Differential diagnosis of peripheral nerve and muscle disease
- Author
- Seward B Rutkove, MD
Seward B Rutkove, MD
- Professor of Neurology
- Harvard Medical School
- Section Editor
- Jeremy M Shefner, MD, PhD
Jeremy M Shefner, MD, PhD
- Section Editor — Neuromuscular Disease
- Professor and Chair of Neurology, Barrow Neurological Institute
- Professor of Neurology, University of Arizona, Phoenix
- Clinical Professor of Neurology, Creighton University
- Deputy Editor
- John F Dashe, MD, PhD
John F Dashe, MD, PhD
- Deputy Editor — Neurology
INTRODUCTION
In some cases, the diagnosis of peripheral nerve and muscle disease can be made from the clinical setting. As examples:
●The diagnosis of diabetic polyneuropathy in a patient with long-standing diabetes mellitus who presents with classic "stocking-glove" sensory loss is relatively straightforward. (See "Clinical manifestations and diagnosis of diabetic polyneuropathy".)
●A reasonable clinical hypothesis can be formed regarding the etiology of proximal weakness in patients taking drugs that can interfere with muscle function (eg, antimalarial, glucocorticoid, or cholesterol lowering medications). (See "Glucocorticoid-induced myopathy" and "Drug-induced myopathies".)
However, patients with disorders of nerves, muscle, or the neuromuscular junction can present with a similar constellation of symptoms. In addition, even when the process is localized to the nerve, it is not always clear if the origin of the problem is in the central or peripheral nervous system.
This topic will review the findings on history and physical examination that are characteristic of diseases of the nerve, muscle, and neuromuscular junction, and then present an approach to distinguishing central from peripheral neurologic disease. Specific neurologic syndromes are discussed in more detail separately.
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To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:Literature review current through: Jun 2017. | This topic last updated: Dec 04, 2016.The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.References- Jabre JF, Dillard JW, Salzsieder BT, et al. The use of multiple Tinel's sign in the identification of patients with peripheral neuropathy. Electromyogr Clin Neurophysiol 1995; 35:131.
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Top- INTRODUCTION
- CLINICAL DISTINCTION BETWEEN NERVE, MUSCLE AND NEUROMUSCULAR JUNCTION DISEASE
- History
- Neurologic examination
- - Motor
- - Sensory
- - Reflexes
- - Additional signs
- Skin examination
- Points of confusion
- DISTINGUISHING PERIPHERAL FROM CENTRAL NERVOUS SYSTEM DISEASE
- History
- - Pain
- - Time course
- - Other central nervous system disease
- Neurologic examination
- - Reflexes
- - Motor examination
- - Sensory examination
- - Coordination
- - Gait
- - Cranial nerves
- Other important distinctions
- DIAGNOSTIC TESTING
- Electrodiagnostic testing
- - Limitations
- Blood tests
- Genetic testing
- Muscle biopsy
- Nerve biopsy
- Skin biopsy
- SUMMARY
- REFERENCES