A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body temperature, body weight, body height; further:
- Inspection (viewing) of the skin and mucous membranes.
- Auscultation (listening) of the heart
- Auscultation of the lungs
- Palpation (palpation) of the abdomen (abdomen), etc.
- Neurological examination [due todifferential diagnoses:
- Amyloid myopathy – muscle disease characterized by the deposition of various substances.
- Amyotrophic lateral sclerosis (ALS; synonyms: Myatrophic Lateral Sclerosis or Motor Neuron Disease and Lou Gehrig’s Syndrome) – degenerative disease of the motor nervous system; progressive and irreversible damage or degeneration of nerve cells (neurons) occurs. The degeneration leads to increasing muscle weakness (paralysis, paresis), which is accompanied by muscle wasting (amyotrophy).
- Epilepsy equivalent
- Guillain-Barré syndrome (GBS; synonyms: Idiopathic polyradiculoneuritis, Landry-Guillain-Barré-Strohl syndrome); two courses: acute inflammatory demyelinating polyneuropathy or chronic inflammatory demyelinating polyneuropathy (peripheral nervous system disease); idiopathic polyneuritis (multiple nerve disease) of spinal nerve roots and peripheral nerves with ascending paralysis and pain; usually occurs after infections
- Isaacs-Mertens syndrome (neuromyotonia) – sudden onset disease that leads to severe permanent tension of the muscles.
- Compression of the spinal cord / spinal nerves.
- Meningitis (meningitis)
- Parkinson’s disease1 (shaking palsy)
- Motor neuron diseases1, 2
- Multiple sclerosis1 (MS)
- Nerve root irritation syndrome1
- Neuralgia – pain may occur in the area of spread of a sensitive nerve without a demonstrable cause.
- Neuropathies1 (diseases of the peripheral nervous system).
- Poliomyelitis (polio)
- Radiculitis (inflammation of the nerve root)
- Somatoform disorders such as chronic lower abdominal pain syndrome or in high stress situations.
- Spinal muscular atrophy (SMA) – neurological disorder caused by nerve damage.
- Stiff person syndrome1 – disease that leads to progressive stiffening of the trunk and limbs.
- Tabes dorsalis (neurolues) – late stage of syphilis in which demyelination of the spinal cord occurs]
- Orthopedic/rheumatologic examination [due todifferential diagnoses:
- Becker muscular dystrophy – genetic muscle wasting.
- Dermatomyositis – chronic systemic disease belonging to the collagenoses; an idiopathic myopathy (= muscle disease) or myositis (= muscle inflammation) with skin involvement, which often occurs paraneoplastic; myalgias in about 50% of cases.
- Duchenne muscular dystrophy – genetically caused muscle atrophy.
- Inclusion body myositis – neuromuscular disease.
- Fibromyalgia (fibromyalgia syndrome) – syndrome that can result in chronic pain (at least 3 months) in multiple areas of the body
- Interstitial myositis
- Lupus erythematosus, systemic (SLE) – severe multi-organ disease; autoimmune disease in which there is formation of autoantibodies; it is one of the collagenoses.
- Muscle contusion
- Muscle contusion
- Muscle contusion
- Muscle tear
- Muscle strain
- Myofascial pain syndrome
- Myopathies (muscle diseases) with enzyme defects.
- Myositis (muscle inflammation), caused by viruses such as Cocsackie virus or bacteria such as Staphylococcus or Borrelia.
- Forms of myotonia such as myotonia congenita or paramyotonia congenita.
- Forms of myotonic dystrophy such as myotonic dystrophy type 1 (Curschmann-Steinert) or proximal myotonic myopathy.
- Panarteriits nodosa – collagenosis leading to thickening of the vascular walls and thus to deficiency of blood flow.
- Polymyalgia rheumatica (disease of the rheumatic type) – bilateral muscle pain and / or bilateral stiffness (> 1 hour).
- Polymyositis – immunologically caused disease, which belongs to the collagenoses; myalgias in about 50% of cases.
- Rheumatoid arthritis – chronic inflammatory multisystem disease that usually manifests as synovitis (inflammation of the synovial membrane). It is also called primary chronic polyarthritis (PcP).
- Vasculitides (vascular inflammation).
- Other degenerative myopathies (muscular dystrophies)]
- Psychiatric examination [due todifferential diagnosis: somatoform disorders such as chronic lower abdominal pain syndrome or in severe stress situations].
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings. 1Muscle cramps (Krampie) 2Fasciculations.
