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Diseases » Muscle pain » Causes
 

Causes of Muscle pain

Contents
  1. Muscle pain: Introduction
  2. List of Causes
  3. Drugs/substances (303 causes)
  4. Drug interaction (131 causes)
  5. Hidden causes
  6. Excerpts from book chapters
  7. Complication causes
  8. Causes of symptoms
  9. News
  10. Related cause information

List of causes of Muscle pain

Following is a list of causes or underlying conditions (see also Misdiagnosis of underlying causes of Muscle pain) that could possibly cause Muscle pain includes:

More causes: see full list of causes for Muscle pain

Causes of Muscle pain (Diseases Database):

The follow list shows some of the possible medical causes of Muscle pain that are listed by the Diseases Database:

Source: Diseases Database

Muscle pain Causes: Book Excerpts

Muscle pain as a complication of other conditions:

Other conditions that might have Muscle pain as a complication may, potentially, be an underlying cause of Muscle pain. Our database lists the following as having Muscle pain as a complication of that condition:

Muscle pain as a symptom:

Conditions listing Muscle pain as a symptom may also be potential underlying causes of Muscle pain. Our database lists the following as having Muscle pain as a symptom of that condition:

Medications or substances causing Muscle pain:

The following drugs, medications, substances or toxins are some of the possible causes of Muscle pain as a symptom. This list is incomplete and various other drugs or substances may cause your symptoms. Always advise your doctor of any medications or treatments you are using, including prescription, over-the-counter, supplements, herbal or alternative treatments.

See full list of 303 medications causing Muscle pain


Drug interactions causing Muscle pain:

When combined, certain drugs, medications, substances or toxins may react causing Muscle pain as a symptom.

The list below is incomplete and various other drugs or substances may cause your symptoms. Always advise your doctor of any medications or treatments you are using, including prescription, over-the-counter, supplements, herbal or alternative treatments.

  • Erythromycin and statin cholesterol-lowering drug interaction interaction
  • A/T/S and statin cholesterol-lowering drug interaction interaction
  • Akne-mycin and statin cholesterol-lowering drug interaction interaction
  • Benzamycin and statin cholesterol-lowering drug interaction interaction
  • Del-Mycin and statin cholesterol-lowering drug interaction interaction
  • more interactions...»

See full list of 131 drug interactions causing Muscle pain

Medical news summaries relating to Muscle pain:

The following medical news items are relevant to causes of Muscle pain:

Related information on causes of Muscle pain:

As with all medical conditions, there may be many causal factors. Further relevant information on causes of Muscle pain may be found in:

Causes of Muscle pain: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Muscle pain.

Myalgia: Differential Diagnosis
(In a Page: Signs and Symptoms)

  • Acute muscle overuse/excessive physical exertion
    –Usually due to exercising poorly conditioned muscles
  • Systemic febrile illness (e.g., influenza)
  • Drugs/medications (e.g., statins)
  • Electrolyte disturbances
    –Especially abnormalities of potassium, calcium, or magnesium
  • Chronic overuse syndromes
    –Frequently related to occupational or vocational activities
  • Myopathies
    –Metabolic: Usually result in muscle pain related to exercise
    –Dystrophies (e.g., mitochondrial myopathies)
    –Inflammatory (e.g., polymyositis, dermatomyositis)
    –Toxic (e.g., alcohol, cocaine, statins)
    –Infectious muscle disease (viral, bacterial, parasitic)
    • Trauma
    • Muscle ischemia (e.g., claudication in patients with peripheral vascular disease)
    • Rheumatologic disorders
      –Polymyalgia rheumatica: Especially pain around the shoulders, back, and hips
      –Fibromyalgia: Diffuse muscle and soft tissue pain with many areas of point tenderness; regionally restricted areas of pain may be referred to as myofascial pain
    • Endocrine disturbances
      –Thyroid disease
      –Parathyroid disease
      –Adrenal disease
      –Diabetes mellitus (muscle infarcts)
    • Muscle pain must also be differentiated from pain of associated or nearby structures (e.g., tendons, ligaments, bone, connective tissue)
    • Rhabdomyolysis

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Muscle Weakness – Distal: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

  • Guillain-Barré syndrome (GBS)
    –Acute, acquired, or monophasic
    –Ascending weakness and parasthesias
  • Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)
    • Compression neuropathy
      –Trauma
      –Neoplasm (e.g., plexiform neurofibroma in neurofibromatosis type 1)
    • Charcot-Marie-Tooth
      –Defect in peripheral myelin protein
      –Causes distal segmental demyelination
      –Manifested by distal muscle atrophy and weakness
  • Drug-induced
    –Phenytoin
    –Isoniazid
    –Nitrofurantoin
    –Vincristine
    –Zidovudine
  • Spinal muscular atrophy
  • Juvenile segmental spinal muscular atrophy
    • Miller-Fisher syndrome
      –Clinical triad of ataxia, ophthalmoplegia, and areflexia
  • Tick paralysis
  • Juvenile amyotrophic lateral sclerosis
  • Giant axonal neuropathy
  • Vitamin B12 deficiency
  • Toxic neuropathy
    –Arsenic
    –Lead
    –Mercury
    –Thallium
    –Glue sniffing
  • Uremic neuropathy
  • Idiopathic axonal neuropathy
  • Hereditary distal myopathy
  • Inclusion body myopathy
  • Rheumatoid arthritis
  • Refsum disease
  • Metachromatic leukodystrophy
  • Krabbe disease
  • Cockayne syndrome
  • Conversion reaction
    –Usually fluctuating and unpredictable

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Muscle Weakness – Proximal: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

  • Duchenne and Becker muscular dystrophy
  • Spinal muscular atrophy
  • Spinal cord disorders
    –Trauma
    –Myelitis
    –Neoplasm
    –AVM
    –Hemorrhage
    –Tansverse myelitis
  • Limb-girdle myasthenia
  • Dermatomyositis
  • Congenital myopathies
    –Central core disease
    –Myotubular
    –Nemaline (rod)
    –Congenital fiber-type disproportion
  • Facioscapulohumeral syndrome
  • Limb-girdle muscular dystrophies
  • Glycogen storage myopathies
  • Endocrine myopathies
    –Hypo- and hyperthyroidism
    –Hyperparathyroidism
    –Adrenalism
  • Polymyositis
  • GM2 gangliosidosis
  • Pompe disease
    –Glycogen storage disease type II
    –Acid maltase deficiency
  • McArdle disease
  • Carnitine deficiency
  • Fatty acid oxidation defects
  • Mitochondrial disorders
  • Steroid-induced myopathy
  • Slow channel syndrome
  • Toxins
    –Organophosphates
    –Aminoglycosides
    –Tetrodotoxin (pufferfish)
  • Conversion reaction
  • Myasthenia gravis

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Muscle weakness: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Amyotrophic lateral sclerosis (ALS)

ALS typically begins with muscle weakness and atrophy in one hand that rapidly spread to the arm and then to the other hand and arm. Eventually, these effects spread to the trunk, neck, tongue, larynx, pharynx, and legs; progressive respiratory muscle weakness leads to respiratory insufficiency.

Anemia

Varying degrees of muscle weakness and fatigue are exacerbated by exertion and temporarily relieved by rest. Other signs and symptoms include pallor, tachycardia, paresthesia, and bleeding tendencies.

Brain tumor

Signs and symptoms of muscle weakness vary with the location and size of the tumor. Associated findings include a headache, vomiting, diplopia, decreased visual acuity, a decreased level of consciousness (LOC), pupillary changes, decreased motor strength, hemiparesis, hemiplegia, diminished sensations, ataxia, seizures, and behavioral changes.

Guillain-Barré syndrome

Rapidly progressive, symmetrical weakness and pain ascends from the feet to the arms and facial nerves and may progress to total motor paralysis and respiratory failure. Associated findings include sensory loss or paresthesia, muscle flaccidity, loss of DTRs, tachycardia or bradycardia, fluctuating hypertension and orthostatic hypotension, diaphoresis, bowel and bladder incontinence, facial diplegia, dysphagia, dysarthria, and hypernasality.

Herniated disk

Pressure on nerve roots leads to muscle weakness, disuse and, ultimately, atrophy. The primary symptom is severe low back pain, possibly radiating to the buttocks, legs, and feet — usually on one side. Diminished reflexes and sensory changes may also occur.

Hypercortisolism

Hypercortisolism may cause limb weakness and eventually atrophy. Related cushingoid features include buffalo hump, moon face, truncal obesity, purple striae, thin skin, acne, elevated blood pressure, fatigue, hyperpigmentation, easy bruising, poor wound healing, and diaphoresis. The male patient may be impotent; the female patient may exhibit hirsutism and menstrual irregularities.

Myasthenia gravis

Gradually progressive skeletal muscle weakness and fatigue are the cardinal symptoms of myasthenia gravis. Typically, weakness is mild upon awakening, but worsens during the day. Early signs include weak eye closure, ptosis, and diplopia; blank, masklike facies; difficulty chewing and swallowing; nasal regurgitation of fluid with hypernasality; and a hanging jaw and bobbing head. Respiratory muscle involvement may eventually lead to respiratory failure.

Osteoarthritis

Osteoarthritis is a chronic disorder that causes progressive muscle disuse and weakness that lead to atrophy.

Parkinson’s disease

Muscle weakness accompanies rigidity in Parkinson’s disease, a degenerative disorder. Related findings include a unilateral pill-rolling tremor, a propulsive gait, dysarthria, bradykinesia, drooling, dysphagia, masklike facies, and a high-pitched, monotone voice.

Peripheral nerve trauma

Prolonged pressure on or injury to a peripheral nerve causes muscle weakness and atrophy. Other findings include paresthesia or sensory loss, pain, and loss of reflexes supplied by the damaged nerve.

Potassium imbalance

With hypokalemia, temporary generalized muscle weakness may be accompanied by nausea, vomiting, diarrhea, decreased mentation, leg cramps, diminished reflexes, malaise, polyuria, dizziness, hypotension, and arrhythmias.

With hyperkalemia, weakness may progress to flaccid paralysis accompanied by irritability and confusion, hyperreflexia, paresthesia or anesthesia, oliguria, anorexia, nausea, diarrhea, abdominal cramps, tachycardia or bradycardia, and arrhythmias.

Rhabdomyolysis

Signs and symptoms include muscle weakness or pain, a fever, nausea, vomiting, malaise, and dark urine. Acute renal failure, due to renal structure obstruction and injury from the kidneys’attempt to filter myoglobin from the bloodstream, is a common complication.

Rheumatoid arthritis

With rheumatoid arthritis, symmetrical muscle weakness may accompany increased warmth, swelling, and tenderness in involved joints; pain; and stiffness, restricting motion.

Seizure disorder

Temporary generalized muscle weakness may occur after a generalized tonic-clonic seizure; other postictal findings include a headache, muscle soreness, and profound fatigue.

Spinal trauma and disease

Trauma can cause severe muscle weakness, leading to flaccidity or spasticity and, eventually, paralysis. Infection, tumor, and cervical spondylosis or stenosis can also cause muscle weakness.

Stroke

Depending on the site and extent of damage, a stroke may produce contralateral or bilateral weakness of the arms, legs, face, and tongue, possibly progressing to hemiplegia and atrophy. Associated effects include dysarthria, aphasia, ataxia, apraxia, agnosia, ipsilateral paresthesia or sensory loss, vision disturbances, an altered LOC, amnesia and poor judgment, personality changes, bowel and bladder dysfunction, a headache, vomiting, and seizures.

Other causes

Drugs

Generalized muscle weakness can result from prolonged corticosteroid use, digoxin, and excessive doses of dantrolene. Aminoglycoside antibiotics may worsen weakness in patients with myasthenia gravis.

Immobility

Immobilization in a cast, a splint, or traction can lead to muscle weakness in the involved extremity; prolonged bed rest or inactivity results in generalized muscle weakness.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Muscle weakness: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Amyotrophic lateral sclerosis

This disorder typically begins with muscle weakness and atrophy in one hand that rapidly spread to the arm and then to the other hand and arm. Eventually, these effects spread to the trunk, neck, tongue, larynx, pharynx, and legs; progressive respiratory muscle weakness leads to respiratory insufficiency.

Anemia

Varying degrees of muscle weakness and fatigue are exacerbated by exertion and temporarily relieved by rest. Other signs and symptoms include pallor, tachycardia, paresthesia, and bleeding tendencies.

Brain tumor

Signs and symptoms of muscle weakness vary with the location and size of the tumor. Associated findings include headache, vomiting, diplopia, decreased visual acuity, decreased level of consciousness, pupillary changes, decreased motor strength, hemiparesis, hemiplegia, diminished sensations, ataxia, seizures, and behavioral changes.

Guillain-Barré syndrome

Rapidly progressive, symmetrical weakness and pain ascends from the feet to the arms and facial nerves and may progress to total motor paralysis and respiratory failure. Associated findings include sensory loss or paresthesia, muscle flaccidity, loss of deep tendon reflexes, tachycardia or bradycardia, fluctuating hypertension and orthostatic hypotension, diaphoresis, bowel and bladder incontinence, facial diplegia, dysphagia, dysarthria, and hypernasality.

Head trauma

Severe head injury can cause varying degrees of muscle weakness. Other findings include decreased level of consciousness, otorrhea or rhinorrhea, raccoon eyes and Battle’s sign, sensory disturbances, and signs of increased intracranial pressure.

Herniated disk

Pressure on nerve roots leads to muscle weakness, disuse, and ultimately, atrophy. The primary symptom is severe low back pain, possibly radiating to the buttocks, legs, and feet—usually on one side. Diminished reflexes and sensory changes may also occur.

Hodgkin’s lymphoma

Muscle weakness may accompany the classic sign of painless, progressive lymphadenopathy. Other findings include paresthesia, fatigue, and weight loss.

Hypercortisolism

This disorder may cause limb weakness and eventually atrophy. Related cushingoid features include buffalo hump, moon face, truncal obesity, purple striae, thin skin, acne, elevated blood pressure, fatigue, hyperpigmentation, easy bruising, poor wound healing, and diaphoresis. The male patient may be impotent; the female patient may exhibit hirsutism and menstrual irregularities.

Hypothyroidism

Reversible weakness and atrophy of proximal limb muscles may occur in hypothyroidism. Accompanying findings commonly include muscle cramps; cold intolerance; weight gain despite anorexia; mental dullness; dry, pale, doughy skin; puffy face, hands, and feet; impaired hearing and balance; and bradycardia.

Multiple sclerosis

Muscle weakness in one or more limbs may progress to atrophy, spasticity, and contractures. Other findings typically wax and wane and may include diplopia and blurred vision, vision loss, nystagmus, hyperactive deep tendon reflexes, sensory loss or paresthesia, dysarthria, dysphagia, incoordination, ataxic gait, intention tremors, emotional lability, impotence, and urinary dysfunction.

Myasthenia gravis

Gradually progressive skeletal muscle weakness and fatigue are the cardinal symptoms of this disorder. Typically, weakness is mild upon awakening but worsens during the day. Early signs include weak eye closure, ptosis, and diplopia; a blank, masklike facies; difficulty chewing and swallowing; nasal regurgitation of fluid with hypernasality; and a hanging jaw and bobbing head. Respiratory muscle involvement may eventually lead to respiratory failure.

Osteoarthritis

This chronic disorder causes progressive muscle disuse and weakness that lead to atrophy.

Paget’s disease

As this disease progresses, muscle weakness or paralysis may develop, along with paresthesia and pain. The patient may also have bowed tibias, frequent fractures, and kyphosis.

Parkinson’s disease

Muscle weakness accompanies rigidity in this degenerative disorder. Related findings include a unilateral pill-rolling tremor, propulsive gait, dysarthria, bradykinesia, drooling, dysphagia, masklike facies, and a high-pitched, monotonic voice.

Peripheral nerve trauma

Prolonged pressure on or injury to a peripheral nerve causes muscle weakness and atrophy. Other findings include paresthesia or sensory loss, pain, and loss of reflexes supplied by the damaged nerve.

Peripheral neuropathy

With this disorder, muscle weakness progresses slowly to flaccid paralysis, generally affecting distal extremities first. It may be accompanied by loss of vibration sense; paresthesia, hyperesthesia, or anesthesia in the hands and feet; hypoactive or absent deep tendon reflexes; mild-to-sharp burning pain; anhidrosis; and glossy red skin.

Poliomyelitis

Rapidly developing asymmetrical muscle weakness, progressing to flaccid paralysis, occurs with paralytic poliomyelitis. Associated signs and symptoms include moderate fever, headache, vomiting, lethargy, irritability, and widespread pain. As the disorder progresses, it may produce loss of superficial and deep reflexes, paresthesia, hyperalgesia, urine retention, constipation, abdominal distention, nuchal rigidity, and Hoyne’s, Kernig’s, and Brudzinski’s signs. Bulbar paralytic poliomyelitis produces symptoms of encephalitis, along with facial weakness, dysphasia, dysphagia, and respiratory abnormalities.

Polymyositis

This disorder produces insidious or acute onset of symmetrical limb and trunk muscle weakness and tenderness. Weakness may progress to facial, neck, pharyngeal, and laryngeal muscles. Associated findings include hypoactive deep tendon reflexes, dysphagia, and dysphonia.

Potassium imbalance

With hypokalemia, temporary generalized muscle weakness may be accompanied by nausea, vomiting, diarrhea, decreased mentation, leg cramps, diminished reflexes, malaise, polyuria, dizziness, hypotension, and arrhythmias.

With hyperkalemia, weakness may progress to flaccid paralysis accompanied by irritability and confusion, hyperreflexia, paresthesia or anesthesia, oliguria, anorexia, nausea, diarrhea, abdominal cramps, tachycardia or bradycardia, and arrhythmias.

Protein deficiency

Prolonged protein deficiency may lead to muscle weakness and wasting, chronic fatigue, apathy, anorexia, lethargy, dry skin, and dull, sparse, dry hair.

Rhabdomyolysis

Signs and symptoms include muscle weakness or pain, fever, nausea, vomiting, malaise, and dark urine. Acute renal failure, due to renal structure obstruction and injury from the kidneys’attempt to filter the myoglobin from the bloodstream, is a common complication.

Rheumatoid arthritis

With this disease, symmetric muscle weakness may accompany increased warmth, swelling, and tenderness in involved joints; pain; and stiffness, restricting motion.

Seizure disorder

Temporary generalized muscle weakness may occur after a generalized tonic-clonic seizure; other postictal findings include headache, muscle soreness, and profound fatigue.

Spinal trauma and disease

Trauma can cause severe muscle weakness, leading to flaccidity or spasticity and, eventually, paralysis. Infection, tumor, and cervical spondylosis or stenosis can also cause muscle weakness.

Stroke

Depending on the site and extent of damage, a stroke may produce contralateral or bilateral weakness of the arms, legs, face, and tongue, possibly progressing to hemiplegia and atrophy. Associated effects include dysarthria, aphasia, ataxia, apraxia, agnosia, ipsilateral paresthesia or sensory loss, visual disturbance, altered level of consciousness, amnesia and poor judgment, personality changes, bowel and bladder dysfunction, headache, vomiting, and seizures.

Thyrotoxicosis

This disorder may produce insidious, generalized muscle weakness and atrophy. Other effects include anxiety, fatigue, heat intolerance, diaphoresis, tremors, tachycardia, palpitations, ventricular or atrial gallop, dyspnea, weight loss, an enlarged thyroid, and warm, flushed skin. Exophthalmos may be present.

Other causes

Drugs

Generalized muscle weakness can result from prolonged corticosteroid use, digoxin, and excessive doses of dantrolene sodium. Aminoglycoside antibiotics may worsen weakness in patients with myasthenia gravis.

Immobility

Immobilization in a cast, a splint, or traction can lead to muscle weakness in the involved extremity; prolonged bed rest or inactivity results in generalized muscle weakness.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Muscle weakness: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) typically begins with muscle weakness and atrophy in one hand that rapidly spread to the arm and then to the other hand and arm. Eventually, these effects spread to the trunk, neck, tongue, larynx, pharynx, and legs; progressive respiratory muscle weakness leads to respiratory insufficiency.

Brain tumor

Signs and symptoms of muscle weakness vary with the tumor’s location and size. Associated findings include headache, vomiting, diplopia, decreased visual acuity, decreased level of consciousness (LOC), pupillary changes, decreased motor strength, hemiparesis, hemiplegia, diminished sensations, ataxia, seizures, and behavioral changes.

Guillain-Barré syndrome

With Guillain-Barré syndrome, rapidly progressive, symmetrical weakness and pain ascends from the feet to the arms and facial nerves and may progress to total motor paralysis and respiratory failure. Associated findings include sensory loss or paresthesia, muscle flaccidity, loss of DTRs, tachycardia or bradycardia, fluctuating hypertension and orthostatic hypotension, diaphoresis, bowel and bladder incontinence, facial diplegia, dysphagia, dysarthria, and hypernasality.

Head trauma

Severe head trauma can cause varying degrees of muscle weakness. Other findings include decreased LOC, otorrhea or rhinorrhea, raccoon eyes and Battle’s sign, sensory disturbances, and signs of increased intracranial pressure.

Herniated disk

Pressure on nerve roots from a herniated disk leads to muscle weakness, disuse and, ultimately, atrophy. The primary symptom is severe low back pain, possibly radiating to the buttocks, legs, and feet — usually on one side. Diminished reflexes and sensory changes may also occur.

Hodgkin’s lymphoma

With Hodgkin’s lymphoma, muscle weakness may accompany the classic sign of painless, progressive lymphadenopathy. Other findings include paresthesia, fatigue, persistent fever, night sweats, and weight loss.

Hypercortisolism

Hypercortisolism may cause limb weakness and, eventually, atrophy. Related cush-ingoid features include buffalo hump, moon face, truncal obesity, purple striae, thin skin, acne, elevated blood pressure, fatigue, hyperpigmentation, easy bruising, poor wound healing, and diaphoresis. The male patient may be impotent; the female patient may exhibit hirsutism and menstrual irregularities.

Hypothyroidism

Reversible weakness and atrophy of proximal limb muscles may occur in hypothyroidism. Accompanying findings commonly include muscle cramps; cold intolerance; weight gain despite anorexia; mental dullness; dry, pale, doughy skin; puffy face, hands, and feet; impaired hearing and balance, and bradycardia.

Multiple sclerosis

With multiple sclerosis, muscle weakness in one or more limbs may progress to atrophy, spasticity, and contractures. Other findings typically wax and wane and may include diplopia and blurred vision, vision loss, nystagmus, hyperactive deep tendon reflexes, sensory loss or paresthesia, dysarthria, dysphagia, incoordination, ataxic gait, intention tremors, emotional lability, impotence, and urinary dysfunction.

Myasthenia gravis

Gradually progressive skeletal muscle weakness and fatigue are the cardinal symptoms of myasthenia gravis. Typically, weakness is mild upon awakening but worsens during the day. Early signs include weak eye closure, ptosis, and diplopia; a blank, masklike facies; difficulty chewing and swallowing; nasal regurgitation of fluid with hypernasality; and a hanging jaw and bobbing head. Respiratory muscle involvement may eventually lead to respiratory failure.

Osteoarthritis

Osteoarthritis is a chronic disorder that causes progressive muscle disuse and weakness that lead to atrophy. Other findings include crepitation; enlarged edematous joints; Heberden’s nodes; increased pain in damp, cold weather; joint stiffness; limited range of motion; pain relieved by resting joints; and smooth, taunt, shiny skin.

Paget’s disease

As Paget’s disease progresses, muscle weakness or paralysis may develop, along with paresthesia and pain. The patient may also have bowed tibias, frequent fractures, and kyphosis.

Parkinson’s disease

Muscle weakness accompanies rigidity in patients with Parkinson’s disease. Related findings include a unilateral pill-rolling tremor, propulsive gait, dysarthria, bradykinesia, drooling, dysphagia, a masklike facies, and a high-pitched, monotonic voice.

Peripheral nerve trauma

Prolonged pressure on or injury to a peripheral nerve causes muscle weakness and atrophy. Other findings include paresthesia or sensory loss, pain, and loss of reflexes supplied by the damaged nerve.

Peripheral neuropathy

With peripheral neuropathy, muscle weakness progresses slowly to flaccid paralysis, generally affecting distal extremities first. It may be accompanied by loss of vibration sense; paresthesia, hyperesthesia, or anesthesia in the hands and feet; hypoactive or absent DTRs; mild to sharp burning pain; anhidrosis; and glossy red skin.

Potassium imbalance

With hypokalemia, temporary generalized muscle weakness may be accompanied by nausea, vomiting, diarrhea, decreased mentation, leg cramps, diminished reflexes, malaise, polyuria, dizziness, hypotension, and arrhythmias.

With hyperkalemia, weakness may progress to flaccid paralysis accompanied by irritability and confusion, hyperreflexia, paresthesia or anesthesia, oliguria, anorexia, nausea, diarrhea, abdominal cramps, tachycardia or bradycardia, and arrhythmias.

Rhabdomyolysis

Signs and symptoms of rhabdomyolysis include muscle weakness or pain, fever, nausea, vomiting, malaise, and dark urine. Acute renal failure due to renal structure obstruction and injury from the kidneys’attempt to filter the myoglobin from the bloodstream is a common complication.

Rheumatoid arthritis

With rheumatoid arthritis, symmetric muscle weakness may accompany increased warmth, swelling, and tenderness in involved joints; pain; and stiffness that restrict motion. These findings typically occur bilaterally.

Seizure disorder

Temporary generalized muscle weakness may occur after a generalized tonic-clonic seizure; other postictal findings include headache, muscle soreness, and profound fatigue. The patient may experience an aura before the seizure.

Spinal trauma and disease

Spinal trauma can cause severe muscle weakness, leading to flaccidity or spasticity and, eventually, paralysis. Infection, tumor, and cervical spondylosis or stenosis can also cause muscle weakness.

Stroke

Depending on the site and extent of damage, a stroke may produce contralateral or bilateral weakness of the arms, legs, face, and tongue, possibly progressing to hemiplegia and atrophy. Associated effects include dysarthria, aphasia, ataxia, apraxia, agnosia, ipsilateral paresthesia or sensory loss, visual disturbance, altered level of consciousness, amnesia and poor judgment, personality changes, bowel and bladder dysfunction, headache, vomiting, and seizures.

Thyrotoxicosis

Thyrotoxicosis may produce insidious, generalized muscle weakness and atrophy. Other effects include anxiety, fatigue, heat intolerance, diaphoresis, tremors, tachycardia, palpitations, ventricular or atrial gallop, dyspnea, weight loss, an enlarged thyroid, and warm, flushed skin. Exophthalmos may be present.

Other causes

Drugs

Generalized muscle weakness can result from prolonged corticosteroid use, digoxin, and excessive doses of dantrolene. Aminoglycoside antibiotics may worsen weakness in patients with myasthenia gravis.

Immobility

Immobilization in a cast, a splint, or traction can lead to muscle weakness in the involved extremity; prolonged bed rest or inactivity results in generalized muscle weakness.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Muscle weakness: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Amyotrophic lateral sclerosis (ALS).ALS typically begins with muscle weakness and atrophy in one hand that rapidly spread to the arm and then to the other hand and arm. Eventually, these effects spread to the trunk, neck, tongue, larynx, pharynx, and legs; progressive respiratory muscle weakness leads to respiratory insufficiency.

Anemia.With anemia, varying degrees of muscle weakness and fatigue are exacerbated by exertion and temporarily relieved by rest. Other signs and symptoms include pallor, tachycardia, paresthesia, and bleeding tendencies.

Brain tumor.Signs and symptoms of muscle weakness vary with a brain tumor's location and size. Associated findings include headache, vomiting, diplopia, decreased visual acuity, decreased level of consciousness (LOC), pupillary changes, decreased motor strength, hemiparesis, hemiplegia, diminished sensations, ataxia, seizures, and behavioral changes.

Guillain-Barré syndrome.Rapidly progressive, symmetrical weakness and pain ascends from the feet to the arms and facial nerves and may progress to total motor paralysis and respiratory failure. With Guillain-Barré syndrome, associated findings include sensory loss or paresthesia, muscle flaccidity, loss of DTRs, tachycardia or bradycardia, fluctuating hypertension and orthostatic hypotension, diaphoresis, bowel and bladder incontinence, facial diplegia, dysphagia, dysarthria, and hypernasality.

Herniated disk.Pressure on nerve roots of herniated disk leads to muscle weakness, disuse and, ultimately, atrophy. The primary symptom is severe low back pain, possibly radiating to the buttocks, legs, and feet—usually on one side. Diminished reflexes and sensory changes may also occur.

Hypercortisolism.Hypercortisolism may cause limb weakness and eventually atrophy. Related cushingoid features include buffalo hump, moon face, truncal obesity, purple striae, thin skin, acne, elevated blood pressure, fatigue, hyperpigmentation, easy bruising, poor wound healing, and diaphoresis. The male patient may be impotent; the female patient may exhibit hirsutism and menstrual irregularities.

Myasthenia gravis.Gradually progressive skeletal muscle weakness and fatigue are the cardinal symptoms of myasthenia gravis. Typically, weakness is mild upon awakening, but worsens during the day. Early signs include weak eye closure, ptosis, and diplopia; blank, masklike facies; difficulty chewing and swallowing; nasal regurgitation of fluid with hypernasality; and a hanging jaw and bobbing head. Respiratory muscle involvement may eventually lead to respiratory failure.

Osteoarthritis.Osteoarthritis is a chronic disorder that causes progressive muscle disuse and weakness that lead to atrophy.

Parkinson's disease.Muscle weakness accompanies rigidity in Parkinson's disease. Related findings include a unilateral pill-rolling tremor, a propulsive gait, dysarthria, bradykinesia, drooling, dysphagia, masklike facies, and a high-pitched, monotone voice.

Peripheral nerve trauma.Prolonged pressure on or injury to a peripheral nerve causes muscle weakness and atrophy. Other findings include paresthesia or sensory loss, pain, and loss of reflexes supplied by the damaged nerve.

Potassium imbalance.With hypokalemia,temporary generalized muscle weakness may be accompanied by nausea, vomiting, diarrhea, decreased mentation, leg cramps, diminished reflexes, malaise, polyuria, dizziness, hypotension, and arrhythmias.

With hyperkalemia, weakness may progress to flaccid paralysis accompanied by irritability and confusion, hyperreflexia, paresthesia or anesthesia, oliguria, anorexia, nausea, diarrhea, abdominal cramps, tachycardia or bradycardia, and arrhythmias.

Rhabdomyolysis.Signs and symptoms of rhabdomyolysis include muscle weakness or pain, fever, nausea, vomiting, malaise, and dark urine. Acute renal failure, due to renal structure obstruction and injury from the kidneys'attempt to filter myoglobin from the bloodstream, is a common complication.

Rheumatoid arthritis.With rheumatoid arthritis, symmetrical muscle weakness may accompany increased warmth, swelling, and tenderness in involved joints; pain; and stiffness, restricting motion.

Seizure disorder.Temporary generalized muscle weakness may occur after a generalized tonic-clonic seizure; other postictal findings include headache, muscle soreness, and profound fatigue.

Spinal trauma and disease.Trauma to the spine can cause severe muscle weakness, leading to flaccidity or spasticity and, eventually, paralysis. Infection, tumor, and cervical spondylosis or stenosis can also cause muscle weakness.

Stroke.Depending on the site and extent of damage, a stroke may produce contralateral or bilateral weakness of the arms, legs, face, and tongue, possibly progressing to hemiplegia and atrophy. Associated effects include dysarthria, aphasia, ataxia, apraxia, agnosia, ipsilateral paresthesia or sensory loss, vision disturbances, altered LOC, amnesia and poor judgment, personality changes, bowel and bladder dysfunction, headache, vomiting, and seizures.

Other causes

Drugs.Generalized muscle weakness can result from prolonged corticosteroid use, digoxin, and excessive doses of dantrolene. Aminoglycoside antibiotics may worsen muscle weakness in patients with myasthenia gravis.

Immobility.Immobilization in a cast, a splint, or traction can lead to muscle weakness in the involved extremity; prolonged bed rest or inactivity results in generalized muscle weakness.

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Source: Nursing: Interpreting Signs and Symptoms, 2007


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