Why does muscle weakness occur in the arms and legs? How to overcome it? Muscle fatigue: causes and ways to eliminate muscle weakness Causes of muscle weakness in the human body

Muscle weakness is a pathology that can occur in a person at any age and for various reasons. There is also an autoimmune disease, myasthenia gravis, in which the muscles cannot cope with their function and quickly tire, as a result, the person cannot move normally.

Myasthenia gravis occurs quite rarely; more often the cause of weakness in the legs or other parts of the body is overwork. In any case, to rule out the presence of a serious pathology, you need to contact a therapist and neurologist and undergo an examination.

With myasthenia gravis, severe weakness appears, the muscles stop contracting normally. The disease occurs due to a malfunction in the immune system, in which a disorder occurs in the area where muscle cells connect to nerve endings.

Myasthenia gravis can affect muscles throughout the body, but most often the disease affects the muscles of the face. Therefore, if weakness appears in the arms or legs, then most likely the reason is different. Why does it appear The disease is not known for sure; there is an assumption that it is inherited, but this statement has not been proven.

Interestingly, myasthenia gravis occurs in the form of attacks, and after a night’s sleep there are usually no signs of the disease. But during the day, muscle weakness appears again, and by the evening the situation completely worsens. Also, the disease may not manifest itself from time to time; often, a long remission occurs during pregnancy.

Myasthenia gravis occurs in three forms:

• Congenital. This pathology is considered quite rare; in this case, a child is born with a genetic pathology in which the conductivity of synapses is disrupted.
• Acquired. This type of myasthenia gravis occurs most often, the exact causes of its occurrence are not known, the disease can appear as a result of infectious diseases, hormonal imbalance, hyperplasia, or a tumor of the thymus.
• Neonatal. In this case, the disease occurs in infants; the disease is associated with the transfer of antibodies from mother to child through the placenta, if the mother has myasthenia gravis.

Causes

There are many reasons why muscle weakness occurs, especially if the pathology affects not the face, but the body. The cause of muscle weakness may be increased fatigue due to diseases such as HIV, mononucleosis, hepatitis, anemia, chronic fatigue syndrome and even depression.

Muscle weakness can occur for the following reasons:

The cause of muscle weakness is bed rest

• For a stroke.
• When the spinal cord is compressed, for example by a tumor.
• It can also be a cause of muscle weakness. This condition usually occurs in bedridden and seriously ill people. In this case, weakness may be throughout the body.
• With acquired myopathies, there may be muscle weakness, for example, with alcoholism.
• This symptom can also occur with long-term use of muscle relaxants, especially in bedridden patients.
• Weakness in the legs can also occur, problems with joints and other disorders.
• Low blood pressure can also cause muscle weakness, even throughout the body.
• Muscle weakness can also be provoked; especially, a lack of potassium has a bad effect on muscle function.

Unfortunately, it is not possible to list absolutely all the causes of muscle weakness in various parts of the body, since such a symptom, to one degree or another, can appear in various pathologies. In any case, you should consult a specialist as soon as possible if the problem bothers you regularly or is accompanied by other unpleasant symptoms.

Symptoms

The symptoms of the disease depend on its cause. With myasthenia gravis, weakness of the facial muscles appears. If the eyes are affected, ptosis of the eyelid occurs and a double image appears. If myasthenia gravis occurs throughout the body, the triceps muscles of the shoulder, eyelids, lips, and neck area are primarily affected. As a result, the patient cannot swallow or speak normally.

Muscle weakness in the legs, which occurs due to damage to blood vessels or joints, is most often accompanied by pain, a change in skin color around the affected area, and a venous network may appear. With alcoholism, not only weakness occurs, but also the condition is associated with recent consumption of alcohol-containing drinks.

With low blood pressure, muscle weakness is often accompanied by dizziness, the patient becomes absent-minded, complains of poor memory, and the patients' hands and feet are cold. And with a stroke, not only weakness occurs throughout the body, but also speech impairment, gait changes, and the person cannot move, swallow, or speak normally.

Only a doctor can accurately compare all the symptoms and establish a diagnosis. It is worth understanding that muscle weakness can also appear due to the negative impact of several pathologies on the body at once, so it is simply impossible to make an accurate diagnosis without examination.

In children

Muscle weakness in children can occur due to serious congenital diseases. Usually in such cases, the pathology is visible to the naked eye, as muscle tone decreases, the body becomes asymmetrical, the child cannot hold the affected limb, and often lags behind in physical development.

Causes of muscle weakness in children:

• Down syndrome;
• Jaundice due to Rh factor conflict;
• Botulism;
• Prader-Willi syndrome;
• Muscle dystrophy;
• Blood poisoning;
• Hypothyroidism;
• Excessive intake of vitamin D;
• Complications after vaccination;
• Rickets;
• Back muscle atrophy;
• Cerebellar ataxia.

It is worth noting that muscles in children do not always indicate a serious congenital disease. Often this pathology is observed in babies who experienced hypoxia in the womb, during a pathological course of pregnancy. Most often, this problem can be solved with massage, physiotherapy and gymnastics; by the age of one year, in this case, the baby is already healthy, sometimes drug treatment may be required.

In any case, if a child at any age becomes lethargic, drowsy, or since birth the baby sleeps a lot, does not cry like other children, eats poorly and moves little, then you need to urgently consult a neurologist for advice. Such symptoms are not always a serious pathology, but it is necessary to undergo an examination.

Diagnostics

A therapist and neurologist diagnoses and treats weak muscles. First of all, the patient is recommended to consult a general practitioner, who, if necessary, gives a referral to a specialist. When diagnosing, it is very important to determine what is bothering the patient: weakness or muscle fatigue.

The doctor usually begins by collecting an anamnesis, the doctor listens to all the patient’s complaints: how and when muscle weakness bothers him, in which parts of the body it is localized, what other symptoms bother him. The doctor is interested in whether the patient can take care of himself, how long ago the weakness began, whether the patient complains of memory, and assesses his general condition.

The specialist must examine the patient externally: skin, weight and reflexes can tell a lot. Illnesses suffered in the past also play an important role, so when you see a doctor, you should definitely take your card and hospital extracts, if present.

Usually, after the interview, the doctor already assumes what exactly the problem may be, so he can prescribe a number of necessary tests to confirm or refute the preliminary diagnosis. Depending on the pathology, the following tests are prescribed:

Blood test is one of the diagnostic methods

• To identify myasthenia gravis, tests with edrophonium are prescribed; they help identify the immune reaction, a blood test for the presence of antibodies to acetylcholine, as well as;
• If there is a suspicion of hereditary pathology, then a genetic study is carried out;
• Muscle biopsy may be indicated for myopathy;
• If suspected, then an antibody test is prescribed;
• Ultrasound, MRI, CT may also be indicated;
• If there are signs of infection, blood and urine tests are ordered;
• If a tumor is detected, it can be punctured.

If the doctor is confident that the cause of the symptom is muscle fatigue, then further testing may not be necessary. In this case, the doctor immediately prescribes treatment and repeated consultations, during which he can assess the patient’s condition.

Treatment

The doctor decides how to treat weak muscles, depending on the diagnosis. If muscle weakness occurs due to any disease, then first of all they treat it. Usually, eliminating the cause of the pathology relieves the patient of an unpleasant symptom, but not with myasthenia gravis.

For myasthenia gravis, long-term physiotherapeutic and drug treatment is prescribed, which is aimed at restoring the functioning of the immune system, as well as normalizing muscle tone. In severe cases, radiation therapy and surgery may be prescribed to remove the thymus gland, usually due to a tumor or failure of conservative treatment.

For myasthenia gravis, the following drugs are prescribed:

• Anticholinesterase drugs, e.g. Such drugs provoke muscles to contract, but they must be selected by a doctor, calculating the dosage individually.
• Hormonal drugs are prescribed for severe disease.
• Immunoglobulins, for example Pentaglobin.
• Sometimes Polyphepan (enterosorbent) may be prescribed.

Physiotherapeutic treatment is prescribed to normalize muscle function and improve their trophism. For myasthenia gravis, the following procedures are prescribed:

• manual massage;
• electrostatic massage;
• aerophytotherapy;
• local darsonvalization;
• medicinal electrophoresis;
• chromotherapy;
• diadynamophoresis;
• electrical neurostimulation.

During the period of remission of myasthenia gravis, patients can be sent to resort and sanatorium treatment, for example, in Sochi, Crimea. It is also worth noting that during an exacerbation the patient is contraindicated in heavy physical activity and taking certain medications.

Folk

Before you start treatment with folk remedies, you need to undergo an examination and find out what is the cause of the symptom. If you start treatment without knowing the exact cause of weakness, you can provoke life-threatening complications, especially with myasthenia gravis.

Muscle weakness must be treated comprehensively; folk remedies are allowed to be used only after consultation with a doctor and with his permission. For myasthenia gravis, traditional healers recommend the following recipes:

• The consumption of dried fruits is recommended for myasthenia gravis, in particular during the period of remission for prevention. You can eat dried apricots, prunes, raisins, adding them to porridges and salads, cook compotes, make infusions, you can add rose hips, dried berries and fruits.
• The following remedy is prepared from three heads of garlic, four lemons, 200 ml of flaxseed oil and a kilogram of honey. All components are crushed and mixed thoroughly, take a teaspoon every day half an hour before meals.

Prevention

The prognosis depends on the disease that was discovered and how it was treated. Myasthenia gravis is a severe chronic disease, it is incurable, but in our time, timely therapy can significantly improve the patient’s quality of life.

Severe myasthenia gravis seriously threatens the patient’s life, so special attention should be paid to the treatment and prevention of the disease. The patient needs to eat properly, excluding fatty and unhealthy foods, avoid increased physical activity, but still do gymnastics as recommended by the doctor.

It is also necessary to follow all doctor’s instructions, take medications if necessary, attend physical procedures, and undergo treatment on time even during remission. It is also very important to treat infectious and other pathologies only under the supervision of specialists, since many antibiotics and other medications are contraindicated in myasthenia gravis.

Myasthenia gravis (video)

Weakness in the arms in the morning often occurs simply due to a sleeping position that is not entirely suitable for the upper limbs, for example, if a person has slept for a long time with his arm under his head, which leads to disruption of normal blood flow.

But constant weakness in the arms, which is observed over a fairly long period of time, may be a signal of serious health problems.

Causes of weakness in the hand

In modern clinical medicine, muscle weakness in the arms, as well as weakness and numbness of the arms, are considered a sign of a wide range of pathological conditions, primarily associated with diseases of the muscular, vascular, and nervous systems. In addition, this symptom manifests itself in metabolic disorders, endocrine pathologies, etc.

Very often, the causes of weakness in the hand are household, industrial or sports injuries. Thus, with a severe dislocation of the shoulder joint, the roots or the entire bundle of nerves of the brachial plexus experience a traumatic effect, as a result of which the innervation of individual muscles of the arm is disrupted, and then weakness of the hands and fingers are felt. Weakness in the arm and limitation of movement - consequences of ruptured tendons of the rotator cuff, etc.

Dizziness and weakness in the arms occur with traumatic brain injuries - due to disturbances in the motor centers of the cerebral cortex. And numbness and weakness in the hands during pregnancy is considered a consequence of toxicosis and, in fact, is nothing more than nutritional vitamin deficiency neuropathy, which appears due to a lack of B vitamins in the body - with frequent vomiting in pregnant women.

But why does weakness in the arms occur with calcium deficiency in the body? Because calcium is responsible not only for the strength of our bones, but also ensures the transmission of exciting nerve impulses and muscle contraction.

Sudden weakness in the arms, as well as rapidly increasing severe weakness in the arms and numbness (most often in one arm), which is accompanied by headache, dizziness, darkening of the eyes, as well as nausea, vomiting and loss of consciousness, are classic signs of acute cerebral disorders. blood circulation – ischemic stroke. Weakness in the left arm (and speech impairment) is observed with a right-sided stroke. And weakness in the right hand is characteristic of a stroke in the left hemisphere of the brain.

Among the causes of constant weakness in the arms, tingling, partial loss of skin sensitivity and motor disorders, some neurologists put in first place degenerative-dystrophic injuries of the spinal cord of various etiologies associated with its compression, that is, compression.

In particular, due to compression of the lower cervical spinal nerves, weakness in the arm is felt with osteochondrosis. Approximately this situation arises with cervical spondylosis - a pathology of the spine caused by ossification and proliferation of tissues adjacent to the vertebrae (such growths are called osteophytes). Experts also include cervical radiculopathy (radiculitis), which develops as a result of prolonged compression of the nerve due to herniation or protrusion of intervertebral discs. In addition to pinching of axons (nerve fibers), compression of the epidural spinal tissues and blood vessels occurs, which also causes complaints such as weakness and numbness of the arms, and the arm muscles begin to twitch involuntarily chaotically (doctors call this phenomenon myoclonus). Similar symptoms occur in Kilo-Nevin syndrome, a compression syndrome of the deep branch of the ulnar nerve in the wrist.

Weakness in the shoulders and arms develops in cases of muscle dystrophy: Arand-Duchenne muscular atrophy, in the late stages of progressive myopathic Kurshman-Steinert syndrome, Landouzy-Dejerine myopathy (scapulohumeral-facial dystrophy), Emery-Dreyfus dystrophy.

Weakness in the arms and tingling are characteristic of autoimmune diseases: multiple sclerosis, Guillain-Barré syndrome (or Landry-Guillain-Barré polyneuropathy), amyotrophic lateral sclerosis (motoneuron disease or Charcot disease). If the cause of incurable Charcot's disease is damage to motor neurons in the cerebral cortex and spinal cord, then the etiology of multiple sclerosis and Guillain-Barré syndrome is a violation of the integrity of the myelin sheath of nerve fibers. Many patients with autoimmune diseases such as rheumatoid arthritis, scleroderma, and systemic lupus erythematosus also have muscle weakness in the arms.

Such signs are present in vascular pathologies: damage to the aortic arch and its branches supplying the upper limbs; nodular periarteritis - vasculitis of medium and small vessels; inflammation of the blood vessels of the hands (Buerger's disease). And weakness and cold hands are characteristic of Raynaud's syndrome, in which patients have significantly increased sensitivity of the fingers to cold.

Pain and weakness in the hand appear when the joints of the hands are affected - arthritis and arthrosis (with arthritis, the joints hurt at rest, with arthrosis - during movement).

There are many reasons that cause weakness and trembling in the hands. Thus, weakness in the arms and tremor are observed in neurological pathology - primary essential tremor of old age, as well as in multiple sclerosis, Wilson's disease, hyperthyroidism (hyperthyroidism), hypoglycemic syndrome (low blood glucose levels) and tick-borne encephalitis.

It should be added to all of the above that the causes of weakness in the hand may have a direct connection with:

• syndrome of the anterior scalene muscle (scalenus syndrome), that is, compression by this muscle of the lower roots of the brachial plexus and the artery passing under the collarbone;
• neuritis (inflammation) of the four main nerves (axillary, radial, ulnar and median), providing innervation to the upper extremities;
• carpal tunnel syndrome - compression of the medial nerve of the forearm in the carpal tunnel;
• stenosis (narrowing) of the spinal canal;
• the presence of malignant tumors or metastases of breast cancer, lung cancer, brain and spinal cord tumors.

Symptoms of weakness in the arms

The most common symptoms of arm weakness include:

• decreased muscle tone;
• rapid hand fatigue with little physical effort;
• stiffness of the hands in the morning (with arthritis and carpal syndrome);
• paresthesia (feeling of “crawling goosebumps”, tingling of the fingertips);
• periodic or constant pain in the joints or muscles of the hand, forearm and shoulder of the affected arm, as well as in the neck;
• varying degrees of reduction in the volume and amplitude of movements;
• decreased sensitivity of the fingers or hand on the palm or back (depending on the location of the innervation disorder);
• impaired skin sensitivity of the hands and a decrease in skin temperature (cold hands);
• tremor (shaking hands);
• involuntary hand movements (with central paralysis and brain injuries).
• partial muscle atrophy.

Treatment for weakness in the arms

To treat weakness in the arms, it is necessary to make an accurate diagnosis, on which the treatment tactics - symptomatic or etiological - depend.

If weakness and numbness of the hands are hidden in arthritis or osteochondrosis, then non-steroidal anti-inflammatory drugs (NSAIDs) with an analgesic effect are prescribed, for example, Ibuprofen (Ibuprex, Brufen, Ibupron, Nurofen, etc.): 1-2 tablets (0.2-0 .4 d) three times a day; the maximum daily dose is 1.2 g. The tablets are taken whole, before meals, with water. The duration of treatment should not exceed a week. Ibuprofen, like almost all NSAIDs prescribed for these pathologies (Nimesil, Indomethacin, Piroxicam, Arthrocid, etc.), can cause side effects: nausea, heartburn, problems with stool, headaches. The drug should not be used in the presence of gastric and duodenal ulcers, blood diseases, liver or kidney dysfunction, as well as during pregnancy and lactation.

Weakness in the arms and tingling (paresthesia), for example, with ischemic stroke or Raynaud's syndrome, suggest the need to improve blood circulation and activate tissue metabolic processes. And for this purpose, neurologists use angioprotective drugs. Thus, Pentoxifylline (Trental, Vazonit, Pentilin) ​​is often prescribed - 100 mg tablets and 2% injection solution. Tablets are taken 2-3 times a day - 2 tablets after meals. 100-600 ml of Pentoxifylline is administered intravenously (drip or stream) (1-2 times a day - depending on the condition). Side effects may include headache, dizziness, nausea, vomiting, intestinal disorders, stomach pain, and decreased blood pressure. This drug is not used in the treatment of patients with atherosclerosis, coronary heart disease and reduced blood clotting.

For ischemic strokes of the brain, as well as traumatic brain injuries, the nootropic drug Piracetam (Nootropil, Pirates, Pyrroxil, Cyclocetam, etc.) is prescribed, which helps regulate the conduction of impulses in the brain, activating tissue metabolism and improving cerebral circulation. Piracetam tablets (0.2 g each) or capsules (0.4 g each) should be taken before meals - 0.8 g in three doses; then the dosage is reduced to 0.4 per dose - twice a day. The course of treatment can last from three weeks to six months.

Weakness in the arms and tremors are treated with pharmacological agents that affect the sympathetic nervous system and block adrenaline receptors, as well as anticonvulsants and anticonvulsants. Topiramate (Maxitopir, Topalepsin, Topamax, etc.) is intended for the treatment of epilepsy, but due to its neuroprotective effect it relieves tremor well - by activating the inhibitory neural (GABAergic) system of the central nervous system and blocking the glutamatergic neurotransmitter system. Prescribed 25-50 mg twice a day.

To treat weakness in the arms due to multiple sclerosis, Betaferon - interferon beta-1b - is used by subcutaneous injection. Physiotherapy - electrophoresis, phonophoresis with painkillers - is also often used for the symptomatic treatment of pain.

Surgical methods for treating the pathologies in question are also used - for such indications as the intensity of pain (if it is impossible to relieve it with medications and physical procedures), the rate of progression of muscle weakness of the arms, the degree of decrease in the functionality of the limb, and the presence of signs of spinal cord compression.

Most often, operations are performed for herniated intervertebral discs, to remove osteophytes in cervical spondylosis, for carpal tunnel syndrome, for ruptured tendons of the shoulder joint, for spinal stenosis, etc. Damaged nerve trunks are surgically reconstructed, and the conductivity of blood vessels is restored using angioplasty in case of their narrowing.

In conclusion, it should be emphasized that, given the presence of such a wide “range” of causes for the development of such a symptom as weakness in the arms, seeking qualified medical help is the only way to maintain health. In this case, it is literally in your hands.

Severe muscle weakness manifested by severe fatigue and muscle weakness. Often this symptom is one of the first signs.

How does severe muscle weakness manifest?

Muscle fatigue characterized by a pronounced decrease in strength in one muscle or several at once. It is very important to clearly distinguish between muscle weakness and the general state of fatigue, weakness and lethargy. Chronic muscle fatigue is felt both in a specific limb and in any other area of ​​the body.

In medicine it is determined objective (in this case, the study confirms the fact of a decrease in muscle strength) and subjective (a person feels tired in a muscle, but the results of the study show that strength is preserved) muscle weakness. Classification related to the affected area is practiced. Varies localized And generalized forms of this disease.

This condition is characterized by rapid fatigue of the striated muscles, which will determine the functioning of the human musculoskeletal system. Quite often, a person, feeling weakness in the muscles of the arms or legs, only suffers from, so the doctor needs to be very careful in the process of making a diagnosis.

Often muscle weakness in the arms or muscle weakness in the legs is a symptom of a disease that is caused by autoimmune attacks of the body . This disease usually appears periodically. Exacerbations of the disease alternate with periods of remission. In patients with myasthenia gravis, the muscular system loses the ability to contract, as the person gradually loses muscle strength. In most cases, the disease affects young and middle-aged women, as well as men over 50 years of age.

Proximal muscle weakness It occurs primarily in the arms and legs, but sometimes it can occur in both the upper and lower extremities.

A patient with this symptom often finds it difficult to move long distances or walk up stairs. In some cases, it is even difficult for such people to stand and sit. Often their gait takes on the characteristics of a so-called “duck” walk - they walk as if rolling from side to side. If the muscles of the foot are affected, then over time the person develops. Subsequently, a person may develop hyperparathyroidism - a disease associated with too active hormone production parathyroid hormone , which subsequently leads to the development hypercalcemia . In such patients, in addition to muscle weakness, there are disorders of the kidneys, gastrointestinal tract, and signs of changes in the nervous system.

Why does severe muscle weakness occur?

The causes of muscle weakness are associated with various diseases and factors affecting the human body. Severe muscle weakness in older people and in younger patients can develop against the background of both muscular and mental diseases. Causes of muscle weakness in the legs and arms are often associated with the development of myasthenia gravis. This disease is of an autoimmune nature. Myasthenia gravis affects synapses – places where nerves and muscles connect. Consequently, this process leads to innervation. Myasthenic syndrome often develops against the background thymus tumors , hyperplasia , as well as for some diseases of the human nervous system. Symptoms of muscle weakness associated with myasthenia gravis are more common in women. Sometimes this illness is a consequence of severe stress or an infectious disease. Muscle weakness is sometimes noted in children. As a rule, the manifestation of this symptom indicates the development muscle tissue dystrophy . A child with this symptom often has various types of disorders in the functions of the central nervous system, muscle development defects, or the presence of certain genetic disorders.

However, the causes of weakness in the arms and legs are not always associated with myasthenia gravis. If a person feels normal, but at the same time notices severe fatigue and weakness in the legs, then in some cases the manifestation of this symptom is explained by overwork, constant work in a standing position, or even regularly wearing not very comfortable shoes. In this case, the patient suffers from fatigue, rumbling in the legs, and fatigue. This symptom is most often observed in older people, but women who prefer high-heeled shoes often report fatigue and a feeling of weakness in the lower extremities. In addition, this phenomenon may be a sign , spinal diseases .

Weakness of the muscles of the neck, back, pelvic floor, limbs, etc. manifests itself not only as a result of an independent autoimmune disease, but can also be a symptom of certain diseases and pathological conditions. Often muscle weakness is observed with a constant protein deficiency, with the active development of inflammatory processes or infectious diseases, with intoxication or dehydration of the body. Patients with, thyroid diseases . Muscle pain and weakness are a symptom of severe poisoning, an overdose of certain medications. Weakness in the leg muscles is characteristic of. It should also be taken into account that in some cases the causes of muscle weakness are associated with the development asthenic syndrome . A person sometimes notices a pronounced feeling of fatigue in the calf muscles after experiencing stress or serious emotional stress.

Weakness of the heart muscle leads to the development heart failure and occurs against the background of many cardiovascular pathologies.

How to get rid of severe muscle weakness?

Treatment of muscle weakness always depends on the underlying disease and is prescribed only after a complete diagnosis and determination of the cause of the disease. For patients who suffer from myasthenia gravis, it is very important to establish a diagnosis as early as possible, since the disease is more effectively treated at an early stage. In the diagnostic process, both laboratory and instrumental research methods are practiced.

During therapy, the doctor prescribes symptomatic treatment, as well as a course of physiotherapeutic procedures that help restore the normal state of a person’s muscles. However, as a rule, the disease has a chronic course, so it is impossible to completely get rid of the symptoms. The doctor prescribes medications and their dosage regimen for patients with myasthenia gravis individually, since it is necessary to take into account the characteristics of the symptoms and course of the disease. Most patients are prescribed drugs that block the destroyers acetylcholine - a substance that is formed in the body and takes part in the transmission of impulses to the muscles.

If necessary, radical treatment methods are prescribed, in particular surgical removal of the thymus gland or its tumor. In some cases, radiation exposure is indicated. With proper treatment, most patients note a noticeable improvement in their general condition. However, periodic maintenance therapy is necessary throughout the patient's life.

The question of how to relieve muscle fatigue is also relevant for people who have fatigue and pain in limbs - This is a consequence of the influence of other factors. If constant pain and a feeling of fatigue are associated with general fatigue, it is necessary to reconsider your lifestyle, ensure regular good rest, and reduce stress. Often, rapid and very severe pain and fatigue in the muscles appears after training. It is important to take a responsible approach to the selection of exercises, taking into account the general condition of the body and the presence of chronic diseases. However, a person must constantly practice adequate physical activity.

It is important to balance your diet and constantly maintain the correct drinking regime to prevent dehydration. If necessary, you should take care of changing your shoes to more comfortable ones. Massage and a warm, relaxing bath help to effectively relieve fatigue.

If muscle weakness is associated with other diseases, you should definitely tell your doctor about this symptom, who will adjust the treatment regimen. Particular attention should be paid to the health of those who have weakness of the heart muscle, since if not properly treated, this condition can be life-threatening.

Muscle weakness can be present in a few muscles or many muscles and develop suddenly or gradually. Depending on its cause, the patient may experience other symptoms. Weakness of certain muscle groups can lead to oculomotor disturbances, dysarthria, dysphagia, or difficulty breathing.

Pathophysiology of muscle weakness

Voluntary movements are initiated by the motor cortex of the brain in the posterior parts of the frontal lobe. Neurons in this area of ​​the cortex (central, or upper motor neurons, or corticospinal tract neurons) transmit impulses to motor neurons in the spinal cord (peripheral, or lower motor neurons). The latter come into contact with the muscles, forming a neuromuscular junction, and cause their contraction. The most common mechanisms for the development of muscle weakness include damage to the following structures:

• central motor neuron (damage to the corticospinal and corticobulbar tracts);
• peripheral motor neuron (for example, with peripheral polyneuropathies or anterior horn lesions);
• neuromuscular junction;
• muscles (for example, with myopathies).

Localization of the lesion at certain levels of the motor system leads to the development of the following symptoms:

• When the central motor neuron is damaged, inhibition is removed from the peripheral motor neuron, which leads to an increase in muscle tone (spasticity) and tendon reflexes (hyperreflexia). Damage to the corticospinal tract is characterized by the appearance of the extensor plantar reflex (Babinski reflex). However, when severe paresis suddenly develops due to central motor neuron damage, muscle tone and reflexes may be suppressed. A similar picture can be observed when the lesion is localized in the motor cortex of the precentral gyrus, far from the associative motor areas.
• Peripheral motor neuron dysfunction leads to rupture of the reflex arc, which is manifested by hyporeflexia and decreased muscle tone (hypotonia). Fasciculations may occur. Over time, muscle atrophy develops.
• Damage in peripheral polyneuropathies is most noticeable if the longest nerves are involved in the process.
• In the most common disease affecting the neuromuscular junction, myasthenia gravis, muscle weakness usually develops.
• Diffuse muscle damage (for example, in myopathies) is best seen in large muscles (muscle groups of the proximal limbs).

Causes of muscle weakness

The numerous causes of muscle weakness can be divided into categories depending on the location of the lesion. As a rule, when the lesion is localized in one or another part of the nervous system, similar symptoms occur. However, in some diseases the symptoms correspond to lesions at several levels. When the lesion is localized in the spinal cord, the pathways from the central motor neurons, peripheral motor neurons (anterior horn neurons), or both of these structures may be affected.

The most common causes of localized weakness include the following:

• stroke;
• neuropathies, including conditions associated with trauma or compression (eg, carpal tunnel syndrome), and immune-mediated diseases; “damage to the spinal nerve root;
• compression of the spinal cord (with cervical spondylosis, metastases of a malignant tumor in the epidural space, trauma);
• multiple sclerosis.

The most common causes of widespread muscle weakness include the following:

• dysfunction of muscles due to their low activity (atrophy from inactivity), which occurs as a result of illness or poor general condition, especially in older people;
• generalized muscle atrophy associated with prolonged stay in the intensive care unit;
• critical illness polyneuropathy;
• acquired myopathies (eg, alcoholic myopathy, hypokalemic myopathy, corticosteroid myopathy);
• use of muscle relaxants in a critically ill patient.

Fatigue. Many patients complain of muscle weakness, meaning general fatigue. Fatigue may interfere with the development of maximal muscle force when testing muscle strength. Common causes of fatigue include acute severe illnesses of almost any nature, malignant tumors, chronic infections (for example, HIV, hepatitis, endocarditis, mononucleosis), endocrine disorders, renal failure, liver failure and anemia. Patients with fibromyalgia, depression, or chronic fatigue syndrome may complain of weakness or fatigue, but have no objective problems.

Clinical examination for muscle weakness

During a clinical examination, it is necessary to distinguish true muscle weakness from fatigue, then identify signs that will allow us to establish the mechanism of the lesion and, if possible, the cause of the disorder.

Anamnesis. The medical history should be assessed using questions such that the patient independently and in detail describes the symptoms he has that he regards as muscle weakness. Following this, follow-up questions should be asked that specifically assess the patient's ability to perform certain activities, such as brushing teeth, combing one's hair, talking, swallowing, rising from a chair, climbing stairs, and walking. It is necessary to clarify how the weakness appeared (suddenly or gradually) and how it changes over time (remains at the same level, increases, varies). Appropriate detailed questions should be asked in order to distinguish between situations where weakness has developed suddenly and where the patient has suddenly realized that he has weakness (the patient may suddenly realize that he has muscle weakness only after the gradually increasing paresis reaches this degree , making it difficult to perform normal activities such as walking or tying shoelaces). Important associated symptoms include sensory disturbances, diplopia, memory loss, speech impairment, seizures and headache. Factors that aggravate weakness, such as overheating (which suggests multiple sclerosis) or repetitive muscle strain (common with myasthenia gravis), should be assessed.

Organ and system records should include information that suggests possible causes of the disorder, including rash (dermatomyositis, Lyme disease, syphilis), fever (chronic infections), muscle pain (myositis), neck pain, vomiting, or diarrhea ( botulism), shortness of breath (heart failure, lung disease, anemia), anorexia and weight loss (malignant tumor, other chronic diseases), change in urine color (porphyria, liver or kidney disease), heat or cold intolerance and depression, difficulty concentrating , agitation and lack of interest in daily activities (mood disorders).

Past medical conditions should be assessed to identify diseases that may cause weakness or fatigue, including thyroid, liver, kidney or adrenal disease, malignancies or risk factors for their development, such as heavy smoking (paraneoplastic syndromes), osteoarthritis and infections. Risk factors for possible causes of muscle weakness should be assessed, including infections (eg, unprotected sex, blood transfusions, contact with tuberculosis patients) and stroke (eg, hypertension, atrial fibrillation, atherosclerosis). It is necessary to find out in detail what medications the patient used.

Family history should be assessed for hereditary diseases (eg, hereditary muscle pathologies, channelopathies, metabolic myopathies, hereditary neuropathies) and the presence of similar symptoms in family members (if a previously undetected hereditary pathology is suspected). Hereditary motor neuropathies often remain unidentified due to variable and incomplete phenotypic presentation. Undiagnosed hereditary motor neuropathy may be indicated by the presence of hammertoes, high arches, and poor performance in sports.

Physical examination. To clarify the location of the lesion or identify symptoms of the disease, it is necessary to conduct a complete neurological examination and muscle examination. It is essential to assess the following aspects:

• cranial nerves;
• motor function;
• reflexes.

Assessing cranial nerve function includes examining the face for gross asymmetry and ptosis; Normally, slight asymmetry is allowed. Eye movements and facial muscles are studied, including determination of the strength of the masticatory muscles. Nasolalia indicates soft palate paresis, whereas testing the swallowing reflex and direct inspection of the soft palate may be less informative. Weakness of the tongue muscles can be suspected by the inability to clearly pronounce certain consonant sounds (for example, “ta-ta-ta”) and slurred speech (ie, dysarthria). Slight asymmetry in tongue protrusion may be normal. The strength of the sternocleidomastoid and trapezius muscles is assessed by turning the patient's head and by how the patient overcomes resistance when shrugging the shoulders. The patient is also asked to blink to detect muscle fatigue when opening and closing the eyes repeatedly.

Study of the motor sphere. The presence of kyphoscoliosis (which in some cases may indicate long-term weakness of the back muscles) and the presence of scars from surgery or injury are assessed. Movement may be impaired by dystonic postures (eg, torticollis), which may mimic muscle weakness. Assess for the presence of fasciculations or atrophy, which may occur in ALS (localized or asymmetrical). Fasciculations in advanced ALS patients may be most noticeable in the tongue muscles. Diffuse muscle atrophy may be best seen on the arms, face, and shoulder muscles.

Muscle tone is assessed during passive movements. Tapping muscles (eg, hypothenar muscles) may reveal fasciculations (in neuropathies) or myotonic contractions (in myotonia).

Assessment of muscle strength should include examination of the proximal and distal muscles, extensors and flexors. To test the strength of large, proximal muscles, you can ask the patient to stand up from a sitting position, squat and straighten, bend and straighten, and turn his head against resistance. Muscle strength is often assessed on a scale of five.

• 0 - no visible muscle contractions;
• 1 - there are visible muscle contractions, but there is no movement in the limb;
• 2 - movements in the limb are possible, but without overcoming gravity;
• 3 - movements in the limb are possible that can overcome the force of gravity, but not the resistance provided by the doctor;
• 4 - movements are possible that can overcome the resistance provided by the doctor;
• 5 - normal muscle strength.

Despite the fact that such a scale seems objective, it can be difficult to adequately assess muscle strength in the range from 3 to 5 points. With unilateral symptoms, comparison with the opposite, unaffected side can help. Often, a detailed description of what the patient can and cannot do is more informative than a simple scale rating, especially if it is necessary to re-examine the patient over the course of the disease. In the presence of a cognitive deficit, the patient may experience variable performance on muscle strength assessments (inability to concentrate on a task), repeating the same action, exerting incomplete effort, or having difficulty following instructions due to apraxia. With malingering and other functional disorders, usually a patient with normal muscle strength “yields” to the doctor when checking it, simulating paresis.

Coordination of movements is checked using finger-nose and heel-knee tests and tandem gait (putting heel to toe) to exclude disorders of the cerebellum, which can develop with impaired blood circulation in the cerebellum, atrophy of the cerebellar vermis (with alcoholism), some hereditary spinocerebellar ataxias, disseminated sclerosis and Miller Fisher variant in Guillain-Barré syndrome.

Gait is assessed for difficulty at the beginning of walking (temporary freezing in place at the beginning of movement, followed by hasty walking with small steps, which occurs in Parkinson's disease), apraxia, when the patient's feet seem to stick to the floor (with normal pressure hydrocephalus and other lesions of the frontal lobe), shuffling gait (with Parkinson's disease), limb asymmetry, when the patient pulls up his leg and/or swings his arms to a lesser extent than normal when walking (with hemispheric stroke), ataxia (with cerebellar damage) and instability when turning (with Parkinsonism) . Walking on heels and on toes is assessed; if the distal muscles are weak, the patient has difficulty performing these tests. Heel walking is especially difficult when the corticospinal tract is affected. Spastic gait is characterized by scissoring, or squinting, leg movements and walking on the toes. With paresis of the peroneal nerve, stepping and foot drop may occur.

Sensitivity is examined for abnormalities that may indicate the location of the lesion causing muscle weakness (for example, the presence of a level of sensory impairment suggests damage to a segment of the spinal cord), or the specific cause of muscle weakness.

Paresthesias distributed in a stripe pattern may indicate spinal cord lesions, which can be caused by both intramedullary and extramedullary lesions.

Study of reflexes. If tendon reflexes are absent, they can be tested using the Jendrassik maneuver. Decreased reflexes can occur normally, especially in older people, but in this case they must be reduced symmetrically and must be induced using the Jendrassik maneuver. Plantar reflexes (flexion and extension) are assessed. The classic Babinski reflex is highly specific for damage to the corticospinal tract. With a normal reflex from the lower jaw and increased reflexes from the arms and legs, the lesion of the corticospinal tract can be localized at the cervical level and, as a rule, is associated with stenosis of the spinal canal. With damage to the spinal cord, the tone of the anal sphincter and the wink reflex may be reduced or absent, but with ascending paralysis in Guillain-Barre syndrome they will be preserved. Abdominal reflexes below the level of the spinal cord lesion are lost. The integrity of the upper segments of the lumbar spinal cord and associated roots in men can be assessed by testing the cremasteric reflex.

The examination also includes an assessment of pain on percussion of the spinous processes (which indicates inflammatory lesions of the spine, in some cases - tumors and epidural abscesses), a test with raising outstretched legs (pain is noted with sciatica), and checking for the presence of pterygoid protrusion of the scapula.

Physical examination. If the patient does not have objective muscle weakness, then physical examination becomes especially important, and in such patients, a disease other than nerve or muscle involvement should be excluded.

Note symptoms of respiratory failure (eg, tachypnea, weakness on inspiration). The skin is assessed for jaundice, pallor, rashes, and stretch marks. Other important changes that may be identified on examination include a moon-shaped face in Cushing's syndrome and enlarged parotid glands, smooth hairless skin, ascites, and stellate hemangiomas in alcoholism. The neck, axillary and groin areas should be palpated to exclude adenopathy; It is also necessary to exclude enlargement of the thyroid gland.

The heart and lungs are assessed for dry and moist rales, prolonged expiration, murmurs, and extrasystoles. The abdomen must be palpated to identify tumors, as well as if there is a suspicion of damage to the spinal cord or a full bladder. A rectal examination is performed to detect blood in the stool. The range of motion in the joints is assessed.

If tick paralysis is suspected, the skin, especially the scalp, should be examined for ticks.

Warning signs. Please pay special attention to the changes listed below.

• Muscle weakness that becomes more severe over a few days or even less time.
• Dyspnea.
• Inability to raise head due to weakness.
• Banal symptoms (eg, difficulty chewing, speaking, and swallowing).
• Loss of the ability to move independently.

Interpretation of survey results. History data allows you to differentiate muscle weakness from fatigue, determine the nature of the disease and provide preliminary data on the anatomical location of weakness. Muscle weakness and fatigue are characterized by various complaints.

• Muscle weakness: Patients usually complain that they are unable to perform a specific activity. They may also notice heaviness or stiffness in the limb. Muscle weakness is usually characterized by a specific temporal and/or anatomical pattern.
• Fatigue: Weakness, which refers to tiredness, usually does not have a temporary (patients complain of fatigue throughout the day) or anatomical pattern (eg, weakness throughout the body). Complaints mostly indicate fatigue rather than the inability to perform a specific activity. Important information can be obtained by assessing the temporal pattern of symptoms.
• Muscle weakness that develops over a period of minutes or even less is usually associated with a severe injury or stroke. Sudden onset weakness, numbness, and severe pain localized to a limb are most likely caused by arterial occlusion and limb ischemia, which can be confirmed by vascular examination (eg, pulse, color, temperature, capillary refill, differences in blood pressure measured with Doppler scanning).
• Muscle weakness that progresses steadily over hours and days may be caused by an acute or subacute condition (eg, spinal cord pressure, transverse myelitis, spinal cord infarction or hemorrhage, Guillain-Barré syndrome, in some cases muscle atrophy may be associated with the patient being in critical condition, rhabdomyolysis, botulism, poisoning with organophosphorus compounds).
• Muscle weakness, progressing over weeks or months, may be caused by subacute or chronic diseases (eg, cervical myelopathy, most hereditary and acquired polyneuropathies, myasthenia gravis, motor neuron disease, acquired myopathies, most tumors).
• Muscle weakness, the severity of which varies from day to day, may be associated with multiple sclerosis and sometimes metabolic myopathies.
• Muscle weakness that varies throughout the day may be due to myasthenia gravis, Lambert-Eaton syndrome, or periodic paralysis.

The anatomical pattern of muscle weakness is characterized by specific activities that patients find difficult to perform. When assessing the anatomical pattern of muscle weakness, certain diagnoses can be suggested.

• Weakness of the proximal muscles makes it difficult to raise the arms (eg, when combing one's hair, lifting objects above the head), climbing stairs, or rising from a sitting position. This pattern is characteristic of myopathies.
• Weakness of the distal muscles impairs activities such as stepping across a sidewalk, holding a cup, writing, buttoning a button, or using a key. This pattern of disorders is characteristic of polyneuropathies and myotonia. In many diseases, proximal and distal muscle weakness may develop, but one pattern of involvement is more pronounced initially.
• Paresis of the boulevard muscles may be accompanied by weakness of the facial muscles, dysarthria and dysphagia, both with and without impaired movements of the eyeballs. These symptoms are common in certain neuromuscular diseases, such as myasthenia gravis, Lambert-Eaton syndrome, or botulism, but may occur in certain motor neuron diseases, such as ALS or progressive supranuclear palsy.

First, the pattern of motor dysfunction as a whole is determined.

• Weakness primarily affecting the proximal muscles suggests myopathy.
• Muscle weakness, accompanied by increased reflexes and muscle tone, suggests damage to the central motor neuron (corticospinal or other motor pathway), especially in the presence of an extensor reflex from the foot (Babinski reflex).
• A disproportionate loss of finger dexterity (eg, fine movements, playing the piano) with relatively intact hand strength indicates selective damage to the corticospinal (pyramidal) tract.
• Complete paralysis is accompanied by the absence of reflexes and a pronounced decrease in muscle tone, which develop suddenly with severe damage to the spinal cord (spinal shock).
• Muscle weakness with hyperreflexia, decreased muscle tone (both with and without fasciculations) and the presence of chronic muscle atrophy suggests peripheral motor neuron damage.
• Muscle weakness, most noticeable in muscles supplied by longer nerves, especially in the presence of sensory loss in the distal parts, suggests impaired peripheral motor neuron function due to peripheral polyneuropathy.
• Absence of nervous system symptoms (i.e., normal reflexes, no muscle atrophy or fasciculations, normal muscle strength or insufficient effort on a muscle strength test) or insufficient effort in patients with fatigue or weakness that is not characterized by any temporal or anatomical pattern , allows us to suspect that the patient has fatigue, and not true muscle weakness. However, if there is intermittent weakness that is not present at the time of examination, abnormalities may go unnoticed.

With the help of additional information, you can more accurately localize the lesion. For example, muscle weakness that is accompanied by signs of central motor neuron disease in combination with other symptoms, such as aphasia, mental status changes, or other symptoms of dysfunction of the cerebral cortex, suggests a lesion in the brain. Weakness associated with peripheral motor neuron disease may result from a disease affecting one or more peripheral nerves; In such diseases, the distribution of muscle weakness has a very characteristic pattern. When the brachial or lumbosacral plexus is damaged, motor, sensory disturbances and changes in reflexes are diffuse in nature and do not correspond to the zone of any of the peripheral nerves.

Diagnosis of the disease causing muscle weakness. In some cases, a set of identified symptoms allows one to suspect the disease that caused them.

In the absence of symptoms of true muscle weakness (for example, a characteristic anatomical and temporal pattern of weakness, objective symptoms) and the patient complains only of general weakness, fatigue, lack of strength, the presence of a non-neurological disease should be assumed. However, in older patients who have difficulty walking due to weakness, determining the distribution of muscle weakness may be difficult because Gait disturbances are usually associated with many factors (see chapter “Features in elderly patients”). Patients with multiple diseases may be functionally limited, but this is not due to true muscle weakness. For example, in patients with heart or lung failure or anemia, fatigue may be associated with shortness of breath or exercise intolerance. Joint abnormalities (such as those associated with arthritis) or muscle pain (such as those associated with polymyalgia rheumatica or fibromyalgia) may make it difficult to exercise. These and other disorders that manifest as complaints of weakness (eg, influenza, infectious mononucleosis, renal failure) are usually already identified or indicated by history and/or physical examination.

In general, if the history and physical examination do not reveal symptoms suggestive of an organic disease, then its presence is unlikely; the presence of diseases that cause general fatigue, but are functional, should be assumed.

Additional research methods. If the patient has fatigue rather than muscle weakness, further testing may not be necessary. Although many additional testing methods can be used in patients with true muscle weakness, they often play only a supporting role.

In the absence of true muscle weakness, clinical examination data (eg, shortness of breath, pallor, jaundice, heart murmur) are used to select additional testing methods.

In the absence of deviations from the norm during the examination, the research results will also most likely not indicate any pathology.

If it develops suddenly or in the presence of severe generalized muscle weakness or any symptoms of respiratory distress, forced vital capacity and maximum inspiratory force should be assessed to assess the risk of developing acute respiratory failure.

If true muscle weakness is present (usually after assessing the risk of developing acute respiratory failure), the study is aimed at finding out its cause. If it is not obvious, routine laboratory tests are usually performed.

If there are signs of central motor neuron damage, the key research method is MRI. CT is used if MRI is not possible.

If myelopathy is suspected, MRI can detect the presence of lesions in the spinal cord. MRI can also identify other causes of paralysis that mimic myelopathy, including damage to the cauda equina and roots. If MRI is not possible, CT myelography can be used. Other studies are also being conducted. Lumbar puncture and cerebrospinal fluid examination may not be necessary if a lesion is identified on MRI (eg, if an epidural tumor is detected) and is contraindicated if a cerebrospinal fluid block is suspected.

If polyneuropathy, myopathy or pathology of the neuromuscular junction is suspected, neurophysiological research methods are key.

After a nerve injury, changes in nerve conduction and denervation of the muscle can develop several weeks later, so in the acute period, neurophysiological methods may not be informative. However, they are effective in diagnosing some acute diseases, such as demyelinating neuropathy, acute botulism.

If myopathy is suspected (the presence of muscle weakness, muscle spasms and pain), it is necessary to determine the level of muscle enzymes. Elevated levels of these enzymes are consistent with a diagnosis of myopathy, but can also occur in neuropathies (indicating muscle atrophy), and very high levels occur in rhabdomyolysis. In addition, their concentration does not increase in all myopathies. Regular use of crack cocaine is also accompanied by a long-term increase in creatine phosphokinase levels (on average up to 400 IU/l).

MRI can detect muscle inflammation, which occurs in inflammatory myopathies. A muscle biopsy may be required to definitively confirm the diagnosis of myopathy or myositis. The appropriate site for biopsy can be determined using MRI or electromyography. However, needle insertion artifacts can mimic muscle pathology and it is recommended to avoid this and not take biopsy material from the same location as the electromyography. Some hereditary myopathies may require genetic testing to confirm.

When motor neuron disease is suspected, studies include electromyography and conduction velocity testing to confirm the diagnosis and exclude treatable diseases that mimic motor neuron disease (eg, chronic inflammatory polyneuropathy, multifocal motor neuropathy, and conduction blocks). In advanced stages of ALS, MRI of the brain may reveal degeneration of the corticospinal tracts.

Specific tests may include the following.

• If myasthenia gravis is suspected, an edrophonium test and serological studies are performed.
• If vasculitis is suspected, determine the presence of antibodies.
• If there is a family history of a hereditary disease - genetic testing.
• If there are symptoms of polyneuropathy, perform other tests.
• In the presence of myopathy not related to drugs, metabolic or endocrine diseases, a muscle biopsy may be performed.

Treatment of muscle weakness

Treatment depends on the disease causing the muscle weakness. In patients with life-threatening symptoms, mechanical ventilation may be required. Physiotherapy and occupational therapy can help you adapt to persistent muscle weakness and reduce the severity of functional impairment.

Features in elderly patients

In older people, there may be a slight decrease in tendon reflexes, but their asymmetry or absence is a sign of a pathological condition.

Because older people tend to lose muscle mass (sarcopenia), bed rest can quickly, sometimes within a few days, lead to the development of disabling muscle atrophy.

Older patients take a large number of medications and are more susceptible to drug-induced myopathies, neuropathies, and fatigue. Therefore, drug therapy is a common cause of muscle weakness in older people.

Weakness that prevents walking often has many causes. These may include muscle weakness (eg, stroke, use of certain drugs, myelopathy due to cervical spondylosis or muscle atrophy), as well as hydrocephalus, parkinsonism, arthritis pain, and age-related loss of neural connections that regulate postural stability (vestibular system, proprioceptive pathways), motor coordination (cerebellum, basal ganglia), vision and praxis (frontal lobe). During the examination, special attention should be paid to correctable factors.

Physical therapy and rehabilitation can often improve a patient's condition regardless of the cause of muscle weakness.

The acute nature of muscle pain indicates trauma to muscle tissue, most often rupture of fibers, fascia, up to complete separation of the muscle. A stretch or simple contraction of a muscle is rarely accompanied by severe pain, even if it occurs, it is characterized as short-term.

Acute muscle pain, possible causes:

• Rupture of muscle, muscle fibers of the 2nd degree. This microtrauma is considered reversible, but is accompanied by acute, sharp pain, often spasm. Pain may intensify with diagnostic palpation.
• A 3rd degree muscle tissue rupture is defined as multiple damage to the connective fibers, often accompanied by an extensive internal hematoma. Acute muscle pain leads to limitation of motor activity, muscle atony, and delayed spasm. The pain is clearly localized, rarely localized, more often diffuse, but within the limits of tissue damage.
• A complete 4th degree muscle avulsion is considered a severe injury, accompanied by intense sharp pain and a clicking sound. An avulsion is a complete separation of the transverse muscle fibers and fascia, while the separated parts of the muscle can be located quite far from each other. The tear site quickly swells, an extensive hematoma develops, the damaged area is very painful and completely immobilized, this is especially typical for muscle rupture in the limbs.

In addition, acute pain can also be caused by trauma to bone tissue - a crack, fracture of a bone, dislocation of a joint; the pain symptom in these cases lasts quite a long time, subsides gradually as the connective tissue regenerates.

Nagging muscle pain

The nagging nature of muscle pain is a symptom of chronic myalgia, fibromyalgia, in addition, a similar nature of pain is inherent in the neuropathic or vascular nature of pain. An example would be pulling pain in the muscles with intermittent claudication, as well as pseudo-ischemic chest pain, similar to the clinical manifestations of angina pectoris. Also, the nagging nature of the pain indicates pathological structural changes in the muscle fibers, for example, after intense training (delayed pain), when excessive load provokes microtraumas of the fibers, their tears, and a situational inflammatory process develops in the connective tissues. Spasmed muscles, a state of stiffness - tension, as a rule, are accompanied by dull, aching pain.

Thus, pulling pain in the muscles is a signal that vascular pathology is developing in the body (atherosclerosis, thrombophlebitis, varicose veins), most often in the pelvic region and lower extremities. Occlusion (blockage) of blood vessels interferes with the normal blood supply to the muscles; oxygen deficiency may develop in them, they lose elasticity and tone, and atrophy may begin. Overexertion, accompanied by hypertonicity and spasm, is also a kind of disruption of the blood supply to the muscle, which causes pain of a pulling, aching nature.

Temperature and muscle pain

Fever and muscle pain are symptoms of Bornholm disease or epidemic myalgia caused by an enterovirus (Coxsackie virus). Muscle pain is paroxysmal, acute, localized in the upper part of the body (chest, back, neck, shoulders, arms), body temperature rises to critical levels of 39-40 degrees.

Purulent myositis can develop as a result of injury to soft tissues and infection in the wound.

Severe muscle pain

Myofascial syndrome is characterized by intense pain, unlike fibromyalgia; in addition, severe muscle pain can be a symptom of non-infectious or symptomatic myositis.

Typical acute non-infectious myositis is localized in the following areas:

• Deltoid muscle – myositis of the shoulder girdle.
• Neck muscles – cervical myositis (muscular torticollis).
• Muscles of the lumbosacral region - lumbago (lumbago).

Acute myositis is characterized by severe pain, leading to motor restrictions and temporary immobility of the neck, legs or arms.

The areas where the inflammatory process is localized are marked by painful sensations on palpation; compactions and nodes can be clearly felt in them. Severe muscle pain caused by simple myositis subsides with rest and goes away after a few days, but can recur without adequate treatment. This is how chronic myositis develops, which is accompanied by pain that is less intense, but constantly present, often even at rest.

Symptomatic myositis can also manifest itself as severe muscle pain; the course of the disease is associated with the main etiological factor, which relates to the internal organs or the spinal column. In this case, severe muscle pain is a reflection of pathological processes, and not an independent condition.

Myalgia associated with physical or psycho-emotional stress, fibromyalgia extremely rarely manifests itself as intense pain; rather, it indicates a combination of muscle hypertonicity and a serious, as yet undiagnosed pathology, for example, polymyalgia rheumatica or rheumatoid arthritis.

Muscle pain and cramps

Cramps are spontaneous contractions, muscle contractions, usually accompanied by pain. Pain and muscle cramps are a typical consequence of overexertion, most often long-term training, swimming, and walking. Accordingly, when it comes to cramps, they are most often associated with the calf muscle; according to statistics, contraction of these muscles accounts for more than 70% of all cramp syndromes in various parts of the body.

Reasons why muscle pain and cramps occur:

• Professional factor, muscle strain under static or dynamic load (salesmen, athletes).
• Varicose veins
• Injuries - microdamage to muscle fibers, less often - muscle hernia.
• Imbalance of potassium, sodium, calcium as a consequence of venous stagnation.
• Neurological diseases.
• Intervertebral disc herniation.
• Uremia (azotemia).
• Fluid and electrolyte imbalance due to excessive sweating or dehydration.
• Latent diseases of the thyroid gland.
• Diabetes.
• Rheumatoid arthritis.
• Calcium deficiency due to overuse of caffeine-containing drinks.
• Atherosclerotic changes in the vascular system.

Muscle cramps can be short-term - clonic or long-lasting, accompanied by severe pain, tonic. Any type of contraction is accompanied by muscle pain. It should be noted that cramps, in principle, cannot be painless, since pain is the key trigger factor for spasm and hypoxia of muscle fibers.

Aching muscle pain

Violation of microcirculation, permeability of vascular walls, ischemia, vascular atherosclerosis - this is not a complete list of reasons that can cause aching muscle pain.

The protopathic nature of the pain symptom is characteristic of vascular pathologies, in principle, and pain in muscle tissue is no exception. If the blood supply and muscle nutrition are disrupted, a disturbance in the oxidative process develops, and dull, aching pain appears. Symptoms develop slowly, are realized only during the period of exacerbation, and it is also difficult to determine a clear localization of pain. It should be noted that painful muscle areas are most often diagnosed using external palpation, when a clear signal is received from the affected muscles.

Diseases that provoke aching muscle pain are always chronic and can be:

• A chronic form of muscle inflammation, myositis. Most often, myositis is accompanied by an intense pain symptom, but its chronic course is characterized by adaptation to the pathological process, when the pain is dull, aching in nature and can only worsen with hypothermia or additional trauma. As a rule, this refers to myositis of the lumbar region, which is manifested by pain of moderate intensity, aggravated by palpation or physical activity.
• Fibromyalgia, which is still a “mysterious” disease of unknown etiology. Myalgia develops gradually, affects almost all muscles of the body, the pain is constant, aching, and mild in nature. Fibromyalgia is never combined with inflammatory processes in the musculoskeletal system or internal organs; a comprehensive examination does not reveal any organic pathologies; the only defining criteria are aching muscle pain at certain trigger points.
• Dull, aching pain symptoms may indicate inflammation of the tendons or tendon tissue - myoenthesitis, parathenotitis. The cause of these conditions is severe fatigue, overstrain of certain muscle groups and microtrauma of the tendons. The muscles in the affected area are tense, swollen, the pain is clearly localized in the load zone.

Weakness and muscle pain

Muscle weakness and hypotonia are characteristic of dynamic muscles and may indicate many diseases, such as the following:

• Metabolic disorders in muscle tissue.
• Polyneuropathy (vasculitis).
• Anterior tibial artery syndrome.
• Myoglobinuria.
• Endocrine disorders.
• Collagenoses.
• Intoxication, including drug intoxication.
• Anorexia.
• Cardiogenic asthenia.
• Neuromyotonia.
• Spinal injuries.
• Post-workout weakness and pain.

The list of diseases and conditions that provoke feelings of weakness and pain in the muscles is long, but most often such a syndrome is defined as myopathy (from myopathia, where myo is muscle, pathia is pain). Myopathy refers to neuromuscular, progressive diseases, which include polymyositis, myositis associated with other connective tissue pathologies, myositis ossificans, and dermatomyositis. Differentiation is carried out using a blood test for the level of CFU - creatine phosphate kinase, histochemical, neurophysiological examinations. The cause of muscle atony can be both hereditary factors and infectious, inflammatory diseases, as well as injuries, hypothermia, metabolic disorders, and intoxication.

Schematic pathogenetic development of weakness and pain in muscle tissue:

• Weakness, atony of the proximal muscles, mainly in the area of ​​the shoulder girdle, pelvis, hips, and neck.
• Difficulties in performing simple actions - climbing stairs, steps, difficulty getting out of a chair, out of bed, combing your hair, washing your face.
• Rapid progression of muscular dystrophy can lead to weakness of the neck muscles and an inability to hold the head upright.
• Spasm of the pharyngeal ring and dysphagia (difficulty swallowing food) may develop.
• All signs of myopathy are accompanied by transient, situational pain.

Weakness and muscle pain as a symptom can be classified into the following groups of diseases:

1. Muscle pathologies:

• IIM – idiopathic inflammatory myopathy (polymyositis, dermatomyositis, all other types of non-infectious myositis).
• Infectious myositis – bacterial, protozoal, nematode, cystoid, viral, granulomatous myositis).
• Intoxication myopathies are drug-induced, toxic myopathies.
• Metabolic myopathies – glycogen-deficient, lipid-deficient, purine-deficient, mitochondrial myopathies.
• Secondary metabolic myopathologies – endocrine myopathies, electrolyte imbalance, osteomalacia myopathies.
• Muscular dystrophies - Duchenne disease, Becker muscular dystrophy, Deifuss-Hoogen disease, Merb disease, Rottauf disease, Mortier-Beyer muscular dystrophy, glenohumeral muscular dystrophy, Landouzy-Dejerine disease and others.
• Low-progressive myodystrophies - myotubular, paramyotonia, Thomsen's myotonia, amyloidosis.

1. Neurogenic pathologies:

• ALS – myotrophic lateral sclerosis.
• Spinal amyotrophy.
• Spinobulbar muscular atrophy.
• Peroneal amyotrophy of Charcot-Marie-Tooth.
• Radiculopathy, including diabetic.
• CIDP is a chronic inflammatory demyelinating polyneuropathy, as well as its acute form.
• Shoulder plexopathy.

1. Impaired conduction of the neuromuscular synapse:

• Myasthenia gravis.
• Lambert-Eaton syndrome.
• Rhabdomyolysis.

Muscle and bone pain

Pain in muscles and bones is a symptom of diffuse or localized myalgia, or rather one of its forms. Musculoskeletal pain is so called because sensations in the muscles are certainly combined with pain in the skeletal system due to their anatomical relationship. The vast majority of causes of musculoskeletal pain (about 75%) are associated with myofascial pain syndrome, when pain is considered a reflection of spondylogenic neurological pathologies. In addition, it should be noted that myofascial symptoms and myotonic manifestations are always combined with psycho-emotional disorders. This is why muscle and bone pain is so difficult to diagnose and differentiate. Basically, the division and classification of pain associated with the musculoskeletal system occurs in the following groups:

• Local pain.
• Radicular pain.
• Referred pain.
• Secondary cramping pain or myofascial pain.

What pathologies are associated with pain in muscles and bones?

1. A clearly localized symptom indicates a pathological process in sensitive nerve endings (pinching, nerve irritation). Localized pain is most often constant, but varies in intensity and depends on the position in which the person is in motion or at rest.
2. Referred pain symptom in the muscles and skeletal system. Such pain can be projected from the spinal column or be a reflection of the pathology of the internal organs. If the pain is secondary and serves as a signal of an internal organ disease, it is not affected by posture or movement of the spinal column, that is, such a symptom does not subside with rest.
3. Radicular syndrome is usually characterized by a high degree of intensity, the pain is strong, sharp and limited to the limits of radicular conduction. The cause is compression, stretching or pinching of the endings of the spinal nerve. Most often, the pain spreads from the center of the lesion and intensifies with reflex movements - coughing, sneezing, laughing. According to the description of subjective sensations on the part of a sick person, pain is felt deeply - in the bones and muscles at the same time.
4. Myofascial syndrome is characterized by clearly localized painful areas that are easy to palpate. Pain provokes muscle hypertonicity; the skeletal system, in principle, is not involved in the pain syndrome, but patients feel the symptom as profound and, according to subjective descriptions, it affects the bones.

Constant muscle pain

Persistent muscle pain is a typical description of either chronic, advanced myositis or evidence of fibromyalgia. In principle, the constant nature of pain always refers to the chronicity of the disease; in this case, muscle pain is considered one of the specific criteria for FM - fibromyalgia, especially if the symptoms are distributed across diagnostic trigger zones.

Fibromyalgia, the etiology of which is still unclear, is accompanied by diffuse, widespread pain that is constant, aching, and less often acute. The diagnosis of the disease is established if constant muscle pain has been present for at least three months. Also, the diagnostic criterion is 11 out of 18 points recommended by the disease classifier.

One of the latest theories about the origin of fibromyalgia is that pain is a consequence of decreased serotonin levels. In addition, the cause of fibromyalgia and constant excruciating pain can be endocrine and hormonal disorders, since the main contingent of patients with FM are women. In addition to constant pain in the muscles, fibromyalgia is characterized by the following symptoms:

• Chronic fatigue, weakness.
• Stiffness of movement, especially in the morning, after sleep.
• Insomnia, disturbance of the phase of slow, relaxing sleep.
• Chronic tension in the neck muscles, which leads to headaches.
• Dysfunctions of the digestive system.
• Restless legs syndrome, less often - cramps.

Muscle pain throughout the body

The most common complaint of fibromyalgia patients is muscle pain throughout the body. Diffuse, symmetrical pain in the muscles and joints of the body, the constant nature of symptoms, clear localization in trigger zones - these are the main diagnostic criteria that help identify this little-studied disease. In addition, the symptoms of FM (fibromyalgia) are so skillfully disguised as signs of other nosological pathologies that they are defined as polysymptoms or syndrome. Pain in the muscles of the whole body, at first glance, occurs spontaneously, without visible objective reasons; any standard examination does not reveal a single organic or systemic lesion that could provoke FM.

Trigger pain currents - tender point - are indeed located throughout the body, they have been studied quite well, there are 18 of them in total, if palpation detects pain in 11 of them, and if the symptoms last more than 3 months and are not associated with organic matter, then the diagnosis of fibromyalgia can be consider certain.

Statistics say that in addition to diffuse pain distributed throughout all parts of the body, fibromyalgia is characterized by the following conditions, complications and consequences:

• More than 50% of patients with FM lose their ability to work and their quality of life deteriorates significantly.
• The performance of patients with FM tends to zero. Over the course of a year, operating efficiency drops from 40% to 10% or lower.
• 75-80% of patients with FM are women over 35 years of age.
• Fibromyalgia, accompanied by pain throughout the body, is often disguised as CFS - chronic fatigue syndrome. In the classifier, these are two different nosological units.
• FM symptoms are 60-70% similar to irritable bowel syndrome.
• Pain throughout the body with FM most often begins with tension headaches and dysfunction of the mandibular joint (in 70-75%)
• Pain areas are very sensitive to weather conditions and temperature changes.

It should be noted that widespread muscle pain is also characteristic of MFPS - myofascial pain syndrome, which is difficult to differentiate from fibromyalgia, however, it is a separate disease.

Periodic muscle pain

Periodic muscle pain or transistor pain is associated with nociceptors - transducers of the receptor response of muscle tissue to a traumatic factor.

This happens when the damage to muscle fibers is insignificant and the pain subsides much earlier than the process of restoring the structure of the fibers ends. The main task performed by periodic muscle pain is a situational reflex response to a relatively safe damaging factor; thus, pain is a kind of learning experience in overcoming injury.

Most often, pain associated with post-training overloads and one-time muscle hypertonicity are periodic in nature.

The so-called soreness after intense training without proper warming up is nothing more than a completely natural thickening of muscle tissue, or its micro-tears.

Also, transient pain can be caused by muscle stretching, disruption of its nutrition (blood supply, microelements, electrolyte balance). As soon as the provoking factor is eliminated, the pain subsides.

For physical overload, rest, a relaxing or warming massage is enough; if there is a deficiency of microelements, additional intake of vitamin preparations and increased nutrition help to quickly cope with the pain symptom. Electrolyte balance is restored by drinking a sufficient amount of mineralized liquid (sodium mineral waters).

To summarize, it can be argued that the periodic, recurrent nature of myalgia indicates the return of a provoking factor, often physical overexertion. Those people who have already experienced temporary transient muscle pain after intense work or after the action of another factor may experience a similar symptom more than once for the following reasons:

• If we are talking about training, then the program is chosen incorrectly or proper preparation (stretching, warming up the muscles) is not carried out before strength exercises.
• If myalgia recurs without the factor of physical stress, therefore, there is an unresolved psycho-emotional, social problem, to which the muscles continue to periodically react in the form of hypertonicity.

Chronic muscle pain

Any pain symptom that lasts longer than the recovery or healing period is considered chronic. Many clinicians talk about chronic symptoms as an independent disease that has its own pathological process and provokes secondary dysfunction at the site of localization.

Chronic muscle pain is associated with dysfunction of muscle fibers, most often due to constant static load. Muscle spasm is caused by excessive activation of metabolic processes and an increase in the contractile properties of fibers. This chronic process inevitably leads to compression of blood vessels, nerve endings and a general circulatory disorder, ischemia.

Constant, chronic pain is not intense; more often it is dull, aching in nature and is more characteristic of fibromyalgia than myositis. The pain symptom in fibromyalgia develops not only in muscle fibers, but also in ligaments and tendons; it is accompanied by asthenia, sleep disturbances, and depression. The pain is diffuse, distributed over trigger points, which upon palpation respond with distinct painful sensations.

The localization of chronic pain depends on many factors, the most common area is the lower back, where a large number of nociceptors (neurons) are located, especially those that have a peripheral, delayed effect. Thus, the task of pain - etiological protection is not fully fulfilled, the body becomes disadapted and begins to “get used to” the painful implicit symptom.

Cutting muscle pain

Acute, cutting pain in muscle fibers is a biological response of the body's adaptive system to damage - initial or already occurred. Most often, cutting pain is associated with dysfunction of smooth muscles without concomitant injury and damage to surrounding tissues. The duration of pain depends on the period of muscle recovery or on the speed of relief of the root cause - vertebrogenic, cervicogenic and other factors.

Cutting, “lancinating” muscle pain is quite rare; its causes may be the following factors:

• Soft tissue injury (open, closed), severe bruise with rupture of subcutaneous tissue and fascia, muscle fibers.
• Myofascial syndrome in combination with cramps and contracture.
• An acute form of infectious myositis, accompanied by abscesses.
• Complete muscle separation, transverse rupture of muscle fibers.

Cutting muscle pain always indicates severe injury, damage to muscle fibers or an acute inflammatory process in them. Cutting pain can also be caused by excessive effort or stress on a stretched muscle that has begun to recover. Severe pain is also accompanied by cramps and contracture, when during involuntary muscle contraction the level of adenosine triphosphate decreases and the electrical conductivity of muscle fibers is disrupted. In addition, sharp pain is caused by reflex muscle contraction when deep layers of soft tissue are affected, and carpopedal spasms (tetany).

Myositis, which is characterized by sharp, cutting pain due to the inflammatory process in muscle tissue, deserves special attention. If the inflammation occurs in a chronic form, its acute period is left without proper treatment, the load on the inflamed muscle increases, and a fibrous compaction forms inside it - a knot. In addition to the fact that the sore muscle is spasmed, it develops a blockage of blood flow, ischemia, an increase in the rate of metabolic processes and the release of specific chemicals that provoke pain. The most typical areas of painful cutting symptoms in myositis are the neck, shoulders, and back.

When diagnosing a cutting painful muscle symptom, possible root causes are always excluded - oncological process, inflammation of internal organs of infectious etiology, acute spinal syndrome. Particularly thorough examinations are required if the sharp pain in the muscle fibers does not subside and does not depend on changes in body position and movements.

Nausea, fever and muscle pain

Myalgia, which is accompanied by nausea and hyperthermia, may indicate many diseases of completely different etiologies. However, a combination of symptoms - nausea, fever, muscle pain - is a sign of a serious condition requiring immediate hospitalization.

What diseases can cause nausea, fever and muscle pain?

• Flu, especially the toxic form. Accompanied by chills, lacrimation, often delirious states with high body temperature, and weakness.
• Meningitis. The main symptoms are high temperature (up to 40 degrees), severe diffuse headache of a bursting nature, rash, nausea and repeated vomiting, stiffness and pain in the neck and leg muscles, and there may be a convulsive syndrome.
• Herpes (genital) - characteristic rashes, itching, weakness in the body, hyperthermia, enlarged lymph nodes, nausea and headache, myalgia. The same symptoms can occur with herpes zoster.
• ITS is an infectious-toxic shock (bacterial shock), which can be triggered by meningitis, dysentery, influenza, candidiasis and other diseases of viral-bacterial etiology. Symptoms are a spontaneous jump in temperature to 39-40 degrees, nausea and vomiting, severe muscle pain, swelling, diarrhea, rash, loss of consciousness, cyanosis, tachycardia.
• Epidemic myalgia. Symptoms are hyperthermia, nausea and vomiting, diarrhea, pain in the abdominal muscles, in the chest muscles.

To summarize, it can be noted that the combination of such threatening signs most often indicates severe intoxication of the body, a serious condition that requires an immediate call to a doctor or emergency medical care.

Colds and muscle pain

What is popularly called a cold would be more correctly called acute respiratory viral infections, acute respiratory infections, sore throat, influenza. According to the difference in nosologies, the symptoms also differ, but there are also common signs - increased body temperature and muscle pain.

Why is it considered that muscle pain is a typical phenomenon during a cold?

Myalgia almost always accompanies elevated body temperature, therefore, if the cold occurs in an acute form, the patient will complain of uncomfortable, pulling, aching sensations in the muscle tissue. As a rule, all colds are accompanied by obvious catarrhal symptoms - runny nose, sore throat, conjunctivitis, but colds are also characterized by intoxication, when the breakdown products of bacteria and viruses enter the bloodstream. The body tries to get rid of toxins through increased sweating, which in turn provokes an imbalance of electrolyte and water-salt balance. It is this disorder that causes myalgia in various areas of the body. To neutralize dehydration and accelerate the elimination of intoxication products, patients are recommended to drink plenty of fluids - hemodilution.

Flu and muscle pain

It is believed that the flu and muscle pain inevitably go together, but this does not always happen. More often, a viral infection is accompanied by transient diffuse myalgia, and real, true myositis - inflammation of muscle tissue - practically does not occur. This is due to the pathogenetic mechanism of penetration of the influenza virus into the body. The primary invasion and reproduction of influenza virions mainly occurs in the epithelial cells of the respiratory system - nasopharynx, bronchi, and endothelial tissue of capillaries. The virus has a cytopathic effect on mucous tissues, provoking total suppression of the immune system (suppression of phagocytosis), but is not able to penetrate muscle fibers due to its molecular structure.

How to determine what provokes myalgia, a simple respiratory disease or the flu, muscle pain caused by overexertion or a virus?

It all depends on the severity of the process, which in case of influenza is determined taking into account two clinical forms - influenza with a predominance of catarrhal symptoms or influenza with a predominance of intoxication symptoms.

The catarrhal course of the disease is rarely accompanied by muscle pain; this is rather characteristic of the intoxication form, when from the very first hours of the illness a person feels aching, pain in the legs (calf muscles), lower back, joints, or generalized muscle pain throughout the body. Then other signs of viral intoxication appear - weakness, dizziness, adynamia. Such characteristic manifestations, given objective information about a possible influenza infection (epidemic, contact with a sick person), can serve as arguments in favor of diagnosing the intoxicating course of influenza.

Muscle aches and pain

The sensation of aching is more likely to be characteristic of joint pain than muscle pain, but patients often describe their condition as “ache and pain in the muscles.” What diseases can provoke such an atypical combination of symptoms?

It is necessary to distinguish between morning stiffness in joints and muscles, which is often confused by patients themselves when describing subjective sensations.

Typical morning pain and stiffness is a typical sign of osteoarthritis, which destabilizes the articular cartilage, but not the muscles. Morning pain is also characterized by diffuse idiopathic skeletal hyperostosis, in which pain after sleep lasts no more than an hour. The pain is localized in the back and affects only the skeletal system, without affecting the muscular system.

In terms of muscle tissue, muscle pain after sleep is most likely due to fibromyalgia, in which diffuse chronic pain is the main symptom. Typical signs of fibromyalgia:

• Sleep disturbance, leading to a feeling of fatigue, weakness, starting in the morning.
• Stiffness of movement after sleep, pain in muscles and joints. Muscle pain zones are clearly palpated within the boundaries of the diagnostic trigger zones.
• Headache, often caused by hypertonicity of the muscles of the neck and shoulder girdle.
• Feeling of numbness in the limbs.
• Pain in the leg muscles, restless legs syndrome during sleep.