STUDY - Technical - New Dacian's Medicine
Muscle
weakness (Classical / Allopathic Medicine)
Muscle weakness is
detected by observing and measuring the strength of an
individual muscle or muscle group. It can result from a
malfunction in the cerebral hemispheres, brain stem, spinal
cord, nerve roots, peripheral nerves, or myoneural junctions
within the muscle itself. Muscle weakness occurs with certain
neurologic, musculoskeletal, metabolic, endocrine, and
cardiovascular disorders; as a response to certain drugs; and
after prolonged immobilization.
HISTORY:
Ask the patient to locate his muscle weakness. Ask him if he has difficulty with specific movements, such as rising from a chair. Also, ask him when he first noticed the weakness.
Ask the patient whether the muscle weakness worsens with exercise or as the day progresses.
Ask the patient about associated signs and symptoms, especially muscle or joint pain, altered sensory function, and fatigue.
Review the patient's medical history for chronic diseases, musculoskeletal or neurologic problems, and recent trauma. Also, ask the patient if there's a family history of chronic muscle weakness, especially in males.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient to locate his muscle weakness. Ask him if he has difficulty with specific movements, such as rising from a chair. Also, ask him when he first noticed the weakness.
Ask the patient whether the muscle weakness worsens with exercise or as the day progresses.
Ask the patient about associated signs and symptoms, especially muscle or joint pain, altered sensory function, and fatigue.
Review the patient's medical history for chronic diseases, musculoskeletal or neurologic problems, and recent trauma. Also, ask the patient if there's a family history of chronic muscle weakness, especially in males.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Testing muscle
strength
Obtain an overall picture of the patient's motor function by testing muscle strength in 10 selected muscle groups. Ask him to attempt normal range-of-motion movements against your resistance. If the muscle group is weak, vary the amount of resistance as necessary to permit accurate assessment. If necessary, position the patient so that his limbs don't have to resist gravity, and repeat the test.
Use the following scale to help you rate muscle strength.
0 = Total paralysis
1 = Visible or palpable contraction but no movement
2 = Full muscle movement with force of gravity eliminated
3 = Full muscle movement against gravity, but no movement against resistance
4 = Full muscle movement against gravity; partial movement against resistance
5 = Full muscle movement against gravity and resistance - normal strength
Arm muscles
Biceps
With your hand on the patient's hand, ask him to flex his forearm against your resistance; watch for biceps contraction.
Deltoid muscle
With the patient's arm fully extended, place one hand over his deltoid muscle and the other on his wrist. Ask him to abduct his arm to a horizontal position against your resistance; as he does so, palpate for deltoid contraction.
Triceps
Ask the patient to abduct and hold his arm midway between flexion and extension. Hold and support his arm at the wrist, and ask him to extend it against your resistance. Watch for triceps contraction.
Dorsal interossei
Ask the patient to extend and spread his fingers, and tell him to try to resist your attempt to squeeze them together.
Forearm and hand (grip)
Ask the patient to grasp his middle and index fingers and squeeze as hard as he can.
Leg muscles
Anterior tibial
With the patient's leg extended, place your hand on his foot and ask him to dorsiflex his ankle against your resistance.
Psoas
While you support his leg, ask the patient to raise his knee and then flex his hip against your resistance. Observe for psoas muscle contraction.
Extensor hallucis longus
With your finger on the patient's great toe, ask him to dorsiflex the toe against your resistance. Palpate for extensor hallucis contraction.
Quadriceps
Ask the patient to bend his knee slightly while you support his lower leg. Then ask him to extend the knee against your resistance; as he's doing so, palpate for quadriceps contraction.
Gastrocnemius
With the patient on his side, support his foot and ask him to plantarflex his ankle against your resistance. Palpate for gastrocnemius contraction.
Obtain an overall picture of the patient's motor function by testing muscle strength in 10 selected muscle groups. Ask him to attempt normal range-of-motion movements against your resistance. If the muscle group is weak, vary the amount of resistance as necessary to permit accurate assessment. If necessary, position the patient so that his limbs don't have to resist gravity, and repeat the test.
Use the following scale to help you rate muscle strength.
0 = Total paralysis
1 = Visible or palpable contraction but no movement
2 = Full muscle movement with force of gravity eliminated
3 = Full muscle movement against gravity, but no movement against resistance
4 = Full muscle movement against gravity; partial movement against resistance
5 = Full muscle movement against gravity and resistance - normal strength
Arm muscles
Biceps
With your hand on the patient's hand, ask him to flex his forearm against your resistance; watch for biceps contraction.
Deltoid muscle
With the patient's arm fully extended, place one hand over his deltoid muscle and the other on his wrist. Ask him to abduct his arm to a horizontal position against your resistance; as he does so, palpate for deltoid contraction.
Triceps
Ask the patient to abduct and hold his arm midway between flexion and extension. Hold and support his arm at the wrist, and ask him to extend it against your resistance. Watch for triceps contraction.
Dorsal interossei
Ask the patient to extend and spread his fingers, and tell him to try to resist your attempt to squeeze them together.
Forearm and hand (grip)
Ask the patient to grasp his middle and index fingers and squeeze as hard as he can.
Leg muscles
Anterior tibial
With the patient's leg extended, place your hand on his foot and ask him to dorsiflex his ankle against your resistance.
Psoas
While you support his leg, ask the patient to raise his knee and then flex his hip against your resistance. Observe for psoas muscle contraction.
Extensor hallucis longus
With your finger on the patient's great toe, ask him to dorsiflex the toe against your resistance. Palpate for extensor hallucis contraction.
Quadriceps
Ask the patient to bend his knee slightly while you support his lower leg. Then ask him to extend the knee against your resistance; as he's doing so, palpate for quadriceps contraction.
Gastrocnemius
With the patient on his side, support his foot and ask him to plantarflex his ankle against your resistance. Palpate for gastrocnemius contraction.
PHYSICAL
ASSESSMENT:
Test all major muscles bilaterally. (See Testing muscle strength.) When testing, be sure the patient's effort is constant; if it isn't, suspect pain or other reluctance to make the effort.
Test for a range of motion at all major joints.
Test sensory function in the involved areas, and test deep tendon reflexes bilaterally.
Test all major muscles bilaterally. (See Testing muscle strength.) When testing, be sure the patient's effort is constant; if it isn't, suspect pain or other reluctance to make the effort.
Test for a range of motion at all major joints.
Test sensory function in the involved areas, and test deep tendon reflexes bilaterally.
SPECIAL
CONSIDERATIONS:
Generalized muscle weakness can result from prolonged corticosteroid use, digoxin toxicity, and excessive doses of dantrolene.
Generalized muscle weakness can result from prolonged corticosteroid use, digoxin toxicity, and excessive doses of dantrolene.
PEDIATRIC
POINTERS:
Muscular dystrophy, usually the Duchenne type, is a major cause of muscle weakness in children.
Muscular dystrophy, usually the Duchenne type, is a major cause of muscle weakness in children.
PATIENT
COUNSELING:
Provide assistive devices, as necessary. Teach the patient and his family safety measures to protect the patient from injury.
Provide assistive devices, as necessary. Teach the patient and his family safety measures to protect the patient from injury.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common symptoms,
Edition V, McGraw - Hill, 2002.