Arm weakness Assessment Questionnaire

Why: to establish if acute or chronic.

Why: e.g. forearm, elbow, upper arm or shoulder.

Why: helps determine which joints, muscles and /or nerves may be affected e.g. peripheral muscle weakness due to peripheral neuropathy is symmetrical compared with individual nerve or nerve root disease which should be suspected if weakness is asymmetrical or confined to one limb.

Why: helps to determine which muscles and/or nerves are affected.

Why: helps to determine the cause of arm weakness e.g. muscle power decreases with use in myasthenia gravis.

Why: e.g. whiplash injury; Brachial plexus injury; fall onto outstretched hand - can determine possible cause of arm weakness.

Why: diabetes and chronic renal failure can be a cause of peripheral neuropathy ; diabetes , hypertension and high cholesterol are risk factors for cerebrovascular disease.

Why: Vitamin B12 deficiency can be a cause of peripheral neuropathy.

Why: some medications can cause peripheral neuropathy e.g. amiodarone, phenytoin, nitrofurantoin; some medications may increase risk of thrombotic cerebrovascular disease e.g. oral contraceptive pill , hormone replacement therapy; some medications can increase the risk of hemorrhagic stroke e.g. warfarin.

Why: is a major risk factor for cerebrovascular disease.

Why: can be a cause of peripheral neuropathy.

Why: Stokes, Diabetes, High Cholesterol, Hypertension, Hereditary motor and sensory neuropathy.

Why: certain occupations requiring repetitive motions are at risk of causing work-induced overuse disorders with consequent muscle wasting and weakness e.g. process and meat workers are at risk of carpal tunnel syndrome due to rapid finger and wrist movement.

Why: This can give some important clues as to the cause of the weakness. Weakness occurring on both sides of the body in roughly the same distribution is more likely to be as a result of a systemic condition. However weakness which is much more localized and asymmetrical is more likely to be as a result of a non-systemic or regional condition.

Why: If it began some time ago then it is more likely to be related to a condition exhibiting chronic deterioration, however if it began only recently then it may be as a result of an acute condition which may or may not need to be identified and treated urgently.

Why: Different conditions can result in different combinations of motor weakness in your arms, legs and trunk. If you have had difficulties walking then you may be suffering from such conditions as stroke/cerebrovascular accident, transient ischemic attack, Guillain Barre Syndrome or Acute Spinal Cord Compression.

Why: These are all conditions which may predispose you to suffer a stroke/cerebrovascular accident or transient ischemic attack. These can result in arm weakness along with other neurological symptoms such as abnormal sensation. These conditions all indicate disease of your blood vessels, and this blood vessel disease may extent to involve the blood vessels supplying your spinal cord (anterior spinal artery syndrome). If this is the case, then it may result in a particular pattern of arm weakness and other peripheral neurological symptoms.

Why: The combination of muscle weakness and abnormal sensation may indicate a neurological cause for your symptoms.

Why: Trauma can cause arm weakness in several ways. If you have experienced trauma to your head then you may have suffered an injury to your brain which has resulted in arm weakness. If this is the case then your arm weakness may have begun some time after the initial trauma. If you have suffered trauma to your neck or spine then this can also cause muscle weakness, and may actually result in the complete loss of ability to perform some movements. You may have suffered trauma to your arm directly, such as a laceration or bone fracture. These types of injuries can damage or cause dysfunction of the nerves which supply the muscles of your arm, and the particular pattern of movements which you cannot perform may give an indication of which nerve has been injured.

Why: These can all be signs of a brain tumor, and even though this is a very rare cause of arm weakness it needs to be ruled out because it can be medically disastrous if not diagnosed. Headaches and vomiting which tend to occur in the morning (or after waking up) have been particularly associated with brain tumors.

Why: Disturbances of visual acuity and of passing urine (micturition) can indicate multiple sclerosis which can be a cause of arm weakness as well.

Why: If you have additionally experienced any weakness or other symptoms in your face as well as arm weakness, then this may raise their suspicions of certain neurological conditions. Depending on the exact pattern of symptoms that you have experienced, they may assist your health professional to locate exactly where the cause for your symptoms is and this may in turn reveal what that cause is. You may experience changes in your voice as some conditions such as Pancoast Syndrome can affect the nerves which control your voice and those which control the muscles in your arm. One particular pattern of facial symptoms is Horner's Syndrome where one of your pupils may seem smaller than the other (meiosis), one eye may appear "sunken" (enophthalmos), one eyelid may "droop" (ptosis) and you may notice less sweating than usual on one forehead (anhydrosis).

Why: In combination with certain patterns of neurological symptoms, which may include arm weakness, a fever may cause your health professional to consider the possibility that you have an infection or abscess in your brain (cerebral abscess). Their suspicion may be increased if you have recently suffered any infections (such as those listed above) as they may appear to resolve clinically whilst they have actually spread to involve your brain tissue and result in the formation of an abscess.

Why: Sometimes arm weakness can be as a result of a deficiency of vitamin B12, which can cause subacute combined degeneration of the spinal cord.

Why: These two types of anemia can be the result of a deficiency of vitamin B12. This may also result in subacute combined degeneration of the spinal cord and resultant arm weakness.

Why: There are many conditions which can result in malabsorption syndromes, and these in turn can cause deficiencies of a wide variety of vitamins which we need in order for our bodies to function properly. One such deficiency is vitamin B12 deficiency which in some cases can result in anemia, or in others subacute combined degeneration of the spinal cord with arm weakness.

Why: This can result in arm weakness by impairing the function of the spinal cord and the motor nerves supplying the arm.

Why: Compression of your spinal cord acute spinal cord compression) can result in arm weakness as well as dysfunction of the muscular sphincters which control your bladder and bowel.

Why: In concert with arm or limb weakness, these can indicate a condition which requires urgent medical treatment. Examples of this are Guillain Barre Syndrome and Acute Spinal Cord Compression.

Why: Some of these conditions can result in the new onset of arm weakness, even though they were diagnosed some time ago.

Why: Cigarette smoking can cause lung cancer which may additionally cause dysfunction of the motor nerves supply your arm (Pancoast syndrome) and so cause arm weakness.

Why: This is a condition which causes the cells which control your motor functions (but not sensory) to degenerate. It can cause arm weakness and muscular wasting. Importantly, it can be an inheritable condition however this is only the case in roughly ten percent of cases.

Why: There are several conditions which can result in both arm weakness and wasting of your muscles, particularly those in your upper arm or upper leg (proximal myopathy).

Why: Whilst these may all sound rather unrelated, these can all cause dysfunction of one particular nerve in the arm. This dysfunction may be felt as arm weakness or an area of paraesthesia. You may not recall laying in a single position without moving for very long, as you would have been asleep at the time. The most common cause for you to do this is Saturday night syndrome where you may drink excessive alcohol, become intoxicated and sedated from the alcohol, then fall asleep without much movement whilst asleep.

Why: This is a syndrome which can cause weakness of some distal arm movements, as well as pain and paraesthesia.

Why: These can damage a nerve in your arm, and so result in weakness and some areas of altered sensation.

Why: These can result in damage to another nerve in your arm which may result in weakness of some movements and sensory deficits.

Why: Mononeuritis Multiplex is a condition where there is dysfunction of 2 or more peripheral nerves, including those that control some motor functions. It can cause arm weakness. A common cause of it is diabetes mellitus.

Why: Diabetes is a surprisingly common disease which can cause either widespread or focal dysfunction of both sensory and motor nerves. Such nerve dysfunction and arm weakness can be delayed or prevented in those suffering diabetes by early diagnosis and appropriate management. You may need testing for this condition may times in your life as it can begin at any time, and a "negative" test does not rule out the possibility that you may have it at some later time.

Why: Muscular dystrophies are inheritable conditions which result in abnormal muscle function and such things as arm or leg weakness. There are several different types which may be diagnosed at different stages of life. For example Duchenne's Muscular Dystrophy becomes obvious and is diagnosed during childhood, usually before the age of 10yrs. Becker's Muscular Dystrophy tends to become obvious later in life during between 20-40yrs, and tends to be milder than other types. Limb Girdle Dystrophy is usually diagnosed during adolescence, affects only certain joints (pelvic girdle, shoulder), and can be severe. Facioscapulohumeral dystrophy may be diagnosed anywhere from late childhood to early middle age, affects similar joints to limb girdle dystrophy with the additional of the face, and tends not to be severe.

Why: These are all potentially systemic disorders which can result in dysfunction of you muscles (acquired myopathy), particularly those in your upper leg or arm (Proximal Myopathy).

Why: This is an important distinction to make, as muscle weakness which gets worse with movement can indicate myasthenia gravis. Muscle weakness which you feel "goes away" (you feel stronger with more movement) can indicate Eaton Lambert syndrome. These are both conditions which are the result of an abnormal immune response to your muscles. Myasthenia gravis can be a primary disease, or secondary to thymic tumor/thymoma, systemic lupus erythematosus, rheumatoid arthritis or hyperthyroidism. Eaton Lambert Syndrome tends to occur as a secondary condition to cancer (paraneoplastic syndrome) or very rarely autoimmune disease, though autoimmune diseases are more likely to cause myasthenia gravis.

Why: There are many different medications which can cause your muscles to not work properly myopathy, and so result in arm weakness. Examples of this are lithium, quinine, chloroquine, labetolol, cholesterol-lowering medications (statins/HMG CoA Reductase Inhibitors), steroids, colchicine, vincristine, cyclosporin, zidovudine, and procainamide.

Why: There are many non-prescribed medications which people may take that can result in muscle dysfunction (myopathy) and arm weakness. Examples of this include cocaine, heroin/diamorphine, and alcohol. Alcohol is not an illicit drug, however it can still cause muscle dysfunction when consumed in large quantities over prolonged periods of time (alcoholism).

Why: These are both conditions which can cause inflammation of your muscles, and in the latter may also result in a typical skin rash (heliotrope rash).

Why: The presentation of this very typical rash along with muscle tenderness and arm weakness can indicate dermatomyositis.

Why: a painful joint or muscle disease may interfere with assessment of arm power.

Why: if there is also paresthesia in the involved extremity this usually suggests herniated cervical disc , spinal cord tumor or cervical spondylosis. Other conditions to consider are brachial plexus neuropathy, thoracic outlet syndrome, cervical rib, Pancoast's tumor, Raynaud's disease, sympathetic dystrophy or various entrapment syndromes such as carpal tunnel syndrome and ulnar nerve entrapment at the elbow.

Why: may indicate that the cause of arm weakness originates from disorders of the cervical spine.

Why: e.g. weakness of the muscles of the face would suggest a diagnosis of cerebrovascular disease, a mass in the brain or spinal cord.

Why: may suggest cerebrovascular disease or mass in brain.

Why: e.g. difficulty with speaking, difficulty with swallowing, visual field defects, cranial nerve palsies, weakness of the leg on the same side, spasticity of affected limbs.