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Manual Muscle Testing: A Method of Measuring Extremity Muscle Strength Applied to Critically Ill Patients

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Clinical Reasoning: A 67-Year-Old Man With Exercise Intolerance and Progressive Weakness.

Alexi Gosset¹, Sandra Perez², Abhinav Thakral³

¹Department of Neurology, University of California, San Francisco.

|March 24, 2026

Summary

This case study details a patient with HIV and diabetes experiencing new muscle weakness. It highlights diagnostic challenges in adult-onset myopathy when test results are unclear.

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Determining the Functional Status of the Corticospinal Tract Within One Week of Stroke

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Published on: February 22, 2020

Area of Science:

Neurology
Clinical Medicine
Biochemistry

Background:

Presents a complex case of a 67-year-old male with long-standing Human Immunodeficiency Virus (HIV) on antiretroviral therapy.
Co-morbidities include type 2 diabetes with polyneuropathy and hyperlipidemia, managed with statin and fibrate therapy.

Purpose of the Study:

To review the diagnostic approach to adult-onset myopathy.
To explore challenges in diagnosing myopathy when clinical presentation and diagnostic tests appear discordant.
To emphasize a structured, stepwise methodology for localization, differential diagnosis, and targeted testing.

Main Methods:

Case presentation of a patient with new-onset hamstring weakness and exercise intolerance.
Review of diagnostic strategies for adult-onset myopathy.
Discussion of discordant findings between clinical examination and laboratory tests (elevated creatine kinase).

Main Results:

The patient exhibited new hamstring weakness alongside chronic distal weakness and sensory loss.
Elevated creatine kinase levels persisted even after statin and fibrate therapy discontinuation, suggesting non-statin/fibrate related myopathy.
The case underscores the complexity of myopathy diagnosis in patients with multiple comorbidities.

Conclusions:

Adult-onset myopathy requires a systematic diagnostic approach, especially when initial tests are inconclusive.
Challenges in myopathy diagnosis can arise from polypharmacy and co-existing conditions like HIV and diabetes.
A stepwise strategy involving localization, differential diagnosis, and targeted testing is crucial for accurate diagnosis and management.