Dr. Huntley's
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Flaccid muscles are profoundly weak and soft, with decreased resistance to movement, increased mobility, and a greater than normal range of motion (ROM). The result of disrupted muscle innervation, flaccidity can be localized to a limb or muscle group or generalized over the entire body. Its onset may be acute, as in trauma, or chronic, as in neurologic disease.
If the patient isn’t in distress, ask about the onset and duration of muscle flaccidity and precipitating factors. Ask about associated symptoms, notably weakness, other muscle changes, and sensory loss or paresthesia.
Examine the affected muscles for atrophy, which indicates a chronic problem. Test muscle strength, and check deep tendon reflexes (DTRs) in all limbs.
Progressive muscle weakness and paralysis are accompanied by generalized flaccidity. Typically, these effects begin in one hand, spread to the arm, and then develop in the other hand and arm. Eventually, they spread to the trunk, neck, tongue, larynx, pharynx, and legs; progressive respiratory muscle weakness leads to respiratory insufficiency. Other findings include muscle cramps and coarse fasciculations, hyperactive DTRs, slight leg muscle spasticity, dysphagia, dysarthria, excessive drooling, and depression.
Frontal and parietal lobe lesions may cause contralateral flaccidity, weakness or paralysis and, eventually, spasticity and possibly contractures. Other findings include hyperactive DTRs, a positive Babinski’s sign, loss of proprioception, stereognosis, graphesthesia, anesthesia, and thermanesthesia.
Guillain-Barré syndrome causes muscle flaccidity. Progression is typically symmetrical and ascending, moving from the feet to the arms and facial nerves within 24 to 72 hours of its onset. Associated findings include sensory loss or paresthesia, absent DTRs, tachycardia (or, less commonly, bradycardia), fluctuating hypertension and orthostatic hypotension, diaphoresis, incontinence, dysphagia, dysarthria, hypernasality, and facial diplegia. Weakness may progress to total motor paralysis and respiratory failure.
Besides flaccidity, progressive mental status changes up to and including dementia and choreiform movements are major symptoms. Others include poor balance, hesitant or explosive speech, dysphagia, impaired respirations, and incontinence.
Muscle weakness and flaccidity are features of myopathies and muscular dystrophies.
Flaccidity, paralysis, and loss of sensation and reflexes in the innervated area can occur.
Flaccidity usually occurs in the legs as a result of chronic progressive muscle weakness and paralysis. It may also cause mild to sharp burning pain, glossy red skin, anhidrosis, and a loss of vibration sensation. Paresthesia, hyperesthesia, or anesthesia may affect the hands and feet. DTRs may be hypoactive or absent.
Brief periods of syncope and generalized flaccidity commonly follow a generalized tonic-clonic seizure.
Spinal shock can result in acute muscle flaccidity or spasticity below the level of injury. Associated signs and symptoms also occur below the level of injury and may include paralysis; absent DTRs; analgesia; thermanesthesia; loss of proprioception and vibration, touch, and pressure sensation; and anhidrosis (usually unilateral). Hypotension, bowel and bladder dysfunction, and impotence or priapism may also occur. Injury in the C1 to C5 region can produce respiratory paralysis and bradycardia.
Provide regular, systematic, passive ROM exercises to preserve joint mobility and increase circulation. Reposition a patient with generalized flaccidity every 2 hours to protect him from skin breakdown. Pad bony prominences and other pressure points, and prevent thermal injury by testing bath water yourself before the patient bathes. Treat isolated flaccidity by supporting the affected limb in a sling or with a splint. Ensure patient safety and reduce the risk of falls by introducing assistive devices and teaching their proper use. Consult a physician and an occupational therapist to formulate a personalized therapy regimen and foster independence.
Prepare the patient for diagnostic tests, such as cranial and spinal X-rays, computed tomography scans, and electromyography.
Pediatric causes of muscle flaccidity include myelomeningocele, Lowe’s disease, Werdnig-Hoffmann disease, and muscular dystrophy. An infant or young child with generalized flaccidity may lie in a froglike position, with his hips and knees abducted.
Read excerpts from these other book chapters related to Muscle weakness:
Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2008 Williams & Wilkins.
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More About This Book:
Title: Handbook of Signs & Symptoms (Third Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-402-1 
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