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Upper Limb Neuro

Proximal Weakness

February 15th, 2021
On this page:Proximal Myopathy


Proximal weakness is most commonly a manifestation of muscular pathology, though may also occur in certain neurologic conditions.
  • Differential Diagnosis of Proximal Weakness

  • Proximal myopathy
  • Neuromuscular disorder - myaesthenia gravis, Lambert-Eaton myaesthenic syndrome
  • Neurologic disorder - polyneuropathy, motor neurone disease

Proximal Myopathy

  • Signs of Proximal Myopathy

  • General Signs

  • Proximal muscle wasting - biceps, deltoids, quadriceps, buttocks
  • Symmetrical proximal weakness - particularly the shoulder and hip muscles
  • Trendelenberg gait - dropping of the affected side during the stance phase
  • Trendelenberg test - dropping of the affected hip on standing on the opposite leg
  • Signs Suggesting a Cause

  • Dermatomyositis - heliotrope rash, Gottron's papules
  • Paraneoplastic syndrome - surgical scars, e.g. in the chest
  • Causes of Proximal Myopathy

  • Congenital

  • Muscular dystrophy - e.g. Duchenne's, Becker's, Emery-Dreyfuss, limb girdle, fascioscapulohumeral
  • Metabolic myopathies - e.g. glycogen and lipid storage disorders
  • Acquired

  • Inflammatory myositis - polymyositis, dermatomyositis
  • Paraneoplastic syndrome
  • Infection - Lyme disease, HIV, infectious pyomyositis, trichinosis, cysticercosis, coxsackievirus
  • Endocrine - thyroid disease, Cushing's, acromegaly, hypopituitarism
  • Metabolic - periodic paralysis
  • Toxins - alcohol, steroids, statins, cocaine
  • Sarcoidosis
  • Proximal Muscles of the Upper Limb

  • Deltoids
  • Biceps
  • Triceps
  • Brachioradialis
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