A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; further:
- Inspection (viewing).
- Skin, mucous membranes, extremities [due topossible cause of muscle twitching (fasciculations)]
- Inspection (viewing).
- Neurological examination – including strength testing, triggering reflexes, etc. [due todifferential diagnoses:
- Amyotrophic lateral sclerosis (ALS) – progressive, irreversible degeneration of the motor nervous system; in this case, fasciculations as a symptom of the demise of α-motoneurons (fasciculations of the muscles and defibrillation in the tongue).
- Creutzfeldt-Jakob disease – disease of the central nervous system leading to progressive (progressive) dementia.
- Encephalitis (inflammation of the brain)
- Myasthenia gravis – rare disorder of neuromuscular transmission of stimuli, which manifests itself in severe load-dependent muscle weakness and rapid onset of fatigability; fasciculations are expressed here in the cholinergic crisis.
- Neuropathy (collective term for many diseases of the peripheral nervous system), new onset: e.g., fasciculations in association with statin-induced neuropathy
- Polyneuropathy, unspecified – generic term for diseases of the peripheral nervous system associated with chronic disorders of peripheral nerves or parts of nerves.
- Post-polio syndrome – muscle weakness or atypical muscle fatigue in damaged muscles; onset no earlier than 15 years after paralytic poliomyelitis (polio).
- Spinal muscular atrophy (SMA) – muscle atrophy caused by progressive loss of motor neurons in the anterior horn of the spinal cord; usually results in thoracic scoliosisNote: Fasciculations are less common in childhood than in adults with anterior horn disease].
- Orthopedic examination [due todifferential diagnoses:
- Cervical spine syndrome (synonym: cervical syndrome) – unpleasant pain and sometimes dysfunction in the neck and neck area.
- Orthopedic diseases with nerve irritation]
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.