Tuesday, November 5, 2024
Subscribe American Journal of Medicine Free Newsletter
CardiologyMyopathyAn Approach to Myopathy for the Primary Care Clinician

An Approach to Myopathy for the Primary Care Clinician

woman holding knee

Patients with muscle weakness are frequently encountered in the primary care clinic; however, the identification of an underlying disorder of muscle can pose a significant challenge. The aim of this review article is to provide a clinical and diagnostic framework to aid the primary care clinician in the detection and evaluation of suspected myopathies.

Introduction

Myopathies are a heterogeneous collection of disorders characterized by the abnormal structure or functioning of skeletal muscle. Such disorders are frequently encountered in primary care practices; however, the recognition and diagnosis of these conditions can be challenging. In this review, we will discuss the symptoms and signs that may alert practitioners to the possibility of underlying muscle disease, as well as the basic elements of an appropriate diagnostic workup, and when to refer to a specialist.

Symptoms

As with most neurologic disorders, the diagnosis of myopathy begins with taking a careful and thorough history. Patients often report symptoms of fatigue, exercise intolerance, generalized weakness, and muscle pain; however, these symptoms are relatively nonspecific and may reflect nonmyopathic conditions, including cardiopulmonary disorders, orthopedic conditions, rheumatologic diseases, medication use, deconditioning, and even depression. In contrast, symptoms that should raise suspicions of an underlying myopathy include discrete patterns of muscle weakness, fatigable weakness, muscle atrophy, myotonia, and recurrent myoglobinuria.1

The evaluation of a patient with suspected myopathy should include a discussion of the duration of symptoms and historyā€”including developmental and early childhood historyā€”as well as a family history of similar symptoms or diagnosed myopathy. Certain congenital, metabolic, and mitochondrial myopathies may present at birth or in early childhood, with such issues as failure to thrive, delayed motor milestones, and contractures, whereas other hereditary and acquired myopathies may not present until adolescence or adulthood. Inflammatory myopathies such as polymyositis and dermatomyositis may occur at any age, whereas inclusion body myositis often presents in late adulthood.

A discussion regarding the tempo of symptom onset and progression, as well as any provoking or exacerbating factors, may also provide diagnostic clues when evaluating patients with presumed muscle disease. For example, patients reporting the onset of symptoms after the initiation of a lipid-lowering therapy may be experiencing an acquired medication-induced myopathy, whereas those with symptoms after a carbohydrate-rich meal may have a periodic paralysis. For patients who describe a family history of disease, one should attempt to determine an inheritance pattern, because this can help guide future genetic testing and counseling.

To read this article in its entirety please visit ourĀ website.

-Rose M. Domingo-Horne, MD, Mohammad Kian Salajegheh, MD

This article originally appeared in theĀ March issueĀ ofĀ The American Journal of Medicine.

Latest Posts

lupus

Sarcoidosis with Lupus Pernio in an Afro-Caribbean Man

A 54-year-old man of Afro-Caribbean ancestry presented with a 2-month history of nonproductive cough, 10-day history of constant subjective fevers, and a 1-day history...
Flue Vaccine

Flu Vaccination to Prevent Cardiovascular Mortality (video)

0
"Influenza can cause a significant burden on patients with coronary artery disease," write Barbetta et al in The American Journal of Medicine. For this...
varicella zoster

Varicella Zoster Virus-Induced Complete Heart Block

0
Complete heart block is usually caused by chronic myocardial ischemia and fibrosis but can also be induced by bacterial and viral infections. The varicella...
Racial justice in healthcare

Teaching Anti-Racism in the Clinical Environment

0
"Teaching Anti-Racism in the Clinical Environment: The Five-Minute Moment for Racial Justice in Healthcare" was originally published in the April 2023 issue of The...
Invisible hand of the market

The ‘Invisible Hand’ Doesn’t Work for Prescription Drugs

0
Pharmaceutical innovation has been responsible for many ā€œmiracles of modern medicine.ā€ Reliance on the ā€œinvisible handā€ of Adam Smith to allocate resources in the...
Joseph S. Alpert, MD

New Coronary Heart Disease Risk Factors

0
"New Coronary Heart Disease Risk Factors" by AJM Editor-in Chief Joseph S. Alpert, MD was originally published in the April 2023 issue of The...
Cardiovascular risk from noncardiac activities

Cardiac Risk Related to Noncardiac & Nonsurgical Activities

0
"Assessment of Cardiovascular Risk for Noncardiac and Nonsurgical Activities" was originally published in the April 2023 issue of The American Journal of Medicine. Cardiovascular risk...