Dominic Stone
Muscle weakness can be caused by a variety of factors, including short-term issues like a tough workout or flu, or more serious long-term problems like neurological conditions or chronic illnesses. If you experience muscle weakness, it's important to determine whether it is true muscle weakness or subjective fatigue, and to seek medical advice if you are concerned. True muscle weakness is characterised by a lack of muscle strength, where the muscles do not contract or move as easily as they should. This can be caused by injury or disease affecting the nerves that connect to the muscles, preventing normal contractions and leading to muscle atrophy. Neurological conditions such as multiple sclerosis, amyotrophic lateral sclerosis (ALS), and myasthenia gravis can cause muscle weakness, as can chronic conditions like diabetes, fibromyalgia, and hypothyroidism. Toxin exposure, certain medications, and ageing can also contribute to muscle weakness.
| Characteristics | Values |
|---|---|
| Muscle weakness due to neurological conditions | Multiple sclerosis, amyotrophic lateral sclerosis (ALS), Guillain-Barré syndrome, myasthenia gravis, botulism, rabies, polio, cervical spondylosis |
| Muscle weakness due to endocrine disorders | Hyperthyroidism, hypothyroidism, adrenal insufficiency (Addison's disease), Cushing syndrome, acromegaly, primary hyperaldosteronism |
| Muscle weakness due to electrolyte imbalances | Hypokalemia, hyperkalemic periodic paralysis, disturbances in calcium, phosphate, potassium, and sodium |
| Muscle weakness due to chronic conditions | Anemia, diabetes, fibromyalgia, chronic fatigue syndrome |
| Muscle weakness due to infections | Flu, Lyme disease, meningitis, HIV, COVID-19 |
| Muscle weakness due to medications | Corticosteroids, statins, fluoroquinolones, glucocorticoids |
| Muscle weakness due to toxins | Heavy metals (arsenic, lead, thallium, mercury), organophosphate poisoning, alcohol, recreational drugs (cocaine, amphetamines, opioids) |
| Muscle weakness due to disuse or inactivity | Bed rest, hospitalization, aging, sarcopenia |
| Muscle weakness due to muscle disorders | Muscular dystrophy, myositis (dermatomyositis, polymyositis, necrotizing myositis, inclusion body myositis) |
| Muscle weakness due to other specific conditions | Stroke, pregnancy, Graves' disease |
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What You'll Learn
Muscular dystrophy
Muscle weakness can be caused by a variety of factors, including chronic conditions, infections, altered electrolyte levels, and nerve damage. Neuromuscular disorders, such as muscular dystrophies, can also be a cause of muscle weakness.
Duchenne muscular dystrophy, the most common type, usually starts in early childhood and causes challenges with movement, including frequent falls, trouble rising from a seated position, and delayed growth. Becker muscular dystrophy, the second most common type, can appear anytime between ages 5 and 60 but typically starts in the teenage years. It affects boys more commonly but can also present milder symptoms in girls.
Other types of muscular dystrophy include Emery-Dreifuss, which causes muscle weakness in the shoulders, upper arms, and shins, and often leads to heart conditions; Myotonic dystrophy, which affects the ability to relax muscles and can impact the heart, lungs, and endocrine system; Facioscapulohumeral (FSHD), which affects the face, shoulders, and upper arms, often causing trouble fully closing the eyelids; and Congenital muscular dystrophies (CMD), which cause overall muscle weakness and possible joint stiffness.
Treatment for muscular dystrophy involves regular monitoring by a team of healthcare providers to manage symptoms. While there is no cure, supportive treatments can help improve quality of life and manage specific symptoms.
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Neurogenic atrophy
Diseases and conditions that can lead to neurogenic atrophy include amyotrophic lateral sclerosis (ALS), Guillain-Barre syndrome, carpal tunnel syndrome, spinal cord injuries, and multiple sclerosis. The time it takes for neurogenic atrophy to develop depends on various factors, including age, fitness level, and the underlying health condition.
Symptoms of neurogenic atrophy include reduced muscle mass, with one limb sometimes appearing smaller than the other. Individuals may experience weakness, numbness, or tingling in their limbs, as well as trouble walking or balancing. In some cases, neurogenic atrophy can affect the facial muscles, leading to difficulty speaking or swallowing.
Diagnosis of neurogenic atrophy typically involves a physical examination, medical history review, and specific tests such as blood tests, muscle or nerve biopsies, electromyography (EMG), and nerve conduction studies. Treatment options may include physical therapy, ultrasound therapy, and, in certain cases, surgery.
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Stroke
Muscle weakness occurs when a person's full effort does not produce a normal contraction or movement. This can be caused by a variety of factors, including chronic conditions, infections, altered electrolyte levels, nerve damage, disuse of muscles, and neurogenic conditions. One such factor is a stroke, which can cause muscle weakness in various parts of the body, depending on the location of the stroke in the brain.
During a stroke, the messaging between the brain and muscles can be disrupted, leading to paralysis or weakness on the side of the body opposite to the damaged side of the brain. This condition is known as hemiparesis and can result in one-sided weakness or an inability to move the affected muscles. The severity of hemiparesis can vary, and it may persist for years, impacting an individual's functional performance.
Several factors contribute to muscle weakness following a stroke. Firstly, there is a decrease in muscle mass, fibre length, and pennation angle, resulting in reduced force generation. Secondly, the tendon becomes stretched and more compliant, further diminishing the muscle's ability to generate force. Additionally, an increase in stretch reflex excitability, antagonist muscle coactivation, and force deficits dependent on muscle length have been observed in individuals with post-stroke muscle weakness.
Rehabilitation and therapy play a crucial role in addressing muscle weakness after a stroke. In-patient rehabilitation, including range-of-motion exercises, strengthening routines, basic activity training, gait training, and activities of daily living (ADL), can help reverse muscle atrophy and improve functional abilities. Electrical stimulation and modified constraint-induced therapy (mCIT) are also recommended to improve nerve function and force generation.
Occupational therapy is particularly beneficial during the stroke rehabilitation process. Therapists can suggest exercises targeting specific muscle groups, such as the upper body, to improve strength and motor skills. Additionally, assistive devices like braces, canes, walkers, and wheelchairs can be prescribed to enhance strength, movement, and balance. These interventions can help individuals regain strength, mobility, and independence following a stroke.
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Infection
Infective myositis, an uncommon inflammatory myopathy, is caused by a range of infective agents such as viruses, bacteria, fungi, and parasites. It is usually confined to particular geographic regions and is related to socio-economic, sanitary, cultural, and dietary habits. Increased travel has resulted in its transmission to other countries.
Myositis can refer to the muscle inflammation itself or a group of diseases where muscle inflammation is the main problem. It is characterized by localized or diffuse pain, tenderness on movement or palpation, swelling, and/or weakness. The weakness from myositis can make it harder to move around or stand up.
- Lyme disease, an inflammatory condition that occurs after a bite from an infected tick, can cause acute or chronic muscle weakness.
- Meningitis, a serious infection that leads to inflammation in the brain and spinal cord, can cause muscle weakness.
- HIV can cause progressive muscle weakness, especially in untreated individuals.
- Polio myositis can cause muscle weakness and sensitivity.
- Rabies, resulting from contact with the saliva of an infected animal, can cause muscle weakness.
- Trichinella larvae invade the muscle, causing disruption and disintegration of the myofibrillar network, leading to muscle weakness.
- Sarcocystosis, a rare protozoal infection caused by ingesting undercooked meat or food contaminated with carnivorous animal feces, can affect the muscle and cause weakness.
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Toxins
Drugs can cause toxic myopathies through a variety of mechanisms, including directly affecting muscle organelles such as mitochondria, lysosomes, and myofibrillar proteins; altering muscle antigens and generating an immunologic or inflammatory reaction; or by disturbing the electrolyte or nutritional balance, which can subsequently impact muscle function. Many drugs used for therapeutic interventions can cause unanticipated toxicity in muscle tissue, leading to considerable morbidity. A drug-induced, or toxic, myopathy is defined as the acute or subacute manifestation of myopathic symptoms such as muscle weakness, myalgia, creatine kinase elevation, or myoglobinuria that can occur in patients without muscle disease when they are exposed to certain drugs.
Several drugs have been reported to cause toxic myopathy, and it is helpful to confirm causation by following strict criteria. A temporal relationship exists between exposure to an offending agent and the development of myopathy. No confounding variables can act synergistically or potentiate the effect of the agent in question. Resolution, total or partial, of the symptoms occurs with withdrawal from exposure. If caused by a drug, the patient should not be rechallenged with the same medication.
The following are some of the more common agents associated with rhabdomyolysis syndrome: cholesterol-lowering drugs, immunophilins (cyclosporine and tacrolimus), the antihypertensive agent labetalol, propofol, and statins. With statins, besides toxic necrotizing myopathy, recent evidence suggests that they also trigger an autoimmune myopathy that progresses for months after statin discontinuation, referred to as statin-associated necrotizing autoimmune myopathy (SANAM). While myalgias, weakness, or asymptomatic elevation of creatine kinase (CK) levels do occur with statin exposure, severe necrotizing myopathy may be complicated by myoglobinuria and renal failure. The degree of serum CK elevation is proportionate to the amount of muscle damage.
Botulism is another rare condition that occurs due to exposure to botulinum toxin and can lead to muscle weakness.
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Frequently asked questions
Muscle weakness occurs when your muscles don't contract or move as easily as they used to, and you experience a lack of muscle strength.
Muscle weakness can be caused by a variety of factors, including:
- Lack of use, such as being on bed rest or immobilised for an extended period.
- Age-related loss of muscle mass, also known as sarcopenia.
- Side effects of certain medications, such as statins and corticosteroids.
- Infections, such as the flu, Lyme disease, or COVID-19.
- Neurological conditions, such as multiple sclerosis or Guillain-Barré syndrome.
- Muscle strain or injury.
While muscle weakness often has benign causes, it can sometimes be a sign of a more serious underlying health condition, such as:
- Stroke: Muscle weakness due to a stroke typically affects one side of the body.
- Neuromuscular disorders, such as muscular dystrophy or amyotrophic lateral sclerosis (ALS).
- Chronic conditions, such as diabetes, hypothyroidism, or fibromyalgia.
- Exposure to toxins, such as heavy metals or botulinum toxin.
If you are experiencing muscle weakness, it is important to consult a healthcare professional. They will ask about your symptoms, medical history, and may perform a physical examination. Determining the cause of muscle weakness can be challenging, so a comprehensive evaluation is essential.
The treatment for muscle weakness depends on the underlying cause. In some cases, physical therapy and regular exercise may help improve muscle strength and prevent further muscle loss. In other cases, medication or other interventions may be necessary to manage the underlying condition causing the muscle weakness.
