Bilateral proximal limb weakness without sensory loss is most suggestive of which condition?

Bilateral proximal limb weakness without sensory loss is most suggestive of which condition?

• A. Alcohol myopathy
• B. Myositis
• C. Neuromuscular junction disorders
• D. Polyneuropathy

Answer: (A)

Proximal symmetric weakness with preserved sensation points to a disease of the muscle itself (a myopathy) rather than nerve or the neuromuscular junction. In myopathies, weakness tends to be greatest in proximal muscles (hips and shoulders), and sensation remains normal because the nerves and sensory pathways are not affected. Alcoholic myopathy is a classic acquired myopathy from chronic alcohol use. It typically presents with bilateral proximal weakness and possible muscle wasting, often without sensory changes. Reflexes are usually preserved, and sensory exam is normal. CK levels can be normal or mildly elevated, and improvement is expected with abstinence and rehabilitation. In contrast, neuromuscular junction disorders often show fatigable weakness that worsens with use and may involve ocular or bulbar muscles, though sensation is still intact. Polyneuropathy usually features sensory loss and a distal-to-proximal pattern of weakness. Inflammatory myositis can also cause proximal weakness but usually presents with muscle pain and marked CK elevation, along with systemic signs.

Proximal symmetric weakness with preserved sensation points to a disease of the muscle itself (a myopathy) rather than nerve or the neuromuscular junction. In myopathies, weakness tends to be greatest in proximal muscles (hips and shoulders), and sensation remains normal because the nerves and sensory pathways are not affected.

Alcoholic myopathy is a classic acquired myopathy from chronic alcohol use. It typically presents with bilateral proximal weakness and possible muscle wasting, often without sensory changes. Reflexes are usually preserved, and sensory exam is normal. CK levels can be normal or mildly elevated, and improvement is expected with abstinence and rehabilitation.

In contrast, neuromuscular junction disorders often show fatigable weakness that worsens with use and may involve ocular or bulbar muscles, though sensation is still intact. Polyneuropathy usually features sensory loss and a distal-to-proximal pattern of weakness. Inflammatory myositis can also cause proximal weakness but usually presents with muscle pain and marked CK elevation, along with systemic signs.