MSK weakness Flashcards
ALS presentation
upper motor neuron (hyperreflexia and spasticity) and lower motor neuro (atrophy, fasciculation) symptoms. Can have distal muscle weakness. no pain seen
Extramedullary tumor with compressive myelopathy presentation
sensory loss, hyperreflexia, spasticity, incontinence.
Polymyositis
symmetrical proximal muscle weakness with or without pain. ESR, CRP, and CPK and aldolase levels are increased.
anterior or cutaneous nerves compression presentation
only sensory nerves and so compression doesn’t cause muscle weakness or absent reflexes
Presentation of acute asymmetrical focal lower extremity weakness in DM2 (well controlled) and see muscle atrophy and areflexia and autonomic dysfunction and unintentional weight loss
diabetic amyotrophy
Treatment of diabetic amyotrophy
PT, pain control, strict glycemic control and most make partial functional recovery.
Differential for myopathy
steroid induced myopathy, polymyaglia rheumatica, inflammatory myopathies, statin induced myopathy, hypothyroid myopathy
clinical features of steroid induced myopathy
progressive proximal muscle weakness and atrophy, without pain or tenderness, lower extremity muscles involved.
inflammatory markers of steroid induced myopathy
Normal ESR and CK
clinical features of polymyalgia rheumatica
muscle pain and stiffness in shoulder and pelvic girdle and tenderness with decreased range of motion at shoulder, neck, and hip responds rapidly to low dose (prednisone 20 mg/daily)
inflammatory markers of steroid induced myopathy
high ESR and CK normal
inflammatory myopathies clinical presentation
muscle pain, tenderness and proximal muscle weakness, skin rash and inflammatory arthritis may be present
inflammatory markers of inflammatory myopathies
high ESR and CK
Inflammatory myopathies are:
dermatomyositis and polymyositis
statin induced myopathy clinical features
prominent muscle pain and tenderness with or without weakness rarely rhabdomyolysis
hypothyroid myopathy clinical features
muscle pain, cramps, weakness involving the proximal muscles, delayed tendon reflexes and myoedema and occasional rhabdomyolysis and severe myopathy
laboratory findings of hypothyroid myopathy
normal and high CK (usually <10 times the upper limit of normal)
laboratory findings of steroid induced myopathy
normal ESR and high CK
what condition can precipitate statin myopathy?
hypothyroidism - thus 1st test to screen for is hypothyroidism prior to starting statin therapy and if someone complains of statin induced myopathy, check the thyroid function.
what labs support a diagnosis of polymyositis?
ANA and EMG makes diagnosis. Can see proximal muscle weakness and elevated CK levels
What two conditions have proximal muscle weakness?
hypothyroid myopathy and polymyositis
Can coenzyme q10 prevent statin myopathy?
no the evidence is weak and so no don’t supplement with coenzyme q 10.
prolonged vitamin D deficency
can cause muscle weakness and bone pain. Also this can lead to secondary hyperparathyroidism and osteomalacia. Would also se low phos and elevated bone turnover makres (alkaline phosphatase)
Complications of dermatomyositis
pulmonary: interstitial lung dx, respiratory muscle weakness GI: dysphagia, nasal regurgitation, aspiration cardiac: myocarditis Malignancy: adenocarcinoma (lung, breast, ovarian) and lymphoma.
velcro crakles and diffuse reticulonodular interstitial opacities in the lung bases and dysphagia with proximal muscle weakness
dermatomyositis
Does polymyalgia rheumatica have muscle weakness
no, it only has pain related to dx and so may see weakness which is really related to pain and not true weakness
age>50,
bilateral pain and morning stiffness
>1 month of 2 of the following areas: neck or torso, shoulders or proximal arms proximal thigh or hip, constitutional fever, malaise or weight loss
polymyalgia rheumatica clinical features
physical exam of polymyalgia rheumatica
decreased ROM of shoulders, neck and hips
Lab findings of polymyalgia rheumatica
ESR>40 and sometimes >100 elevated CRP>10 in 90% of individuals normocytic anemia possible 20% can have normal studies
20% of people can have normal ESR and still have PMR
CRP is elevated in most people
but if there’s still uncertainty can start empiric low dose prednisone at 10-15mg/day and slow taper over 1-2 years. PMR pts should see improvement in about 3 days after starting prednisone.
treatment of PMR or polymyalgia rheumatica
prednisone 15-20 mg daily provides rapid relief and this distinguishes this from other myopathies
diabetic amyotrophy presentation
acute asymmetrical pain followed by gradual worsening proximal lower extremity and back weakness and autonomic failure and weight loss
wide spread MSK pain fatigue, stiffness and aching on characteristic tender points
fibromyalgia Normal CRP and ESR and prevalence increases with age
myaglias, weakness and elevated creatine kinase
hypothyroid myopathy See high TSH
chart of myopathies
morning stiffness of shoulders, hips girdles, neck
PMR or polymyalgia rheumatica
Diagnosis of meralgia peresthetica is:
Treatment of meralgia paresthetica
self limited condition and conservative treatment is needed in >90% of pts
avoid tight garments
weight loss
anticonvulsants (gabapentin) or local nerve block
injury to lateral femoral cutaneous nerve or compression at inguinal ligament or injury during local surgery or seat belt injury from MVA causes this:
meralgia paresthetica
risk factors for meralgia paresthetica
obesity with heavy panniculus
diabetes
pregnancy
tight clothing and belts at waist
paresthesias and decreased sensation at the upper lateral thigh
no motor deficits
meralgia paresthetica presentation
MRI of the diagnosing the radiculopathy spinal stenosis or spondylolisthesis
see weakness and sensory loss of the affected spinal root nerves
