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Approach to Weakness

Weakness. Reduction in the power that can be exerted by one or more muscles.. Weakness . Parts involvedMode of onsetDuration Progression Symmetry . . Is it UMN or LMN ?. UMN . Muscles are involved in groups Weakness of : Shoulder abduction Finger movements Hip flexion Toe do

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Approach to Weakness

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    1. Approach to Weakness Dr Chaitanya Vemuri

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

    3. Weakness Parts involved Mode of onset Duration Progression Symmetry

    4. Is it UMN or LMN ?

    5. 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

    6. 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

    7. 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

    8. LMN ? Anterior horn cell disease Spinal root Peripheral nerve Neuromuscular Junction Muscle

    9. 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

    10. 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

    11. 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 )

    12. Ask for symptoms sugg of distal muscle weakness – lower limb Tripping on small objects Dragging of foot while walking Slipping of chappals with awareness

    13. 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 ?

    14. 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 ?

    15. Any other associated systemic complaints ?

    16. Past history Fever prior to weakness Trauma Drugs h/o Tb, DM , HTN, DLP, Cervical spondylosis CV junction anomaly

    17. Family History Similar complaints in family members Consanguinous marriage Tuberculosis Psychiatric illness Muscular dystrophy

    18. Personel history Vaccination prior to onset of weakness Extramarital contact Alcohol Smoking Drug abuse

    19. Thank you

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