Muscle weakness

Question 1

Site

Answer 1

Where are you experiencing the muscle weakness?
Is the weakness the same on both sides?
Have you experienced
weakness in any other part of your body?
Is a single muscle affected or a whole group of muscles that are affected?
Has it been spreading?

Question 2

Thinking about for site?

Answer 2

Generalised?
Bilateral?
Symmetrical?
Upper and Lower limbs?
Spread over time
Distal (Peripheral neuropathy  or motor neuron disease) or Proximal (Axial muscles)
Single muscle or all muscle groups?

Question 3

Severity

Answer 3

Are you able to move the affected area at all?

What is the muscle weakness stopping you from doing?

Question 4

Time course

Answer 4

Did the weakness start suddenly?
How long have you had muscle weakness for? 
Does it come and go?
Has it been getting worse?
Is it worse after activity?

Question 5

Context

Answer 5

What were you doing when the weakness started?

Question 6

Relieving factors

Answer 6

Is there anything that makes it better?

Have you tried taking anything to make it better?

Question 7

Aggravating factors

Answer 7

Is there anything that makes it worse?

Is there anything that triggers episodes of weakness?

Question 8

Associated features

Answer 8

• Pain
• Visual Disturbances
• Fatigue
• Loss of sensation/ tingling/ numbness
• Muscle Atrophy
• blood in urine

Question 9

Differential diagnosis

Answer 9

MS - visual disturbances, sensory loss, family history

Myasthenia Gravis – muscle become fatigued, family history

Stroke - family history, past history of cardiovascular problems, high cholesterol, hypertension, sensorimotor loss

Emotional – depression, lack of motivation

Sarcopaenia – Old, loss of muscle mass

Cancer – Loss of muscle mass, weight loss, fatigue, loss of appetite, family history of cancer, age, fever
Joint Pain – Pain in joint where weakness is, context

Motor neuron Disease/ Neurodegen – context, family history, distal weakness

Nerve compression – possible pain, past trauma

Myasthenia Gravis – Fatiguability, History of Autoimmune conditions, Generalised pattern of motor weakness

Metabolic Disorders – exercise intolerance, myoglobinuria, heart problems

Hypothyroidism - Weight gain, insensitivity to cold, depression, loss of hair, neck enlargement, heavy periods

Addison’s Disease – Fatigue, skin pigmentation, nausea, vomiting, diarrhoea, weight loss, low blood pressure, recurrent infections

Medications- eg statins

Muscle damage/ Muscle overuse – context, pain