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Upper Limb Neuro

Myaesthenia Gravis

February 15th, 2021


Patients with myaesthenic syndromes exhibit muscle fatigability, or the inability to maintain contraction of muscles over time.
  • Signs of Myaesthenia Gravis

  • Skeletal Muscle Fatiguability

  • Simpson's test - ptosis on sustained upward gaze
  • Peek sign - inability to maintain sustained eye closure
  • Bulbar fatiguability - development of nasal speech with reading
  • Proximal muscle fatigability - inability to maintain arms above the head
  • Signs of Management

  • Thymectomy scar

Proximal Muscle Fatigability

  • How to Perform

  • Ask the patient to hold their arms above their head for as long as they can.
  • Interpretation

  • Inability to hold this position suggests proximal weakness, though if the patient is initially able to hold their arms up without issues then fatigues, this is a sign of myaesthenia.
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