Muscle Weakness Flashcards
muscle weakness (power)
5= normal 4= slight weakness 3= active against gravity but not resistance 2= active but not against gravity or resistance 1= small trace contraction 0 = complete paralysis
where can muscle weakness arise from?
upper motor neurone
NMJ
lower motor neurone
muscle tone
upper motor neuron
tone is increased (spastic paralysis)
lower motor neurone decreased tone (flaccid)
NMJ tone is decreased
muscle bulk
upper- normal
NMJ- normal
lower- severe atrophy (disuse)
reflexes
upper- hyper-reflexia
NMJ- preserved
lower- hypoactive / absent
fasiculations
small muscle twitches
*only in lower motor neuone
upper motor neurone lesion extra
babinski *lateral aspect (plantarflexion is normal) (dorsiflexion is the babinski +ve)
pronator drift
outstretch with palms faced upwards
forearm pronator
suddenly drift to pronator
causes of muscle weakness
- brain
- spinal cord
- anterior horn
- peripheries
- NMJ
brain: stroke, space occupying lesions
spinal cord: trauma, disk herniation, spinal stenosis, spinal epidural abscess, hematoma, syringomyelia, MS
anterior horn cells
amyotrophic lateral
poliomyelitis
peripheries:
diabetic neuropathy
NMJ:
myasthenia gravis
Lambert eaton
dermatomyostiis
brain symptoms
stroke- sudden onset, hemiparesis and hemisensory loss, aphasia, neglect, visual field defect
basilar artery- locked in syndrome. quadripareiss, intact consciousnesss, eye movement
space occupying lesions:
gradual onset weakness
spinal cord lesions symptoms
weakness in the extremities without cortical signs
penetrating trauma- hemisection of the spinal cord (brown squared) ipsilateral hemiparesis , loss of proprioception but CONTRALATERAL loss of pain and temp
at spinal level of lesions there is loss of all sensation and flaccid paralysis of the msucle
intervertebral disc herniation: weakness and pain (sciatic)
compression of caudal equine and spinal cord + bladder and bowel dysfunction
spinal cord artery occlusion
usually affects anterior 2/3 of spinal cord
sudden onset bilateral flaccid paralysis that evolves into spastic paralysis
weakness
bilateral loss of pain and temp
*preseved dorsal column to proproception and vibration is spared
syringomyelia
cavity or syrinx grows from centre of spinal cord outwards destroying grey and white matter. effects cervical spinal cord and extends into brain stem
bilateral loss of pain and temp
cape like distribution
shoulders and upper arms
MS
chronic inflammatory demyelinating
effects white
optic neuritis
upper motor damage
RAPD
diplopia
ataxia, vertigo, chronic constipation, bladder dysfunction (overactive detrusor muscle)
Lhermitte’s sign- electric shock like down back with neck flexion
uhtoffs phenomenon
worsening of symptoms when body temperature increases
disseminated in time and place
relapsing-remitting
diagnosis: brain and spinal cord MRI. periventricular (around the ventricles)
lumbar puncture- oligoclonal bands (discrete sets of antibodies IgG)
evoked potential conduction velocity- slowing of electrical events
treatment of MS
disease modifying meds
IFN-B, glatriamer acetate, natalizumab
symptomatic therapy
spasticity: tx baclofen
(muscle relaxant)
urge urinary incontinence: amitriptyline
urinary retention: bethanechol
neuropathic pain
anticonvulsants
carbamezapine, gabapentin, pregabalin.
antidepressants
amyotrophic lateral sclerosis
affects anterior horn and cortical motor neurons
purely motor
steven hawkin had this
diplopia
difficult with speech and swallowing
focal limb weakness
muscle relaxants
percutaneous gastronomy
polyneuropathies
moloneuropathies
polyneuropathies
DANG MY THERAPIST
D- diabetic neuropathy A- alcoholic neuropathy Nutritional (vit B1, B6, B12) Gullian Barre syndrome Medications Toxins (lead, arsenic poisoning) Hereditary (Charcot Marie Tooth) renal failure (uraemic neuropathy) Amyloidosis Prophyrias Infection- leprosy, syphilis, HIV systemic disorders (hypothyroidism) Tumors
diabetic neuropathy
sensory - loss of sensation and paraesthesis (stocking and glove neuropathy)
motor weakness- cranial nere palsy
autonomic
arrhythmias, orthostatic hypotension, erectile disfunction, gastroporesis
gullian-barre
autoimmune demyelinating diosrer
acute inflammatory diarrhoea
caused by campylobacter jeuni
acute inflammatory demyelinating polyneuropathy
two-four weeks post infection. rapid progressive symmetric ascending weakness in distal lower extremities.
flaccid paralysis. decreased or absent tendon reflex.
fluctatoni in BP, cardiac arrhythmias
*sensory is rare
Ix: CSF analysis (albuminocytological dissociation)
tx: immunoglobulins
charcot-marie tooth
progressive hereditary motor and sensory polyneuropathy
distal lower extremity weakness
foot drop (common perineal nerve)
high arching of foot (pes caves)
scoliosis
sensory: pain, sensory loss
diagnosis:
electrodiagnostic testing
genetic testing
management:
physiotherapy
rehabilitation
chemotherapetuic- vincristine, isonizid, paclitexl, colchicine.
mono-neuropathies
facial nerve palsy
carpal tunnel syndrome
facial nerve palsy
ipsilateral complete paralysis
eye - paralysis of orbiculares oculars (cannot close eyes)
ears- sensitive (hyperacusis)
tongue- abnormal taste (dysgeusia)
Bell's palsy lyme disease Ramsay hunt syndrome (herpes zoster) (painful eruption in external auditory canal) sarcoidosis gullian barre syndrome acoustic neuroma
bells palsy treatment
10 days prednisolone
in some cases HSV is involved so sometimes give acyclovir
cover with eye patch to prevent cornea from getting dry
carpal tunnel syndrome
*mononeuropathy
entrapment of median nerve
receptive use of wrist
numbness and tingling on lateral 3 1/2 fingers
O/E
tinnels test
phalanx test (raised forearms)
treat:
immobilise the wrist (splint)
injection of glucocorticoids
surgical decompression (carpal tunnel release)
NMJ disorders
myasthenia gravis
Lambert eaton myasthenic syndrome
