis | ||||||||||||||
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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[1] | Variable | Proximal | − | + | − | − | − | + | − | − |
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Statins[2] | 60+ | Proximal | − | + | − | − | − | − | − | −/+(Rhabdomyolysis) |
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Alcohol[3] | Variable | Proximal | − | − | − | + | +/− | − | − | − |
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Organ system | Disease | Age of onset | Muscle weakness | Fever | Myalgia | Contractures | Gait abnormality | Neuropathy | Atrophy | Stiffness | Myoglobinuria | Other features | History | Physical
Examination |
Laboratory Findings | Creatine Kinase | Muscle Biopsy | Electromyogram | |
Endocrine | Cushing's disease[4] | 25 −45 | Proximal | − | − | − | − | − | + | − | − |
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Normal | |
Adrenal insufficiency[5] | 30−50 years | Proximal | − | + | − | − | − | − | + | − |
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Hyperaldosteronism with myopathy[6] | 50 | Proximal & distal |
− | − | − | − | − | − | − | + |
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Hyperthyroidism[7] | 40 | Proximal | − | − | − | − | − | + | + | + |
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Hypothyroidism[8] | 55 | Proximal | − | + | + | − | − | + | + | + Rhabdomyolysis |
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Diabetic infraction[9] | 45 | Proximal | + | + | − | − | + | + | − | − |
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Organ system | Disease | Age of onset | Muscle weakness | Fever | Myalgia | Contractures | Gait abnormality | Neuropathy | Atrophy | Stiffness | Myoglobinuria | Other features | History | Physical
Examination |
Laboratory Findings | Creatine Kinase | Muscle Biopsy | Electromyogram | |
Inflammatory/ Rheumatologic | Dermatomyositis[10] | 40s−50s Can affect children |
Proximal | + | + | − | − | − | − | + | − |
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Polymyositis[11] | > 18 years | Proximal | + | + | − | − | − | − | + | − |
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Inclusion body myositis[12] | 50s | Proximal & distal |
− | − | − | − | − | − | − | − |
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Fibromyalgia[13] | 40−50s | Generalized | − | − | − | − | + | − | − | − |
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Polymyalgia Rheumatica[14] | 50s | Diffuse | + | + | − | − | − | − | + | − |
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Organ system | Disease | Age of onset | Muscle weakness | Fever | Myalgia | Contractures | Gait abnormality | Neuropathy | Atrophy | Stiffness | Myoglobinuria | Other features | History | Physical
Examination |
Laboratory Findings | Creatine Kinase | Muscle Biopsy | Electromyogram | |
Genetic | Becker muscular dystrophy[15] | <13yrs | Proximal | − | − | + | + | − | + | − | − |
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Duchenne muscular dystrophy[16] | <13 yrs | Proximal | − | − | + | + | − | + | − | − |
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Limb−girdle muscular dystrophies[17] | <15 yrs | Proximal | − | + | + | + | − | + | − | − |
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Myotonic dystrophy[18] | <18 years | Proximal & distal |
− | − | + | + | − | − | + | − |
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Glycogen storage disease[19] | Variable | Proximal | − | − | − | − | − | + | − | − |
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Organ system | Disease | Age of onset | Muscle weakness | Fever | Myalgia | Contractures | Gait abnormality | Neuropathy | Atrophy | Stiffness | Myoglobinuria | Other features | History | Physical
Examination |
Laboratory Findings | Creatine Kinase | Muscle Biopsy | Electromyogram | |
Infectious | Lyme disease[20] | Variable | Proximal | + | + | − | +/− | + | − | − | − |
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Influenza[21] | Variable | Diffuse | + | + | − | + | − | − | − | + |
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Polio[22] | <5 yrs | Proximal | − | − | − | + | + | + | − | − |
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Syphilis[23] | Variable | Generalized | − | − | − | + | + | − | − | − |
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Pyomyositis[24] | Variable | Proximal & Distal |
+ | + | − | − | − | − | + | − |
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Organ system | Disease | Age of onset | Muscle weakness | Fever | Myalgia | Contractures | Gait abnormality | Neuropathy | Atrophy | Stiffness | Myoglobinuria | Other features | History | Physical
Examination |
Laboratory Findings | Creatine Kinase | Muscle Biopsy | Electromyogram | |
Neurologic | ALS[25] | >35 | Proximal & Distal |
− | − | − | − | + | + | + | − |
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Stroke[26] | >65 | Proximal & distal |
− | − | − | + | + | + | − | − |
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GBS[27] | 18 −350 | Proximal | − | − | − | + | − | − | + | − |
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Multiple Sclerosis[28] | 30's | Proximal & distal |
− | − | − | + | + | − | − | − |
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Neuromuscular | Myasthenia gravis[29] | Variable | Proximal | − | − | + | + | − | − | + | − |
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References
- ↑ 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.
- ↑ Kannourakis G (April 2002). "Glycogen storage disease". Semin. Hematol. 39 (2): 103–6. PMID 11957192.
- ↑ 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.
- ↑ Howard RS (June 2005). "Poliomyelitis and the postpolio syndrome". BMJ. 330 (7503): 1314–8. doi:10.1136/bmj.330.7503.1314. PMC 558211. PMID 15933355.
- ↑ French P (January 2007). "Syphilis". BMJ. 334 (7585): 143–7. doi:10.1136/bmj.39085.518148.BE. PMC 1779891. PMID 17235095.
- ↑ Crum NF (September 2004). "Bacterial pyomyositis in the United States". Am. J. Med. 117 (6): 420–8. doi:10.1016/j.amjmed.2004.03.031. PMID 15380499.
- ↑ Zarei S, Carr K, Reiley L, Diaz K, Guerra O, Altamirano PF, Pagani W, Lodin D, Orozco G, Chinea A (2015). "A comprehensive review of amyotrophic lateral sclerosis". Surg Neurol Int. 6: 171. doi:10.4103/2152-7806.169561. PMC 4653353. PMID 26629397.
- ↑ Baldwin K, Orr S, Briand M, Piazza C, Veydt A, McCoy S (May 2010). "Acute ischemic stroke update". Pharmacotherapy. 30 (5): 493–514. doi:10.1592/phco.30.5.493. PMID 20412000.
- ↑ van Doorn PA (June 2013). "Diagnosis, treatment and prognosis of Guillain-Barré syndrome (GBS)". Presse Med. 42 (6 Pt 2): e193–201. doi:10.1016/j.lpm.2013.02.328. PMID 23628447.
- ↑ Goldenberg MM (March 2012). "Multiple sclerosis review". P T. 37 (3): 175–84. PMC 3351877. PMID 22605909.
- ↑ Jayam Trouth A, Dabi A, Solieman N, Kurukumbi M, Kalyanam J (2012). "Myasthenia gravis: a review". Autoimmune Dis. 2012: 874680. doi:10.1155/2012/874680. PMC 3501798. PMID 23193443.