The diagnosis of suspected muscle weakness in infants up to the age of five years is difficult unless one uses a systematic approach. The steps in the examination are (1) palpation of the muscles, (2) examination for muscle tightness, and (3) demonstration of muscle function. Palpation not only reveals tenderness but also distinguishes among conditions that affect the consistency of the muscle mass. Tightness may be seen in either the affected muscles or their antagonists during passive movements. To observe the function of individual muscles calls for much special maneuvering and close observation. Even after the child supposes the examination to be over, the movements of its arms during the act of dressing afford indications as to the status of the deltoid and other muscles of the upper extremity. Electrodiagnostic methods can prove helpful. These methods of differential diagnosis are essential to proper treatment, since they may decide, as in the case history here cited, between such conditions as poliomyelitis and polymyositis.
Johnson EW. EXAMINATION FOR MUSCLE WEAKNESS IN INFANTS AND SMALL CHILDREN. JAMA. 1958;168(10):1306–1313. doi:10.1001/jama.1958.03000100008003
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