Spence Rehabilitation Center
1650 45th Ave. Suite 2C
Munster, IN 46321
Visit our Porter County location!
1620 Country Club Rd. Ste E
Valparaiso, IN 46383
Phone : (219) 513-2267
What Are Some Potential Causes of Muscle
1. Disorders of the brain:
Stroke, brain tumors, meningitis, multiple scleroisis, etc.
2. Disorders of the spinal cord:
Myelopathy, spinal cord metastasis from cancer,
arteriovenous malformations, abscess from infection.
3. Radiculopathies:
Pinched nerves can be caused by disc herniations or
spinal stenosis.
4. Compression Mononeuropathies:
pinched nerves elsewhere in the body such as at
the arms or legs. Some examples are carpal tunnel
syndrome which is compression of the median nerve
at the wrist.
5. Peripheral Polyneuropathies:
Many of the nerves in the body are affected particularly
in the arms and legs. Common causes include diabetes,
alcohol use, toxins. Etc.
6. Neuromuscular Junction disorders:
A disorder involving where the nerve and muscle
communicates. The disorder can be due to broken
neurotransmitters, improperly working receptors
at the muscle, etc. One example is Myesthenia
6. Myopathy:
A disorder of the muscle. The muscle can be inflamed
also known as myositis or have a structural problem
which is known as muscular dystrophy.
7. Dislocated kneecap (patella):
Caused by direct trauma or forceful straightening of the
leg. If present, you will notice the patella being out of
place and may have difficulty flexing or extending your
What are some Important things to consider in the
patient history?
1. Family History:
Hereditary disorders include Duchennes Muscular
2. Recent viral infections: 
Can hint at West Nile Virus or Guillain Barre.
3. Recent exposure to toxins: 
Such as alcohol, lead. 
4. Other Medical Problems:
Diabetes and thyroid problems can result in neuropathies.
What are some symptoms that can accompany
muscle weakness?
1. Choking or difficulties swallowing
2. Shortness of breath
3. Slurred speech or difficulties talking
4. Poor exercise tolerance
5. Numbness and tingling
6. Spasticity


Joint pain
8. Fatigue
9. Difficulty climbing stairs, combing hair, or rising from
a chair
What are important factors to consider on
physical exam?
1. Inspection:
For muscle atrophy which is muscle wasting.
2. Muscle tenderness:
Could mean inflammation of the muscle also known
as myositis.
3. Muscle strength:
Which muscles are weak? Is the weakness symmetric
or asymmetric?
4. Reflexes:
If they are absent it can mean a problem with the
peripheral nerve or muscle while brisk reflexes can
mean there are brain and spinal cord problems.
What laboratory studies are important when
evaluating for Muscle weakness?
1. Elevation of plasma muscle enzymes:
(creatine kinase, aldolase, lactate dehydrogenase, and
the aminotransferases) are highly suggestive of muscle
2. Urinalysis:
A positive test for urine blood, in the absence of red
blood cells in the sediment, is suggestive of
3. Labs to evaluate for Inflammatory diseases:
Antinuclear antibodies, antibodies against extractable
nuclear antigens (anti-Ro/SSA, anti-La/SSB, anti-Sm,
and anti-RNP)
4. Labs to check for Myositis anti-histidyl-t-RNA synthase
5. Labs to check for vasculitis Anti-neutrophil cytoplasmic
antibody (ANCA) titers, hepatitis B and C serologies
6. Genetic Testing:
If there is a family history of muscle weakness
7. Electrolytes:
Metabolic abnormalities particularly calcium and
magnesium are associated with weakness
What tests can be used to evaluate for Muscle
1. X-rays of the spine
2. CT or MRI of the Brain and Spinal Cord
3. Bone Scan
4. EMG and Nerve Conduction Studies:
Can look for abnormalities of the peripheral nerve,
the neuromuscular junction that attaches the muscle
and nerve, and the muscle itself.
5. Muscle Biopsy:
A small sample of the muscle is taken and sent to a
pathologist to look for abnormalities.
Treatment of Muscle Weakness:
Treatment options will vary depending on the diagnosis,
medical comorbidities, and disease severity.
Physical Therapy
1. Moderate Resistance Strengthening Exercises:
Performed two to three times a week for eight to twelve
weeks can be helpful.
a. It is important not to over exercise particularly in
patients with certain nerve and muscle disorders
such as Muscular Dystrophy and Amyotrophic
Lateral Sclerosis.
b. Also, isometric exercises are less likely to cause
muscle injury while eccentric exercises should be
avoided (for examples of isometric and eccentric
exercises, please refer to the physical therapy link).
c. Patients that develop severe muscle cramping or
muscle heaviness should inform their doctor.
2. Submaximal, Low impact Aerobic Exercises:
Such as walking, swimming, and using the stationary
bicycle can help minimize fatigue and improve heart
3. Range-of-Motion and Stretching exercises:
Should be performed daily to keep the joints moving
properly and minimizes the likelihood of joint stiffness
which is also known as contracture. If a contracture
does develop, splinting can help to regain the joints
range of movement.
4. Gait training:
A term used by doctors and therapists when they want
you to practice walking and provide you with safe
walking practices. The therapist can help you work on
visual cues and balance techniques
5. Transfer training:
Strategies to safely move from your bed to your
wheelchair, etc.
6. Bracing:
Can help to support the weak extremity and allow you
to perform activities that would be difficult without its
use. One example is an ankle-foot-orthosis which can
be used for a person with foot drop to support a weak
ankle and allow them to walk.
7. Assistive Devices:
Are used to improve mobility in a person with .
weakness. Examples of assistive devices include
canes, walkers, and wheelchairs. A doctor and
qualified physical therapist are well trained to
determine which device is most appropriate for
your situation.
Occupational Therapy
1. Energy Conservation techniques
2. Adaptive Equipment Evaluation:
certain devices can be attached to your wheelchair
or arm and used to perform daily activities. For
example, a universal cuff is commonly prescribed
for patients with poor grasp to hold a spoon or fork.
Another example is a balanced forearm orthosis
which is sometimes used for upper arm weakness. It
is attached to the wheelchair to support the arm and
helps eliminate the effects of gravity.
"Nothing contained on this website should be interpreted to be medical advice. This website is for general information only.
Please consult a physician for medical advice regarding any medical condition."
  © 2008 Spence Rehabilitation Center. All rights reserved. Designed by :   KSN TECHNOLOGIES PVT. LTD.