Approach to Weakness

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Approach to Weakness

• Dr Chaitanya Vemuri

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Weakness

• Reduction in the power that can be exerted by one
  or more muscles.

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Weakness

• Parts involved
• Mode of onset
• Duration
• Progression
• Symmetry

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• Is it UMN or LMN ?

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UMN

• Muscles are involved in groups
• Weakness of
• Shoulder abduction
• Finger movements
• Hip flexion
• Toe dorsiflexion
• Distal muscle groups are affected more than
  proximal groups

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UMN

• Axial muscles are spared unless lesion is
  bilateral
• Rapid repetitive movements are slow but rhythm is
  preserved
• Hypertonia spastic
• Exaggerated tendon reflexes
• Loss of abdominal reflexes
• Extensor plantar response
• No muscle wasting except disuse atrophy

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LMN

• Weakness in the distribution of lesion in
  spinal segment, root, nerve
• Wasting
• Hypotonia
• Loss of tendon reflex
• Fasiculations of affected muscles
• Contracture of muscle
• Trophic changes in skin , nail

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LMN ?

• Anterior horn cell disease
• Spinal root
• Peripheral nerve
• Neuromuscular Junction
• Muscle

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Ask for symptoms sugg of proximal muscles
weakness upper limb

• Unable to comb hair
• Not able to take things from height
• Not able to hang clothes on cloth lin e

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Ask for symptoms sugg of distal muscle weakness
upper limb

• Unable to button shirt
• Not able to write
• Difficulty in holding things
• Cannot open a jar
• Cannot close water tap

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Ask for symptoms sugg of proximal muscle weakness
lower limb

• Unable to run or hop
• Not able to get up from chair / squatting
• posture
• Not able to climb up stairs ( extensor weakness )
• Unable to come down stairs ( quadriceps muscle
  weakness )

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Ask for symptoms sugg of distal muscle weakness
lower limb

• Tripping on small objects
• Dragging of foot while walking
• Slipping of chappals with awareness

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• History of neck pain , back pain
• History of pain over vertebrae
• Are attacks of weakness precipitated by heavy
  carbohydrate meal ?
• Is the weakness precipitated by exposure to cold
  and exercise ?
• Is there weakness of neck muscles ?

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• Are there fasiculations and muscle wasting ?
• Is there exercise induced weakness / fatigue with
  pain ?
• Is there weakness and fatiguability after severe
  exercise ?
• Any diurnal variation in weakness ?

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• Any other associated systemic complaints ?

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Past history

• Fever prior to weakness
• Trauma
• Drugs
• h/o Tb, DM , HTN, DLP, Cervical spondylosis
• CV junction anomaly

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Family History

• Similar complaints in family members
• Consanguinous marriage
• Tuberculosis
• Psychiatric illness
• Muscular dystrophy

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Personel history

• Vaccination prior to onset of weakness
• Extramarital contact
• Alcohol
• Smoking
• Drug abuse

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Thank you