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American Family Physician Jan 2020Although the prevalence of muscle weakness in the general population is uncertain, it occurs in about 5% of U.S. adults 60 years and older. Determining the cause of... (Review)
Review
Although the prevalence of muscle weakness in the general population is uncertain, it occurs in about 5% of U.S. adults 60 years and older. Determining the cause of muscle weakness can be challenging. True muscle weakness must first be differentiated from subjective fatigue or pain-related motor impairment with normal motor strength. Muscle weakness should then be graded objectively using a formal tool such as the Medical Research Council Manual Muscle Testing scale. The differential diagnosis of true muscle weakness is extensive, including neurologic, rheumatologic, endocrine, genetic, medication- or toxin-related, and infectious etiologies. A stepwise approach to narrowing this differential diagnosis relies on the history and physical examination combined with knowledge of the potential etiologies. Frailty and sarcopenia are clinical syndromes occurring in older people that can present with generalized weakness. Asymmetric weakness is more common in neurologic conditions, whereas pain is more common in neuropathies or radiculopathies. Identifying abnormal findings, such as Chvostek sign, Babinski reflex, hoarse voice, and muscle atrophy, will narrow the possible diagnoses. Laboratory testing, including electrolyte, thyroid-stimulating hormone, and creatine kinase measurements, may also be helpful. Magnetic resonance imaging is indicated if there is concern for acute neurologic conditions, such as stroke or cauda equina syndrome, and may also guide muscle biopsy. Electromyography is indicated when certain diagnoses are being considered, such as amyotrophic lateral sclerosis, myasthenia gravis, neuropathy, and radiculopathy, and may also guide biopsy. If the etiology remains unclear, specialist consultation or muscle biopsy may be necessary to reach a diagnosis.
Topics: Adult; Aged; Aged, 80 and over; Diagnosis, Differential; Humans; Muscle Weakness; Muscles; Muscular Diseases; Neurologic Examination; Neurology
PubMed: 31939642
DOI: No ID Found -
Postgraduate Medical Journal Nov 1995The plantar response is a reflex that involves not only the toes, but all muscles that shorten the leg. In the newborn the synergy is brisk, involving all flexor muscles...
The plantar response is a reflex that involves not only the toes, but all muscles that shorten the leg. In the newborn the synergy is brisk, involving all flexor muscles of the leg; these include the toe 'extensors', which also shorten the leg on contraction and therefore are flexors in a physiological sense. As the nervous system matures and the pyramidal tract gains more control over spinal motoneurones the flexion synergy becomes less brisk, and the toe 'extensors' are no longer part of it. The toes then often go down instead of up, as a result of a segmental reflex involving the small foot muscles and the overlying skin, comparable to the abdominal reflexes. With lesions of the pyramidal system, structural or functional, this segmental, downward response of the toes disappears, the flexion synergy may become disinhibited and the extensor hallucis longus muscle is again recruited into the flexion reflex of the leg: the sign of Babinski. A true Babinski sign denotes dysfunction of the pyramidal tract, and should be clearly distinguished from upgoing toes that do not belong to the flexion synergy of the leg. Correct interpretation of the plantar response depends only to a minor degree on the method or site of stimulation of the foot. It is therefore most important to assess the response in the entire leg.
Topics: Humans; Muscle Contraction; Physical Stimulation; Pyramidal Tracts; Reflex, Babinski; Spinal Cord Diseases
PubMed: 7494766
DOI: 10.1136/pgmj.71.841.645 -
Journal of the Neurological Sciences Aug 2014
Topics: Humans; Pyramidal Tracts; Reflex, Babinski
PubMed: 24906710
DOI: 10.1016/j.jns.2014.05.026 -
Fortschritte Der Neurologie-Psychiatrie Dec 2003
Topics: History, 20th Century; Humans; Reflex, Babinski
PubMed: 14661156
DOI: 10.1055/s-2003-45347 -
European Journal of Neurology Sep 2008The Babinski Reflex, first described in 1896, is still an integral part of the neurological examination. Many have studied the consistency of this reflex, but none have... (Comparative Study)
Comparative Study
BACKGROUND AND PURPOSE
The Babinski Reflex, first described in 1896, is still an integral part of the neurological examination. Many have studied the consistency of this reflex, but none have compared the inter- and intra-observer consistency of the Babinski reflex and its variants.
METHODS
Thirty-four subjects were examined by six neurologists. The Babinski, Gordon, Chaddock, and Oppenheim reflexes were tested, and each neurologist concluded if the plantar response was flexor or extensor. Six subjects were re-tested 1 week later to determine intra-observer consistency.
RESULTS
The Babinski reflex had the highest interobserver consistency with a kappa value of 0.5491. The Chaddock, Oppenheim, and Gordon reflexes had kappa values of 0.4065, 0.3739, and 0.3515, respectively. For intra-observer consistency, Gordon was the most consistent with a kappa value of 0.6731. When reflexes were combined in pairs, the Babinski and Chaddock reflexes together were the most reliable.
CONCLUSIONS
The Babinski reflex was shown to be the most consistent between examiners. The Gordon reflex had the highest intra-observer consistency; however, the small sample size should limit conclusions drawn from this calculation. Clinicians often utilize more than one reflex to examine the plantar response; the combination of the Babinski and Chaddock reflexes was the most reliable.
Topics: Humans; Nervous System Diseases; Neurologic Examination; Observer Variation; Reflex, Abnormal; Reflex, Babinski; Reproducibility of Results; Single-Blind Method; Stroke
PubMed: 18637037
DOI: 10.1111/j.1468-1331.2008.02219.x -
Neurology Aug 1999
Topics: Humans; Neurology; Reflex, Babinski
PubMed: 10449145
DOI: 10.1212/wnl.53.3.655