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At least 145 records · Page 8Linked to original sources
PubMed2002

Hand muscle weakness in long-term vibration exposure.

Hand muscle strength was compared between workers regularly exposed to hand-held vibrating tools (n=81) and a non-exposed control group (n=45). Maximal voluntary strengths of hand grip, thumb pinch, thumb palmar abduction and index and little finger abduction were measured. The exposed workers had significantly weaker extrinsic (7%, P<0.01) and intrinsic (19%, P<0.0001) muscles than the controls. Reduced vibration perception was noted in nine vibration-exposed workers who presented with symptoms of hand muscle weakness (P<0.01). Cold intolerance following vibration exposure was found to precede sensorineural and vasospastic symptoms. We therefore postulate that cold intolerance may be a valuable marker for early detection of the adverse effects of vibration. This study emphasizes the need for tests of intrinsic muscle strength in order to evaluate the impairment of hand function observed in vibration-exposed workers.

Adult↗
PubMed1999

Trunk muscle weakness as a risk factor for low back pain. A 5-year prospective study.

STUDY DESIGN: A 5-year prospective study. OBJECTIVES: To investigate trunk muscle weakness as a risk factor for low back pain in asymptomatic volunteers. SUMMARY OF BACKGROUND DATA: Muscle strength has not been sufficiently studied as a risk factor for low back pain. METHODS: The study participants included 30 male and 37 female volunteers (mean age, 17 +/- 2 years), who neither reported nor had ever been treated for low back pain. Trunk muscle strength was measured isokinetically (60 degrees/sec), using the trunk extension and flexion and torso rotation units. The peak torques of the volunteers' extension, flexion, rightward rotation, and leftward rotation were measured, and the agonist/antagonist ratios were calculated as extension/flexion and left rotation/right rotation ratio. The volunteers then were followed prospectively for 5 years to determine the incidence of low back pain and were classified into a non-low back pain group (volunteers with no low back pain during the 5-year follow-up period) and a low back pain group (volunteers who experienced low back pain during this period). RESULTS: The low back pain group consisted of 8 male and 10 female volunteers. There were no significant differences between the non-low back pain group and the low back pain group regarding age, height, weight, the peak torque values, or the left rotation/right rotation ratio. However, the extension/flexion ratio of the low back pain group (men, 0.96 +/- 0.27; women, 0.77 +/- 0.19) demonstrated significantly lower values than that of the non-low back pain group (1.23 +/- 0.28 and 1.00 +/- 0.16 for men and women, respectively, P < 0.05). CONCLUSIONS: An imbalance in trunk muscle strength, i.e., lower extensor muscle strength than flexor muscle strength, might be one risk factor for low back pain.

Adolescent↗
PubMed2005

Using induced accelerations to understand knee stability during gait of individuals with muscle weakness.

The purpose of this case series was to quantify the effectiveness of different compensatory strategies used by individuals with muscle weakness to produce knee extension during the stance phase gait. Subjects were three males with less than anti-gravity strength in the quadriceps femoris and a variable pattern of weakness elsewhere in the lower extremity. They walked independently at a self-selected speed without assistive devices. Gait analysis of the pelvis and bilateral lower extremity segments was performed with a six-camera, two force platform motion capture system. Joint angles and net internal moments were computed from the motion data. Induced acceleration analysis was performed to quantify the relative ability of each lower extremity joint moment and gravity to produce knee angular acceleration. Results showed that a variety of adaptive strategies both within and across limbs can control knee position during gait. One subject generated knee extension almost exclusively via the hip extensor moment. Another relied less on the hip extensor moment (39%) and more on the ankle plantar flexor moment (61%) to create knee extension. The third subject used the ipsilateral hip extensor moment (24%) and the contralateral ankle plantar flexor moment (67%) to assist knee extension. The strategy selected by each subject likely was influenced by both their total pattern of impairments and the effectiveness of the available compensations. This case series demonstrates how an induced acceleration analysis can augment a traditional gait analysis to expand and enhance our understanding of compensatory movement control strategies.

Acceleration↗
PubMed1994

Proximal muscle weakness in a patient with hepatocellular carcinoma.

Asthenia and generalized weakness are common in cancer patients. There are multiple causes for these symptoms. We describe a case of rapid onset of proximal muscle weakness in a patient with hepatocellular carcinoma. The differential diagnosis of muscle weakness in the palliative care patient is reviewed. The discussion centers on steroid myopathy and its treatment.

Asthenia↗
PubMed2006

Acute iliopsoas and adductor brevis abscesses presenting with proximal leg muscle weakness.

Pyomyositis is a bacterial infection of skeletal muscle. We describe the clinical case of a 77-year-old woman affected by gait disturbance, repetitive falls, low back pain and left thigh and groin pain, but without symptoms of systemic infection. Computed tomography and magnetic resonance imaging of the abdomen and pelvis showed abscesses in the left psoas and adductor brevis muscles. Investigations of urogenital tract and gastrointestinal system were normal. Systemic antibiotic treatment alone was not efficient, while surgical drainage improved the clinical picture. The aetiological organism, isolated from the abscess, was Staphylococcus aureus. We suggest that this patient had a primary pyomyositis rather than a secondary form. This is the first report of concomitant abscesses of psoas and adductor brevis muscles with early neurological involvement.

Aged↗
PubMed1997

Relationship between chronic hypercapnia and inspiratory-muscle weakness in myotonic dystrophy.

We studied 134 patients with Steinert's myotonic dystrophy (MD) in order to determine the prevalence of chronic hypercapnia, the level of muscle weakness and forced expiratory volume at which hypercapnic respiratory failure is likely to occur, and how clinical assessment might help predict hypercapnic respiratory failure. Subjects were divided into five classes with a muscular disability rating scale (MDRS): 0 = no clinical impairment (n = 9), I = minimal signs of impairment (n = 11), II = distal weakness (n = 41), III = moderate proximal weakness (n = 62), and IV = nonambulatory (n = 11). The prevalence of hypercapnia (PaCO2 > or = 43 mm Hg) was found to be 0%, 27%, 29%, 45% and 55% for MDRS 0 to 4, respectively (p = 0.03). A multiple regression analysis limited to clinical data showed that daytime hypersomnolence was a significant cofactor with the MDRS (p = 0.01) in predicting PaCO2 (r = 0.40). Among respiratory parameters, FVC, respiratory muscle strength (RMS), and maximal inspiratory pressure against occluded airways (PImax) were found to be predictors of nearly equal strength, explaining 16%, 15%, and 14% of the PaCO2 variance, respectively. In multiple regression analysis, sex, daytime sleepiness, and the expected/observed FVC ratio for a given RMS were found to be significant cofactors with PImax in predicting PaCO2 (r = 0.51). It is concluded that respiratory insufficiency should be suspected in MD patients with proximal weakness or daytime sleepiness. The likelihood of hypercapnia also increases with volume restriction and respiratory muscle weakness. Our study suggests that the combination of inspiratory muscle weakness and loading plays a predominant role in the pathogenesis of chronic alveolar hypoventilation in MD patients. The occurrence of daytime hypersomnolence suggests that other factors, such as low central ventilatory drive or sleep apnea, might play an additional role.

Chronic Disease↗
PubMed2002

Resistance versus endurance training in patients with COPD and peripheral muscle weakness.

The effects of endurance training on exercise capacity and health-related quality of life (HRQL) in chronic obstructive pulmonary disease (COPD) patients have been studied thoroughly, while resistance training has been rarely evaluated. This study investigated the effects of resistance training in comparison with endurance training in patients with moderate to severe COPD and peripheral muscle weakness (isometric knee extension peak torque <75% predicted). Forty-eight patients (age 64+/-8 yrs, forced expiratory volume in one second 38+/-17% pred) were randomly assigned to resistance training (RT, n=24) or endurance training (ET, n=24). The former consisted of dynamic strengthening exercises. The latter consisted of walking, cycling and arm cranking. Respiratory and peripheral muscle force, exercise capacity, and HRQL were re-evaluated in all patients who completed the 12-week rehabilitation (RT n=14, ET n=16). Statistically significant increases in knee extension peak torque (RT 20+/-21%, ET 42+/-21%), maximal knee flexion force (RT 31+/-39%, ET 28+/-37%), elbow flexion force (RT 24+/-19%, ET 33+/-25%), 6-min walking distance (6MWD) (RT 79+/-74 m, ET 95+/-57 m), maximum workload (RT 15+/-16 Watt, ET 14+/-13 Watt) and HRQL (RT 16+/-25 points, ET 16+/-15 points) were observed. No significant differences in changes in HRQL and 6MWD were seen between the two treatments. Resistance training and endurance training have similar effects on peripheral muscle force, exercise capacity and health-related quality of life in chronic obstructive pulmonary disease patients with peripheral muscle weakness.

Aged↗
PubMed1994

Muscle weakness in intensive care patients: initial manifestation of vitamin D deficiency.

A 72-year-old woman was referred to hospital for obnubilation with general muscle weakness and hypotonia. Biology showed hypocalcemia, hypophosphatemia, increased serum creatine kinase and alkaline phosphatase levels. Brain CT scan, cerebrospinal fluid examination, and electromyogram were normal. Clinical status and electroencephalogram were consistent with non-convulsive generalized status epilepticus. The treatment included clonazepam and CaCl2 and consciousness returned to normal. A treatment with multivitamin infusion containing vitamin D2 was given for 3 weeks. Muscle weakness improved partially. Serum vitamin D3 level was low and osteomalacic myopathy was diagnosed. A treatment was given with 25OH vitamin D3, 50 micrograms per day. Two months later, serum vitamin D3 and creatine kinase levels were normal and the patient could walk without help. We conclude that vitamin D status should be monitored in elderly patients with muscle symptoms and abnormal calcium status. Osteomalacic myopathy should be considered in critically ill patients with muscle symptoms of an unclear cause.

Aged↗
PubMed1981

Cough dynamics during progressive expiratory muscle weakness in healthy curarized subjects.

The dynamics of voluntary cough were studied in healthy supine subjects during four successive infusions of d-tubocurarine (dTc) (0.05 mg/kg) to assess the effects of progressive expiratory muscle weakness on cough performance. Curarization produced a progressive decline in maximal static expiratory muscle strength (PEmax) measured at the mouth and in pleural pressures (Ppl) generated during coughing. Expiratory flow rates during coughing did not decrease except during the initial cough from total lung capacity with the last dTc dose (18% below control). This was associated with a decrease in end-inspiratory volume prior to coughing and with a marked decrease in Ppl to 30% of control. Although the decrease in flow rates was minimal compared with Ppl, flow patterns suggest that dynamic airway compression was reduced during these coughs. We conclude that the principal effect of the expiratory muscle weakness in curarized subjects is to reduce the cough-induced dynamic compression and linear velocity of airflow though the major intrathoracic airways.

Adult↗
PubMed2003

Stroke patients have selective muscle weakness in shortened range.

Weakness is recognized as a major problem after stroke. This study examined the torque-angle curves of stroke individuals and compared them with those of neurologically normal controls to determine (i) if stroke patients were selectively weak when their muscles were placed in a shortened range and (ii) whether contracture influenced any selective weakness. This descriptive research study measured elbow flexor and extensor torque-angle curves and contracture. Twenty-two stroke subjects who had suffered a stroke 5 months to 6 years ago and 11 neurologically normal controls of similar age participated. Torque-angle curves of the elbow flexors and extensors were determined by measuring maximum isometric torque at 0, 20, 40, 60, 80, 100 and 120 degrees of elbow flexion (0 degrees being full elbow extension), where possible. Contracture of the elbow flexors and extensors was measured as the loss of passive elbow joint range of motion. Repeated measures analysis of variance revealed that the torque-angle curves of stroke subjects (with or without contracture) were significantly different from those of the control subjects for both the elbow flexors (P < 0.05) and extensors (P < 0.05). The stroke subjects appeared relatively weaker when the muscles were in their shortened range. This study confirms that selective weakness exists at short muscle lengths after stroke. The findings of this study help to explain why people after stroke have difficulty functioning when their muscles are in their shortened range. Therefore, strength training should be targeted specifically at muscles at their shortened lengths in order to promote the recovery of function after stroke.

Aged↗
PubMedDate not supplied

Profound muscle weakness as the presenting feature of disseminated cryptococcal infection.

A patient with chronic lymphocytic leukemia who was treated with immunosuppressive therapy for a prolonged period presented with profound muscle weakness secondary to disseminated cryptococcosis. The infection developed despite 3 months of continuous ketoconazole therapy and was not responsive to amphotericin B or flucytosine. At autopsy, Cryptococcus neoformans was present in all sampled skeletal muscles, myocardium, and muscularis propria of the gastrointestinal tract but was not identified in either the central nervous system or the lungs. A review of the English-language literature failed to identify a similar case with such profound myotropism due to Cryptococcus. This case demonstrates that cryptococcosis should be considered in the differential diagnosis of an immunocompromised host presenting with muscle weakness.

Cryptococcosis↗
PubMed2005

Respiratory insufficiency and limb muscle weakness in adults with Pompe's disease.

The objective of the present study was to prospectively evaluate relationships linking age, respiratory function and locomotor function in 29 outpatients with late-onset Pompe's disease and to retrospectively determine clinical outcomes. Using univariate regression analysis, vital capacity (VC) was weakly, but significantly, correlated to shoulder motility, Walton score and lower-limb Modified Medical Research Council score. Six patients were able to walk without a walking aid and with only the help of a handrail on the stairs (Walton score=3), although VC was <50%. No parameters were significantly correlated with age. As assessed retrospectively, VC and locomotion deteriorated over time in most patients. In contrast, among the 16 patients started on invasive or noninvasive ventilation with VC monitoring, eight had a VC increase at the first measurement time-point. The absence of correlation with age and the presence, in some patients, of severe respiratory insufficiency without severe limb girdle muscle weakness indicate that respiratory function should be monitored independently from the degree of peripheral muscle weakness. Mechanical ventilation and tracheostomy may improve vital capacity and should, therefore, be taken into account when evaluating treatments for the adult form of Pompe's disease.

Age Distribution↗
PubMed1983

Pattern of breathing in a case of generalized respiratory muscle weakness.

A patient with motor neuron disease is described. He had signs and laboratory data indicating generalized, symmetrical weakness, involving both inspiratory and expiratory muscle groups. The pattern of breathing involving recruitment of accessory muscles and expiratory contraction of abdominal muscles is similar to that seen in normal people at high minute ventilation, and suggests the compensating mechanism for increasing motor discharge to weak respiratory muscles is mediated centrally. Observation of this sort of respiratory activity gives a clinical clue to generalized respiratory muscle weakness.

Humans↗
PubMed2003

Contributing factors to muscle weakness in children with cerebral palsy.

The aim of this study was to determine the extent of ankle muscle weakness in children with cerebral palsy (CP) and to identify potential causes. Maximal voluntary contractions of plantar (PF) and dorsiflexors (DF) were determined at optimal angles in knee flexion and extension in both legs of 14 children with hemiplegia (7 males, 7 females) and 14 with diplegia (8 males, 6 females). Their results were compared to 14 age- and weight-matched control participants (5 males, 9 females). Muscle cross-sectional areas of soleus, posterior, and anterior compartment muscles were determined from MRIs in 14 children with CP (eight diplegia, six hemiplegia) and 18 control children. Specific tension (torque/unit area) of PF and DF was determined from torque and cross-sectional area results. Muscle volumes of PF and DF were also determined in both legs of five control children and five with hemiplegia. Muscle EMG was recorded from soleus, medial gastrocnemius, and tibialis anterior during each maximal voluntary contraction. Mean amplitude was significantly reduced in PF and DF in both CP groups and significantly higher levels of coactivation of antagonists were found compared to control participants. Strength of PF and DF was significantly reduced in both CP groups, but more importantly the muscles were found to be weak based on significantly reduced specific tensions. The PF were most affected, particularly in the group with hemiplegia. It is believed that an inability to maximally activate their muscles contributed to this weakness. A combination of incomplete activation and high levels of PF coactivation are thought to have contributed to DF weakness.

Cerebral Palsy↗
PubMed2002

Prevalence of diaphragmatic muscle weakness and dyspnoea in Graves' disease and their reversibility with carbimazole therapy.

OBJECTIVES: Dyspnoea is a common complaint among patients with thyrotoxicosis. However, its causative mechanisms have not been identified. We assessed the role of thoracic diaphragmatic muscle weakness in dyspnoea among patients with active Graves' disease. METHODS: Twenty-seven patients (19 female, 8 male) with active Graves' disease were assessed for the clinical severity of dyspnoea, functional (pressure generating capacity) and anatomical aspects (thickness and excursion) of the diaphragm at presentation. The severity of dyspnoea was assessed using a visual analogue scale (VAS) and the 6 min walk test. Lung function tests, diaphragmatic strength (sniff oesophageal pressure, SniffP(oeso)), maximum inspiratory and expiratory pressures, diaphragmatic thickness and movements on real time ultrasonography were evaluated during normal and deep respiration. Twenty of the 27 patients were reassessed after achieving euthyroidism with carbimazole therapy at a mean interval of 5+/-2 months. RESULTS: Reevaluation after carbimazole therapy revealed a significant reduction in dyspnoea on the VAS (59+/-26 to 23+/-13%). Patients covered a similar distance during the 6 min walk before and after euthyroidism. Significant improvement was observed in the vital capacity (2.57+/-0.62 to 2.94+/-0.60 l), forced expiratory volume in the first second (2.21+/-0.49 to 2.45+/-0.47 l), total lung capacity (3.57+/-1.19 to 4.1+/-1.12 l), diaphragmatic movement during deep respiration (5.5+/-1.0 to 6.6+/-1.1 cm) and SniffP(oeso) (68.7+/-23 to 93.1+/-25.2 cmH(2)O). There was no significant change in the distance walked in 6 min, tidal volume, lung diffusion capacity and diaphragmatic thickness. There was no significant correlation between the net change in dyspnoea score and net change in lung function tests, diaphragmatic movement and SniffP(oeso). CONCLUSIONS: Significant functional weakness of diaphragm muscle is present in patients with active Graves' disease. This weakness is more marked during a maximal respiratory manoeuvre, indicating a diminished diaphragmatic reserve which could be the cause of dyspnoea observed on exertion among patients with thyrotoxicosis.

Adult↗