Muscle weakness and Myalgia: Difference between revisions

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[[Dexamethasone suppression test|<nowiki/>]]
{{CMG}}
 
==Differential Diagnosis of Muscle Weakness and Myalgia==
 
{|
{|
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Organ system
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Organ system
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! style="background:#4479BA; color: #FFFFFF;" align="center" + |Electromyogram
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Electromyogram
|-
|-
! rowspan="2" style="background:#DCDCDC;" align="center" + |Medication−induced
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Medication−induced
! style="background:#DCDCDC;" align="center" + |[[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>
! style="background:#DCDCDC;" align="center" + |[[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>
| style="background:#F5F5F5;" align="center" + |Variable
| style="background:#F5F5F5;" align="center" + |Variable
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* Normal
* Normal
|-
|-
! rowspan="3" |Endocrine
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Endocrine
! style="background:#DCDCDC;" align="center" + |[[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>
! style="background:#DCDCDC;" align="center" + |[[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>
| style="background:#F5F5F5;" align="center" + |30−50 years
| style="background:#F5F5F5;" align="center" + |30−50 years
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! style="background:#4479BA; color: #FFFFFF;" align="center" + |Electromyogram
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Electromyogram
|-
|-
! rowspan="3" style="background:#DCDCDC;" align="center" + |Inflammatory/ Rheumatologic
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Inflammatory/ Rheumatologic
! style="background:#DCDCDC;" align="center" + |[[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>
! style="background:#DCDCDC;" align="center" + |[[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>
| style="background:#F5F5F5;" align="center" + |40s−50s<br>Can affect children  
| style="background:#F5F5F5;" align="center" + |40s−50s<br>Can affect children  
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* Normal  
* Normal  
|-
|-
!Genetic
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Genetic
! style="background:#DCDCDC;" align="center" + |[[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>
! style="background:#DCDCDC;" align="center" + |[[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>
| style="background:#F5F5F5;" align="center" + |<15 yrs
| style="background:#F5F5F5;" align="center" + |<15 yrs
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! style="background:#4479BA; color: #FFFFFF;" align="center" + |Electromyogram
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Electromyogram
|-
|-
! rowspan="3" style="background:#DCDCDC;" align="center" + |Infectious
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Infectious
! style="background:#DCDCDC;" align="center" + |[[Lyme disease]]<ref name="pmid2795056">{{cite journal |vauthors=Schoenen J, Sianard-Gainko J, Carpentier M, Reznik M |title=Myositis during Borrelia burgdorferi infection (Lyme disease) |journal=J. Neurol. Neurosurg. Psychiatry |volume=52 |issue=8 |pages=1002–5 |date=August 1989 |pmid=2795056 |pmc=1031843 |doi= |url=}}</ref>
! style="background:#DCDCDC;" align="center" + |[[Lyme disease]]<ref name="pmid2795056">{{cite journal |vauthors=Schoenen J, Sianard-Gainko J, Carpentier M, Reznik M |title=Myositis during Borrelia burgdorferi infection (Lyme disease) |journal=J. Neurol. Neurosurg. Psychiatry |volume=52 |issue=8 |pages=1002–5 |date=August 1989 |pmid=2795056 |pmc=1031843 |doi= |url=}}</ref>
| style="background:#F5F5F5;" align="center" + |Variable
| style="background:#F5F5F5;" align="center" + |Variable
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* N/A
* N/A
|}
|}
<references />
 
==References==
{{Reflist|2}}
 
[[Category:Medicine]]
[[Category:Neurology]]
[[Category:Rheumatology]]
[[Category:Up-To-Date]]

Latest revision as of 22:48, 29 July 2020

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

Differential Diagnosis of Muscle Weakness and Myalgia

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[1] Variable Proximal + +
  • Positive h/o medications
  • Facial and sphincter muscles are usually spared
  • Normal
  • Normal
  • Normal
Statins[2] 60+ Proximal + −/+(Rhabdomyolysis)
  • N/A
  • Positive h/o medications
  • H/o other medication use
  • ↑↑ Liver enzymes
  • ↑↑
  • Necrosis
  • Degeneration, and regeneration of fibers
  • Phagocytic infiltration
  • Normal
Endocrine Adrenal insufficiency[3] 30−50 years Proximal + +
  • Normal
  • Normal
  • Normal
Hypothyroidism[4] 55 Proximal + + + + + Rhabdomyolysis
  • ↑↑
  • Nonspecific 
  • Normal
Diabetic infraction[5] 45  Proximal + + + +
  • Normal
  • Normal
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[6] 40s−50s
Can affect children
Proximal + + +
  • ↑↑
  • Perimysial mononuclear infiltrate
Polymyositis[7] > 18 years Proximal + + +
  • N/A
  • N/A
  • ↑↑
  • Endomysial mononuclear infiltrate
  • Patchy necrosis
Polymyalgia Rheumatica[8] 50s Diffuse + + +
  • History of joints stiffness, worse in the morning
  • Restricted shoulder motion
  • Normal
  • Normal
  • Normal
Genetic Limb−girdle muscular dystrophies[9] <15 yrs Proximal + + + +
  • LMNA gene
  • CAV3 gene
  • ↑↑
  • N/A
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[10] Variable Proximal + + +/− +
  • H/o tick bite
  • Hiking trip
  • Clinical diagnosis
  • +Serology
  • N/A
  • N/A
  • N/A
Influenza[11] Variable Proximal and Distal + + + +
  • Cold weather
  • H/o Ill contacts
  • Muscle weakness, tenderness, and swelling.
  • ↑↑ Liver enzymes
  • Positive PCR
  • ↑↑
  • N/A
  • N/A
Pyomyositis[12] Variable Proximal
&
Distal
+ + +
    • Muscles are painful, swollen, tender, and indurated.
    • Depending on the site of involvement, it may mimic appendicitis (psoas muscle), septic arthritis of the hip (iliacus muscle), or epidural abscess (piriformis muscle).
  • Leukocytosis
  • Elevated ESR
  • N/A
  • N/A
  • N/A

References

  1. 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.
  2. Tomaszewski M, Stępień KM, Tomaszewska J, Czuczwar SJ (2011). "Statin-induced myopathies". Pharmacol Rep. 63 (4): 859–66. PMID 22001973.
  3. Ruff RL, Weissmann J (August 1988). "Endocrine myopathies". Neurol Clin. 6 (3): 575–92. PMID 3065602.
  4. 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.
  5. 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.
  6. Dalakas MC (1991). "Polymyositis, dermatomyositis and inclusion-body myositis". N Engl J Med. 325 (21): 1487–98. doi:10.1056/NEJM199111213252107. PMID 1658649.
  7. Dalakas MC (1991). "Polymyositis, dermatomyositis and inclusion-body myositis". N Engl J Med. 325 (21): 1487–98. doi:10.1056/NEJM199111213252107. PMID 1658649.
  8. 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.
  9. 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.
  10. 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.
  11. 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.
  12. 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.