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{{About|the medical condition}}
{{Infobox medical condition (new)
| name = Weakness
| image =
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| field = [[Neurology]]
| pronounce =
| synonyms = Asthenia
| symptoms =
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'''Weakness''' is a [[symptom]] of many different medical conditions.<ref name=Rosen10>{{cite book |title=Rosen's Emergency Medicine: Concepts and Clinical Practice |edition=7th |last=Marx |first=John |year=2010 |publisher=Mosby/Elsevier |location=Philadelphia, PA |isbn=978-0-323-05472-0 |page=Chapter 11 }}</ref> The causes are many and can be divided into conditions that have true or perceived muscle weakness. True muscle weakness is a primary symptom of a variety of skeletal muscle diseases, including [[muscular dystrophy]] and [[inflammatory myopathy]]. It occurs in [[neuromuscular junction]] disorders, such as [[myasthenia gravis]].{{citation needed|date=June 2022}}
==Pathophysiology==
{{See also|Muscle contraction}}
Muscle cells work by detecting a [[Action potential|flow]] of electrical impulses from the [[brain]], which signals them to [[Muscle contraction|contract]] through the release of [[calcium]] by the [[sarcoplasmic reticulum]]. Fatigue (reduced ability to generate force) may occur due to the nerve, or within the muscle cells themselves. New research from scientists at Columbia University suggests that muscle fatigue is caused by calcium leaking out of the muscle cell. This makes less calcium available for the muscle cell. In addition, the Columbia researchers propose that an enzyme activated by this released calcium eats away at muscle fibers.<ref>{{cite news| url=https://www.nytimes.com/2008/02/12/health/research/12musc.html | work=The New York Times | title=Finding May Solve Riddle of Fatigue in Muscles | first=Gina | last=Kolata | date=February 12, 2008}}</ref>
[[Substrate (biochemistry)|Substrates]] within the muscle generally serve to power muscular contractions. They include molecules such as [[adenosine triphosphate]] (ATP), [[glycogen]] and [[Phosphocreatine|creatine phosphate]]. ATP binds to the [[myosin]] head and causes the 'ratchetting' that results in contraction according to the [[Sliding filament mechanism|sliding filament model]]. Creatine phosphate stores energy so ATP can be rapidly regenerated within the muscle cells from [[adenosine diphosphate]] (ADP) and inorganic phosphate ions, allowing for sustained powerful contractions that last between 5–7 seconds. Glycogen is the intramuscular storage form of [[glucose]], used to generate energy quickly once intramuscular creatine stores are exhausted, producing [[lactic acid]] as a metabolic byproduct. Contrary to common belief, lactic acid accumulation doesn't actually cause the burning sensation felt when people exhaust their oxygen and oxidative metabolism, but in actuality, lactic acid in presence of oxygen recycles to produce [[pyruvate]] in the liver, which is known as the [[Cori cycle]].{{citation needed|date=August 2021}}
Substrates produce metabolic fatigue by being depleted during exercise, resulting in a lack of intracellular energy sources to fuel contractions. In essence, the muscle stops contracting because it lacks the energy to do so.{{citation needed|date=August 2021}}
==Differential diagnosis==
===True vs. perceived weakness===
* True weakness (or neuromuscular) describes a condition where the force exerted by the muscles is less than would be expected, for example [[muscular dystrophy]].
* Perceived weakness (or non-neuromuscular) describes a condition where a person feels more effort than normal is required to exert a given amount of force but actual muscle strength is normal, for example.<ref>{{cite book | title=Adams and Victor's Principles of Neurology, Ninth Edition | publisher=McGraw-Hill |author1=Ropper, Allan H. |author2=Samuels, Martin A. | author-link=Chapter 24. Fatigue, Asthenia, Anxiety, and Depressive Reactions | year=2009 | isbn=978-0071499927}}</ref>
In some conditions, such as [[myasthenia gravis]], muscle strength is normal when resting, but ''true weakness'' occurs after the muscle has been subjected to exercise. This is also true for some cases of [[chronic fatigue syndrome]], where objective post-exertion muscle weakness with delayed recovery time has been measured and is a feature of some of the published definitions.<ref>{{cite journal |doi=10.1046/j.1468-1331.1999.610063.x |vauthors=Paul L, Wood L, Behan WM, Maclaren WM |title=Demonstration of delayed recovery from fatiguing exercise in chronic fatigue syndrome |journal=Eur. J. Neurol. |volume=6 |issue=1 |pages=63–9 |date=January 1999 |pmid=10209352 |s2cid=33480143 }}</ref><ref>{{cite journal |doi=10.1042/CS19980372 |vauthors=McCully KK, Natelson BH |title=Impaired oxygen delivery to muscle in chronic fatigue syndrome |journal=Clin. Sci. |volume=97 |issue=5 |pages=603–8; discussion 611–3 |date=November 1999 |pmid=10545311 }}</ref><ref>{{cite journal |doi=10.1001/archinte.160.21.3270 |vauthors=De Becker P, Roeykens J, Reynders M, McGregor N, De Meirleir K |title=Exercise capacity in chronic fatigue syndrome |journal=Arch. Intern. Med. |volume=160 |issue=21 |pages=3270–7 |date=November 2000 |pmid=11088089 |url=http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=11088089 |doi-access= |access-date=2011-03-12 |archive-date=2011-08-12 |archive-url=https://web.archive.org/web/20110812232955/http://archinte.ama-assn.org/cgi/content/full/160/21/3270 |url-status=dead }}</ref><ref>{{cite journal |doi=10.1046/j.1365-2796.2001.00890.x |vauthors=De Becker P, McGregor N, De Meirleir K |title=A definition-based analysis of symptoms in a large cohort of patients with chronic fatigue syndrome |journal=J. Intern. Med. |volume=250 |issue=3 |pages=234–40 |date=September 2001 |pmid=11555128 |doi-access=free }}</ref><ref>{{cite book |first1=Bruce M. |last1=Carruthers |first2=Anil Kumar |last2=Jain |first3=Kenny L. |last3=De Meirleir |first4=Daniel L. |last4=Peterson |first5=Nancy G. |last5=Klimas |first6=A. Martin |last6=Lerner |first7=Alison C. |last7= Bested |first8=Pierre |last8=Flor-Henry |first9=Pradip |last9=Joshi |first10=A. C. Peter |last10=Powles |first11=Jeffrey A. |last11=Sherkey |first12=Marjorie I. |last12=van de Sande |display-authors=5 |title=Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols |journal=Journal of Chronic Fatigue Syndrome |volume=11 |issue=1 |pages=7–115 |year=2003 |isbn=978-0-7890-2207-3 |issn=1057-3321 |doi=10.1300/J092v11n01_02}}</ref><ref>{{cite journal |vauthors=Jammes Y, Steinberg JG, Mambrini O, Brégeon F, Delliaux S |title=Chronic fatigue syndrome: assessment of increased oxidative stress and altered muscle excitability in response to incremental exercise |journal=J. Intern. Med. |volume=257 |issue=3 |pages=299–310 |date=March 2005 |pmid=15715687 |doi=10.1111/j.1365-2796.2005.01452.x |doi-access=free }}</ref>
==={{anchor|Asthenia}}Asthenia vs. myasthenia===
'''Asthenia''' or '''asthaenia''' ({{lang-el|ἀσθένεια}}, literally ''lack of strength'' but also ''disease'') is a medical term referring to a condition in which the body lacks or has lost strength either as a whole or in any of its parts. It is a poorly defined condition that can include true or primary [[muscle weakness]] or perceived muscle weakness.<ref>{{Citation |last1=Kauffman |first1=Timothy L. |title=Chapter 16 - Muscle weakness and therapeutic exercise |date=2014-01-01 |url=https://www.sciencedirect.com/science/article/pii/B9780702045882000164 |work=A Comprehensive Guide to Geriatric Rehabilitation (Third Edition) |pages=112–119 |editor-last=Kauffman |editor-first=Timothy L. |access-date=2023-11-19 |place=Oxford |publisher=Churchill Livingstone |isbn=978-0-7020-4588-2 |last2=Kemmis |first2=Karen |editor2-last=Scott |editor2-first=Ron |editor3-last=Barr |editor3-first=John O. |editor4-last=Moran |editor4-first=Michael L.}}</ref> For perceived muscle weakness, asthenia has been described as the feeling of weak or tired muscles in the absence of muscle weakness, that is the muscle can generate a normal amount of force but it is perceived as requiring more effort.<ref name=":0">{{Cite journal |last=Saguil |first=Aaron |date=2005-04-01 |title=Evaluation of the Patient with Muscle Weakness |url=https://www.aafp.org/pubs/afp/issues/2005/0401/p1327.html |journal=American Family Physician |language=en-US |volume=71 |issue=7 |pages=1327–1336 |pmid=15832536 |quote=Asthenia is a sense of weariness or exhaustion in the absence of muscle weakness.}}</ref><ref>{{Cite web |date=2021-06-28 |title=Muscle Weakness and Fatigue {{!}} Causes and Treatment |url=https://patient.info/signs-symptoms/tiredness-fatigue/muscle-weakness |access-date=2023-11-19 |website=patient.info |language=en |quote=Muscle tiredness: This is sometimes called asthenia. It is a sense of weariness or exhaustion that you feel when using the muscle. The muscle isn't genuinely weaker, it can still do its job but it takes you more effort to manage it.}}</ref>
General asthenia occurs in many chronic wasting diseases (such as tuberculosis and cancer), sleep disorders or chronic disorders of the heart, lungs or kidneys, and is probably most marked in diseases of the adrenal gland. Asthenia may be limited to certain [[organ (anatomy)|organs]] or systems of organs, as in [[asthenopia]], characterized by ready fatiguability. Asthenia is also a side effect of some medications and treatments, such as [[Ritonavir]] (a [[Protease inhibitor (pharmacology)|protease inhibitor]] used in [[HIV]] treatment). <ref>{{Cite web |date=28 November 2022 |title=PubChem Compound Summary for CID 392622, Ritonavir |url=https://pubchem.ncbi.nlm.nih.gov/compound/ritonavir |access-date=28 November 2022 |website=NCBI}}</ref>
Differentiating psychogenic (perceived) asthenia and true asthenia from myasthenia is often difficult, and in time apparent psychogenic asthenia accompanying many chronic disorders is seen to progress into a primary weakness.{{citation needed|date=August 2021}}
Myasthenia or myasthaenia (my- from {{lang-el|μυο}} meaning "muscle" + -asthenia [''{{lang|el|ἀσθένεια}}''] meaning "weakness"), or simply muscle weakness, is a lack of muscle strength. The causes are many and can be divided into conditions that have either true or perceived muscle weakness. True muscle weakness is a primary symptom of a variety of skeletal muscle diseases, including muscular dystrophy and inflammatory myopathy. It occurs in [[neuromuscular disease]]s, such as myasthenia gravis. Perceived muscle weakness occurs in diseases such as sleep disorders, and depression.<ref name=":0" />
===Types===
Muscle fatigue can be central, neuromuscular, or peripheral muscular. Central muscle fatigue manifests as an overall sense of energy deprivation, and peripheral muscle weakness manifests as a local, muscle-specific inability to do work.<ref>{{cite book |vauthors=Gandevia SC, Enoka RM, McComas AJ, Stuart DG, Thomas CK |title=Fatigue |chapter=Neurobiology of Muscle Fatigue |volume=384 |pages=515–25 |year=1995 |pmid=8585476 | doi = 10.1007/978-1-4899-1016-5_39|series=Advances in Experimental Medicine and Biology |isbn=978-1-4899-1018-9 }}</ref><ref>{{cite journal |author=Kent-Braun JA |title=Central and peripheral contributions to muscle fatigue in humans during sustained maximal effort |journal=European Journal of Applied Physiology and Occupational Physiology |volume=80 |issue=1 |pages=57–63 |year=1999 |pmid=10367724 |doi=10.1007/s004210050558|s2cid=22515865 }}</ref> Neuromuscular fatigue can be either central or peripheral.{{citation needed|date=August 2021}}
====Central fatigue====
The central fatigue is generally described in terms of a reduction in the [[nervous system|neural]] drive or nerve-based motor command to working muscles that results in a decline in the force output.<ref>{{cite journal |author=Gandevia SC |title=Spinal and supraspinal factors in human muscle fatigue |journal=Physiol. Rev. |volume=81 |issue=4 |pages=1725–89 |year=2001 |pmid=11581501 |doi=10.1152/physrev.2001.81.4.1725 }}</ref><ref>{{cite journal |vauthors=Kay D, Marino FE, Cannon J, St Clair Gibson A, Lambert MI, Noakes TD |title=Evidence for neuromuscular fatigue during high-intensity cycling in warm, humid conditions |journal=Eur. J. Appl. Physiol. |volume=84 |issue=1–2 |pages=115–21 |year=2001 |pmid=11394239 |doi=10.1007/s004210000340|s2cid=25906759 }}</ref><ref>{{cite journal |doi=10.3109/13813459109145909 |vauthors=Vandewalle H, Maton B, Le Bozec S, Guerenbourg G |title=An electromyographic study of an all-out exercise on a cycle ergometer |journal=Archives Internationales de Physiologie, de Biochimie et de Biophysique |volume=99 |issue=1 |pages=89–93 |year=1991 |pmid=1713492 }}</ref> It has been suggested that the reduced neural drive during exercise may be a protective mechanism to prevent organ failure if the work was continued at the same intensity.<ref>{{cite journal |vauthors=Bigland-Ritchie B, Woods JJ |title=Changes in muscle contractile properties and neural control during human muscular fatigue |journal=Muscle Nerve |volume=7 |issue=9 |pages=691–9 |year=1984 |pmid=6100456 |doi=10.1002/mus.880070902|s2cid=13606531 }}</ref><ref>{{cite journal |author=Noakes TD |title=Physiological models to understand exercise fatigue and the adaptations that predict or enhance athletic performance |journal=Scandinavian Journal of Medicine & Science in Sports |volume=10 |issue=3 |pages=123–45 |year=2000 |pmid=10843507 |doi=10.1034/j.1600-0838.2000.010003123.x|s2cid=23103331 }}</ref> The exact mechanisms of central fatigue are unknown, though there has been considerable interest in the role of [[serotonin|serotonergic]] pathways.<ref>{{cite journal |author=Davis JM |title=Carbohydrates, branched-chain amino acids, and endurance: the central fatigue hypothesis |journal=International Journal of Sport Nutrition |volume=5 |issue=Suppl |pages=S29–38 |year=1995 |pmid=7550256 |doi=10.1123/ijsn.5.s1.s29 }}</ref><ref>Newsholme, E. A., Acworth, I. N., & Blomstrand, E. 1987, 'Amino acids, brain neurotransmitters and a functional link between muscle and brain that is important in sustained exercise', in G Benzi (ed.), Advances in Myochemistry, Libbey Eurotext, London, pp. 127-133.</ref><ref>{{cite book |vauthors=Newsholme EA, Blomstrand E |chapter=Tryptophan, 5-Hydroxytryptamine and a Possible Explanation for Central Fatigue |title=Fatigue |volume=384 |pages=315–20 |year=1995 |pmid=8585461 |doi=10.1007/978-1-4899-1016-5_25|series=Advances in Experimental Medicine and Biology |isbn=978-1-4899-1018-9 }}</ref>
====Neuromuscular fatigue====
[[Nerve]]s control the contraction of muscles by determining the number, sequence, and force of muscular contraction. When a nerve experiences [[synaptic fatigue]] it becomes unable to stimulate the muscle that it innervates. Most movements require a force far below what a muscle could potentially generate, and barring [[pathology]], neuromuscular fatigue is seldom an issue.{{citation needed|date=August 2021}}
For extremely powerful contractions that are close to the upper limit of a muscle's ability to generate force, neuromuscular fatigue can become a limiting factor in untrained individuals. In novice [[strength training|strength trainers]], the muscle's ability to generate force is most strongly limited by nerve's ability to sustain a [[rate coding|high-frequency signal]]. After an extended period of maximum contraction, the nerve's signal reduces in frequency and the force generated by the contraction diminishes. There is no sensation of pain or discomfort, the muscle appears to simply 'stop listening' and gradually cease to move, often [[Muscle contraction#Eccentric contraction|lengthening]]. As there is insufficient stress on the muscles and tendons, there will often be no [[delayed onset muscle soreness]] following the workout. Part of the process of strength training is increasing the nerve's ability to generate sustained, high frequency signals which allow a muscle to contract with their greatest force. It is this "neural training" that causes several weeks worth of rapid gains in strength, which level off once the nerve is generating maximum contractions and the muscle reaches its physiological limit. Past this point, training effects increase muscular strength through myofibrillar or sarcoplasmic [[Muscle hypertrophy#Strength training|hypertrophy]] and metabolic fatigue becomes the factor limiting contractile force.
====Peripheral muscle fatigue====
Peripheral muscle fatigue during physical work is considered{{By whom|date=April 2012}} an inability for the body to supply sufficient energy or other metabolites to the contracting muscles to meet the increased energy demand. This is the most common case of physical fatigue—affecting a national{{Where|date=April 2012}} average of 72% of adults in the work force in 2002. This causes contractile dysfunction that manifests in the eventual reduction or lack of ability of a single muscle or local group of muscles to do work. The insufficiency of energy, i.e. sub-optimal [[cellular respiration|aerobic metabolism]], generally results in the accumulation of [[lactic acid]] and other [[acid]]ic anaerobic metabolic by-products in the muscle, causing the stereotypical burning sensation of local muscle fatigue, though recent studies have indicated otherwise, actually finding that lactic acid is a source of energy.<ref name=robergs>{{cite journal |author1=R. Robergs |author2=F. Ghiasvand |author3=D. Parker | title = Biochemistry of exercise-induced metabolic acidosis | journal = Am J Physiol Regul Integr Comp Physiol | volume = 287 | issue = 3 | pages = R502–16 | year = 2004 | doi = 10.1152/ajpregu.00114.2004 | pmid = 15308499|s2cid=2745168 }}</ref>
The fundamental difference between the peripheral and central theories of muscle fatigue is that the peripheral model of muscle fatigue assumes failure at one or more sites in the chain that initiates muscle contraction. Peripheral regulation therefore depends on the localized metabolic chemical conditions of the local muscle affected, whereas the central model of muscle fatigue is an integrated mechanism that works to preserve the integrity of the system by initiating muscle fatigue through muscle derecruitment, based on collective feedback from the periphery, before cellular or organ failure occurs. Therefore, the feedback that is read by this central regulator could include chemical and mechanical as well as cognitive cues. The significance of each of these factors will depend on the nature of the fatigue-inducing work that is being performed.{{citation needed|date=August 2021}}
Though not universally used, "metabolic fatigue" is a common alternative term for peripheral muscle weakness, because of the reduction in contractile force due to the direct or indirect effects of the reduction of substrates or accumulation of metabolites within the [[muscle fiber|myocytes]]. This can occur through a simple lack of energy to fuel contraction, or through interference with the ability of Ca<sup>2+</sup> to stimulate [[actin]] and [[myosin]] to contract.
==Management==
{{Empty section|date=October 2017}}
==References==
{{Reflist}}
== External links ==
{{Medical resources
| DiseasesDB = 22832
| ICD10 = {{ICD10|R|53||m|60}}
| ICD9 = {{ICD9|728.87}} ({{ICD9|728.9}} before 10/01/03); alternatively, {{ICD9|780.79}}
| ICDO =
| MedlinePlus = 003174
| eMedicineSubj =
| eMedicineTopic =
| MeshID = D018908
| ICD10CM = {{ICD10CM|R53.1}}
}}
{{Wiktionary}}
{{Wikiquote}}
* [http://www.mcardlesdisease.org McArdle's disease]
{{Myopathy}}
{{Common Cold}}
{{Interwiki extra|qid=Q633403}} <!--"Asthenia" interwikis-->
[[Category:Symptoms and signs: Nervous system]]
[[Category:Neurological disorders]]
[[Category:Muscular disorders]]
[[Category:Symptoms and signs: musculoskeletal system]]' |
New page wikitext, after the edit (new_wikitext) | '{{short description|Physical symptom}}
{{About|the medical condition}}
{{Infobox medical condition (new)
| name = Weakness yeah don't f tier for this site
it ffing sucks drug dick
| image =
| caption =
| field = [[Neurology]]
| pronounce =
| synonyms = Asthenia
| symptoms =
| complications =
| onset =
| duration =
| types =
| causes =
| risks =
| diagnosis =
| differential =
| prevention =
| treatment =
| medication =
| prognosis =
| frequency =
| deaths =
}}
'''Weakness''' is a [[symptom]] of many different medical conditions.<ref name=Rosen10>{{cite book |title=Rosen's Emergency Medicine: Concepts and Clinical Practice |edition=7th |last=Marx |first=John |year=2010 |publisher=Mosby/Elsevier |location=Philadelphia, PA |isbn=978-0-323-05472-0 |page=Chapter 11 }}</ref> The causes are many and can be divided into conditions that have true or perceived muscle weakness. True muscle weakness is a primary symptom of a variety of skeletal muscle diseases, including [[muscular dystrophy]] and [[inflammatory myopathy]]. It occurs in [[neuromuscular junction]] disorders, such as [[myasthenia gravis]].{{citation needed|date=June 2022}}
==Pathophysiology==
{{See also|Muscle contraction}}
Muscle cells work by detecting a [[Action potential|flow]] of electrical impulses from the [[brain]], which signals them to [[Muscle contraction|contract]] through the release of [[calcium]] by the [[sarcoplasmic reticulum]]. Fatigue (reduced ability to generate force) may occur due to the nerve, or within the muscle cells themselves. New research from scientists at Columbia University suggests that muscle fatigue is caused by calcium leaking out of the muscle cell. This makes less calcium available for the muscle cell. In addition, the Columbia researchers propose that an enzyme activated by this released calcium eats away at muscle fibers.<ref>{{cite news| url=https://www.nytimes.com/2008/02/12/health/research/12musc.html | work=The New York Times | title=Finding May Solve Riddle of Fatigue in Muscles | first=Gina | last=Kolata | date=February 12, 2008}}</ref>
[[Substrate (biochemistry)|Substrates]] within the muscle generally serve to power muscular contractions. They include molecules such as [[adenosine triphosphate]] (ATP), [[glycogen]] and [[Phosphocreatine|creatine phosphate]]. ATP binds to the [[myosin]] head and causes the 'ratchetting' that results in contraction according to the [[Sliding filament mechanism|sliding filament model]]. Creatine phosphate stores energy so ATP can be rapidly regenerated within the muscle cells from [[adenosine diphosphate]] (ADP) and inorganic phosphate ions, allowing for sustained powerful contractions that last between 5–7 seconds. Glycogen is the intramuscular storage form of [[glucose]], used to generate energy quickly once intramuscular creatine stores are exhausted, producing [[lactic acid]] as a metabolic byproduct. Contrary to common belief, lactic acid accumulation doesn't actually cause the burning sensation felt when people exhaust their oxygen and oxidative metabolism, but in actuality, lactic acid in presence of oxygen recycles to produce [[pyruvate]] in the liver, which is known as the [[Cori cycle]].{{citation needed|date=August 2021}}
Substrates produce metabolic fatigue by being depleted during exercise, resulting in a lack of intracellular energy sources to fuel contractions. In essence, the muscle stops contracting because it lacks the energy to do so.{{citation needed|date=August 2021}}
==Differential diagnosis==
===True vs. perceived weakness===
* True weakness (or neuromuscular) describes a condition where the force exerted by the muscles is less than would be expected, for example [[muscular dystrophy]].
* Perceived weakness (or non-neuromuscular) describes a condition where a person feels more effort than normal is required to exert a given amount of force but actual muscle strength is normal, for example.<ref>{{cite book | title=Adams and Victor's Principles of Neurology, Ninth Edition | publisher=McGraw-Hill |author1=Ropper, Allan H. |author2=Samuels, Martin A. | author-link=Chapter 24. Fatigue, Asthenia, Anxiety, and Depressive Reactions | year=2009 | isbn=978-0071499927}}</ref>
In some conditions, such as [[myasthenia gravis]], muscle strength is normal when resting, but ''true weakness'' occurs after the muscle has been subjected to exercise. This is also true for some cases of [[chronic fatigue syndrome]], where objective post-exertion muscle weakness with delayed recovery time has been measured and is a feature of some of the published definitions.<ref>{{cite journal |doi=10.1046/j.1468-1331.1999.610063.x |vauthors=Paul L, Wood L, Behan WM, Maclaren WM |title=Demonstration of delayed recovery from fatiguing exercise in chronic fatigue syndrome |journal=Eur. J. Neurol. |volume=6 |issue=1 |pages=63–9 |date=January 1999 |pmid=10209352 |s2cid=33480143 }}</ref><ref>{{cite journal |doi=10.1042/CS19980372 |vauthors=McCully KK, Natelson BH |title=Impaired oxygen delivery to muscle in chronic fatigue syndrome |journal=Clin. Sci. |volume=97 |issue=5 |pages=603–8; discussion 611–3 |date=November 1999 |pmid=10545311 }}</ref><ref>{{cite journal |doi=10.1001/archinte.160.21.3270 |vauthors=De Becker P, Roeykens J, Reynders M, McGregor N, De Meirleir K |title=Exercise capacity in chronic fatigue syndrome |journal=Arch. Intern. Med. |volume=160 |issue=21 |pages=3270–7 |date=November 2000 |pmid=11088089 |url=http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=11088089 |doi-access= |access-date=2011-03-12 |archive-date=2011-08-12 |archive-url=https://web.archive.org/web/20110812232955/http://archinte.ama-assn.org/cgi/content/full/160/21/3270 |url-status=dead }}</ref><ref>{{cite journal |doi=10.1046/j.1365-2796.2001.00890.x |vauthors=De Becker P, McGregor N, De Meirleir K |title=A definition-based analysis of symptoms in a large cohort of patients with chronic fatigue syndrome |journal=J. Intern. Med. |volume=250 |issue=3 |pages=234–40 |date=September 2001 |pmid=11555128 |doi-access=free }}</ref><ref>{{cite book |first1=Bruce M. |last1=Carruthers |first2=Anil Kumar |last2=Jain |first3=Kenny L. |last3=De Meirleir |first4=Daniel L. |last4=Peterson |first5=Nancy G. |last5=Klimas |first6=A. Martin |last6=Lerner |first7=Alison C. |last7= Bested |first8=Pierre |last8=Flor-Henry |first9=Pradip |last9=Joshi |first10=A. C. Peter |last10=Powles |first11=Jeffrey A. |last11=Sherkey |first12=Marjorie I. |last12=van de Sande |display-authors=5 |title=Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols |journal=Journal of Chronic Fatigue Syndrome |volume=11 |issue=1 |pages=7–115 |year=2003 |isbn=978-0-7890-2207-3 |issn=1057-3321 |doi=10.1300/J092v11n01_02}}</ref><ref>{{cite journal |vauthors=Jammes Y, Steinberg JG, Mambrini O, Brégeon F, Delliaux S |title=Chronic fatigue syndrome: assessment of increased oxidative stress and altered muscle excitability in response to incremental exercise |journal=J. Intern. Med. |volume=257 |issue=3 |pages=299–310 |date=March 2005 |pmid=15715687 |doi=10.1111/j.1365-2796.2005.01452.x |doi-access=free }}</ref>
==={{anchor|Asthenia}}Asthenia vs. myasthenia===
'''Asthenia''' or '''asthaenia''' ({{lang-el|ἀσθένεια}}, literally ''lack of strength'' but also ''disease'') is a medical term referring to a condition in which the body lacks or has lost strength either as a whole or in any of its parts. It is a poorly defined condition that can include true or primary [[muscle weakness]] or perceived muscle weakness.<ref>{{Citation |last1=Kauffman |first1=Timothy L. |title=Chapter 16 - Muscle weakness and therapeutic exercise |date=2014-01-01 |url=https://www.sciencedirect.com/science/article/pii/B9780702045882000164 |work=A Comprehensive Guide to Geriatric Rehabilitation (Third Edition) |pages=112–119 |editor-last=Kauffman |editor-first=Timothy L. |access-date=2023-11-19 |place=Oxford |publisher=Churchill Livingstone |isbn=978-0-7020-4588-2 |last2=Kemmis |first2=Karen |editor2-last=Scott |editor2-first=Ron |editor3-last=Barr |editor3-first=John O. |editor4-last=Moran |editor4-first=Michael L.}}</ref> For perceived muscle weakness, asthenia has been described as the feeling of weak or tired muscles in the absence of muscle weakness, that is the muscle can generate a normal amount of force but it is perceived as requiring more effort.<ref name=":0">{{Cite journal |last=Saguil |first=Aaron |date=2005-04-01 |title=Evaluation of the Patient with Muscle Weakness |url=https://www.aafp.org/pubs/afp/issues/2005/0401/p1327.html |journal=American Family Physician |language=en-US |volume=71 |issue=7 |pages=1327–1336 |pmid=15832536 |quote=Asthenia is a sense of weariness or exhaustion in the absence of muscle weakness.}}</ref><ref>{{Cite web |date=2021-06-28 |title=Muscle Weakness and Fatigue {{!}} Causes and Treatment |url=https://patient.info/signs-symptoms/tiredness-fatigue/muscle-weakness |access-date=2023-11-19 |website=patient.info |language=en |quote=Muscle tiredness: This is sometimes called asthenia. It is a sense of weariness or exhaustion that you feel when using the muscle. The muscle isn't genuinely weaker, it can still do its job but it takes you more effort to manage it.}}</ref>
General asthenia occurs in many chronic wasting diseases (such as tuberculosis and cancer), sleep disorders or chronic disorders of the heart, lungs or kidneys, and is probably most marked in diseases of the adrenal gland. Asthenia may be limited to certain [[organ (anatomy)|organs]] or systems of organs, as in [[asthenopia]], characterized by ready fatiguability. Asthenia is also a side effect of some medications and treatments, such as [[Ritonavir]] (a [[Protease inhibitor (pharmacology)|protease inhibitor]] used in [[HIV]] treatment). <ref>{{Cite web |date=28 November 2022 |title=PubChem Compound Summary for CID 392622, Ritonavir |url=https://pubchem.ncbi.nlm.nih.gov/compound/ritonavir |access-date=28 November 2022 |website=NCBI}}</ref>
Differentiating psychogenic (perceived) asthenia and true asthenia from myasthenia is often difficult, and in time apparent psychogenic asthenia accompanying many chronic disorders is seen to progress into a primary weakness.{{citation needed|date=August 2021}}
Myasthenia or myasthaenia (my- from {{lang-el|μυο}} meaning "muscle" + -asthenia [''{{lang|el|ἀσθένεια}}''] meaning "weakness"), or simply muscle weakness, is a lack of muscle strength. The causes are many and can be divided into conditions that have either true or perceived muscle weakness. True muscle weakness is a primary symptom of a variety of skeletal muscle diseases, including muscular dystrophy and inflammatory myopathy. It occurs in [[neuromuscular disease]]s, such as myasthenia gravis. Perceived muscle weakness occurs in diseases such as sleep disorders, and depression.<ref name=":0" />
===Types===
Muscle fatigue can be central, neuromuscular, or peripheral muscular. Central muscle fatigue manifests as an overall sense of energy deprivation, and peripheral muscle weakness manifests as a local, muscle-specific inability to do work.<ref>{{cite book |vauthors=Gandevia SC, Enoka RM, McComas AJ, Stuart DG, Thomas CK |title=Fatigue |chapter=Neurobiology of Muscle Fatigue |volume=384 |pages=515–25 |year=1995 |pmid=8585476 | doi = 10.1007/978-1-4899-1016-5_39|series=Advances in Experimental Medicine and Biology |isbn=978-1-4899-1018-9 }}</ref><ref>{{cite journal |author=Kent-Braun JA |title=Central and peripheral contributions to muscle fatigue in humans during sustained maximal effort |journal=European Journal of Applied Physiology and Occupational Physiology |volume=80 |issue=1 |pages=57–63 |year=1999 |pmid=10367724 |doi=10.1007/s004210050558|s2cid=22515865 }}</ref> Neuromuscular fatigue can be either central or peripheral.{{citation needed|date=August 2021}}
====Central fatigue====
The central fatigue is generally described in terms of a reduction in the [[nervous system|neural]] drive or nerve-based motor command to working muscles that results in a decline in the force output.<ref>{{cite journal |author=Gandevia SC |title=Spinal and supraspinal factors in human muscle fatigue |journal=Physiol. Rev. |volume=81 |issue=4 |pages=1725–89 |year=2001 |pmid=11581501 |doi=10.1152/physrev.2001.81.4.1725 }}</ref><ref>{{cite journal |vauthors=Kay D, Marino FE, Cannon J, St Clair Gibson A, Lambert MI, Noakes TD |title=Evidence for neuromuscular fatigue during high-intensity cycling in warm, humid conditions |journal=Eur. J. Appl. Physiol. |volume=84 |issue=1–2 |pages=115–21 |year=2001 |pmid=11394239 |doi=10.1007/s004210000340|s2cid=25906759 }}</ref><ref>{{cite journal |doi=10.3109/13813459109145909 |vauthors=Vandewalle H, Maton B, Le Bozec S, Guerenbourg G |title=An electromyographic study of an all-out exercise on a cycle ergometer |journal=Archives Internationales de Physiologie, de Biochimie et de Biophysique |volume=99 |issue=1 |pages=89–93 |year=1991 |pmid=1713492 }}</ref> It has been suggested that the reduced neural drive during exercise may be a protective mechanism to prevent organ failure if the work was continued at the same intensity.<ref>{{cite journal |vauthors=Bigland-Ritchie B, Woods JJ |title=Changes in muscle contractile properties and neural control during human muscular fatigue |journal=Muscle Nerve |volume=7 |issue=9 |pages=691–9 |year=1984 |pmid=6100456 |doi=10.1002/mus.880070902|s2cid=13606531 }}</ref><ref>{{cite journal |author=Noakes TD |title=Physiological models to understand exercise fatigue and the adaptations that predict or enhance athletic performance |journal=Scandinavian Journal of Medicine & Science in Sports |volume=10 |issue=3 |pages=123–45 |year=2000 |pmid=10843507 |doi=10.1034/j.1600-0838.2000.010003123.x|s2cid=23103331 }}</ref> The exact mechanisms of central fatigue are unknown, though there has been considerable interest in the role of [[serotonin|serotonergic]] pathways.<ref>{{cite journal |author=Davis JM |title=Carbohydrates, branched-chain amino acids, and endurance: the central fatigue hypothesis |journal=International Journal of Sport Nutrition |volume=5 |issue=Suppl |pages=S29–38 |year=1995 |pmid=7550256 |doi=10.1123/ijsn.5.s1.s29 }}</ref><ref>Newsholme, E. A., Acworth, I. N., & Blomstrand, E. 1987, 'Amino acids, brain neurotransmitters and a functional link between muscle and brain that is important in sustained exercise', in G Benzi (ed.), Advances in Myochemistry, Libbey Eurotext, London, pp. 127-133.</ref><ref>{{cite book |vauthors=Newsholme EA, Blomstrand E |chapter=Tryptophan, 5-Hydroxytryptamine and a Possible Explanation for Central Fatigue |title=Fatigue |volume=384 |pages=315–20 |year=1995 |pmid=8585461 |doi=10.1007/978-1-4899-1016-5_25|series=Advances in Experimental Medicine and Biology |isbn=978-1-4899-1018-9 }}</ref>
====Neuromuscular fatigue====
[[Nerve]]s control the contraction of muscles by determining the number, sequence, and force of muscular contraction. When a nerve experiences [[synaptic fatigue]] it becomes unable to stimulate the muscle that it innervates. Most movements require a force far below what a muscle could potentially generate, and barring [[pathology]], neuromuscular fatigue is seldom an issue.{{citation needed|date=August 2021}}
For extremely powerful contractions that are close to the upper limit of a muscle's ability to generate force, neuromuscular fatigue can become a limiting factor in untrained individuals. In novice [[strength training|strength trainers]], the muscle's ability to generate force is most strongly limited by nerve's ability to sustain a [[rate coding|high-frequency signal]]. After an extended period of maximum contraction, the nerve's signal reduces in frequency and the force generated by the contraction diminishes. There is no sensation of pain or discomfort, the muscle appears to simply 'stop listening' and gradually cease to move, often [[Muscle contraction#Eccentric contraction|lengthening]]. As there is insufficient stress on the muscles and tendons, there will often be no [[delayed onset muscle soreness]] following the workout. Part of the process of strength training is increasing the nerve's ability to generate sustained, high frequency signals which allow a muscle to contract with their greatest force. It is this "neural training" that causes several weeks worth of rapid gains in strength, which level off once the nerve is generating maximum contractions and the muscle reaches its physiological limit. Past this point, training effects increase muscular strength through myofibrillar or sarcoplasmic [[Muscle hypertrophy#Strength training|hypertrophy]] and metabolic fatigue becomes the factor limiting contractile force.
====Peripheral muscle fatigue====
Peripheral muscle fatigue during physical work is considered{{By whom|date=April 2012}} an inability for the body to supply sufficient energy or other metabolites to the contracting muscles to meet the increased energy demand. This is the most common case of physical fatigue—affecting a national{{Where|date=April 2012}} average of 72% of adults in the work force in 2002. This causes contractile dysfunction that manifests in the eventual reduction or lack of ability of a single muscle or local group of muscles to do work. The insufficiency of energy, i.e. sub-optimal [[cellular respiration|aerobic metabolism]], generally results in the accumulation of [[lactic acid]] and other [[acid]]ic anaerobic metabolic by-products in the muscle, causing the stereotypical burning sensation of local muscle fatigue, though recent studies have indicated otherwise, actually finding that lactic acid is a source of energy.<ref name=robergs>{{cite journal |author1=R. Robergs |author2=F. Ghiasvand |author3=D. Parker | title = Biochemistry of exercise-induced metabolic acidosis | journal = Am J Physiol Regul Integr Comp Physiol | volume = 287 | issue = 3 | pages = R502–16 | year = 2004 | doi = 10.1152/ajpregu.00114.2004 | pmid = 15308499|s2cid=2745168 }}</ref>
The fundamental difference between the peripheral and central theories of muscle fatigue is that the peripheral model of muscle fatigue assumes failure at one or more sites in the chain that initiates muscle contraction. Peripheral regulation therefore depends on the localized metabolic chemical conditions of the local muscle affected, whereas the central model of muscle fatigue is an integrated mechanism that works to preserve the integrity of the system by initiating muscle fatigue through muscle derecruitment, based on collective feedback from the periphery, before cellular or organ failure occurs. Therefore, the feedback that is read by this central regulator could include chemical and mechanical as well as cognitive cues. The significance of each of these factors will depend on the nature of the fatigue-inducing work that is being performed.{{citation needed|date=August 2021}}
Though not universally used, "metabolic fatigue" is a common alternative term for peripheral muscle weakness, because of the reduction in contractile force due to the direct or indirect effects of the reduction of substrates or accumulation of metabolites within the [[muscle fiber|myocytes]]. This can occur through a simple lack of energy to fuel contraction, or through interference with the ability of Ca<sup>2+</sup> to stimulate [[actin]] and [[myosin]] to contract.
==Management==
{{Empty section|date=October 2017}}
==References==
{{Reflist}}
== External links ==
{{Medical resources
| DiseasesDB = 22832
| ICD10 = {{ICD10|R|53||m|60}}
| ICD9 = {{ICD9|728.87}} ({{ICD9|728.9}} before 10/01/03); alternatively, {{ICD9|780.79}}
| ICDO =
| MedlinePlus = 003174
| eMedicineSubj =
| eMedicineTopic =
| MeshID = D018908
| ICD10CM = {{ICD10CM|R53.1}}
}}
{{Wiktionary}}
{{Wikiquote}}
* [http://www.mcardlesdisease.org McArdle's disease]
{{Myopathy}}
{{Common Cold}}
{{Interwiki extra|qid=Q633403}} <!--"Asthenia" interwikis-->
[[Category:Symptoms and signs: Nervous system]]
[[Category:Neurological disorders]]
[[Category:Muscular disorders]]
[[Category:Symptoms and signs: musculoskeletal system]]' |
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Parsed HTML source of the new revision (new_html) | '<div class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Physical symptom</div>
<style data-mw-deduplicate="TemplateStyles:r1033289096">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}</style><div role="note" class="hatnote navigation-not-searchable">This article is about the medical condition. For other uses, see <a href="/wiki/Weakness_(disambiguation)" class="mw-disambig" title="Weakness (disambiguation)">Weakness (disambiguation)</a>.</div>
<div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1218072481">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}body.skin-minerva .mw-parser-output .infobox-header,body.skin-minerva .mw-parser-output .infobox-subheader,body.skin-minerva .mw-parser-output .infobox-above,body.skin-minerva .mw-parser-output .infobox-title,body.skin-minerva .mw-parser-output .infobox-image,body.skin-minerva .mw-parser-output .infobox-full-data,body.skin-minerva .mw-parser-output .infobox-below{text-align:center}html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data div{background:#1f1f23!important;color:#f8f9fa}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data div{background:#1f1f23!important;color:#f8f9fa}}</style><table class="infobox"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Weakness yeah don't f tier for this site
it ffing sucks drug dick</th></tr><tr><th scope="row" class="infobox-label">Other names</th><td class="infobox-data">Asthenia</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Neurology" title="Neurology">Neurology</a></td></tr></tbody></table>
<p><b>Weakness</b> is a <a href="/wiki/Symptom" class="mw-redirect" title="Symptom">symptom</a> of many different medical conditions.<sup id="cite_ref-Rosen10_1-0" class="reference"><a href="#cite_note-Rosen10-1">[1]</a></sup> The causes are many and can be divided into conditions that have true or perceived muscle weakness. True muscle weakness is a primary symptom of a variety of skeletal muscle diseases, including <a href="/wiki/Muscular_dystrophy" title="Muscular dystrophy">muscular dystrophy</a> and <a href="/wiki/Inflammatory_myopathy" title="Inflammatory myopathy">inflammatory myopathy</a>. It occurs in <a href="/wiki/Neuromuscular_junction" title="Neuromuscular junction">neuromuscular junction</a> disorders, such as <a href="/wiki/Myasthenia_gravis" title="Myasthenia gravis">myasthenia gravis</a>.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (June 2022)">citation needed</span></a></i>]</sup>
</p>
<div id="toc" class="toc" role="navigation" aria-labelledby="mw-toc-heading"><input type="checkbox" role="button" id="toctogglecheckbox" class="toctogglecheckbox" style="display:none" /><div class="toctitle" lang="en" dir="ltr"><h2 id="mw-toc-heading">Contents</h2><span class="toctogglespan"><label class="toctogglelabel" for="toctogglecheckbox"></label></span></div>
<ul>
<li class="toclevel-1 tocsection-1"><a href="#Pathophysiology"><span class="tocnumber">1</span> <span class="toctext">Pathophysiology</span></a></li>
<li class="toclevel-1 tocsection-2"><a href="#Differential_diagnosis"><span class="tocnumber">2</span> <span class="toctext">Differential diagnosis</span></a>
<ul>
<li class="toclevel-2 tocsection-3"><a href="#True_vs._perceived_weakness"><span class="tocnumber">2.1</span> <span class="toctext">True vs. perceived weakness</span></a></li>
<li class="toclevel-2 tocsection-4"><a href="#Asthenia_vs._myasthenia"><span class="tocnumber">2.2</span> <span class="toctext">Asthenia vs. myasthenia</span></a></li>
<li class="toclevel-2 tocsection-5"><a href="#Types"><span class="tocnumber">2.3</span> <span class="toctext">Types</span></a>
<ul>
<li class="toclevel-3 tocsection-6"><a href="#Central_fatigue"><span class="tocnumber">2.3.1</span> <span class="toctext">Central fatigue</span></a></li>
<li class="toclevel-3 tocsection-7"><a href="#Neuromuscular_fatigue"><span class="tocnumber">2.3.2</span> <span class="toctext">Neuromuscular fatigue</span></a></li>
<li class="toclevel-3 tocsection-8"><a href="#Peripheral_muscle_fatigue"><span class="tocnumber">2.3.3</span> <span class="toctext">Peripheral muscle fatigue</span></a></li>
</ul>
</li>
</ul>
</li>
<li class="toclevel-1 tocsection-9"><a href="#Management"><span class="tocnumber">3</span> <span class="toctext">Management</span></a></li>
<li class="toclevel-1 tocsection-10"><a href="#References"><span class="tocnumber">4</span> <span class="toctext">References</span></a></li>
<li class="toclevel-1 tocsection-11"><a href="#External_links"><span class="tocnumber">5</span> <span class="toctext">External links</span></a></li>
</ul>
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<h2><span class="mw-headline" id="Pathophysiology">Pathophysiology</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Weakness&action=edit&section=1" title="Edit section: Pathophysiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h2>
<link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1033289096"><div role="note" class="hatnote navigation-not-searchable">See also: <a href="/wiki/Muscle_contraction" title="Muscle contraction">Muscle contraction</a></div>
<p>Muscle cells work by detecting a <a href="/wiki/Action_potential" title="Action potential">flow</a> of electrical impulses from the <a href="/wiki/Brain" title="Brain">brain</a>, which signals them to <a href="/wiki/Muscle_contraction" title="Muscle contraction">contract</a> through the release of <a href="/wiki/Calcium" title="Calcium">calcium</a> by the <a href="/wiki/Sarcoplasmic_reticulum" title="Sarcoplasmic reticulum">sarcoplasmic reticulum</a>. Fatigue (reduced ability to generate force) may occur due to the nerve, or within the muscle cells themselves. New research from scientists at Columbia University suggests that muscle fatigue is caused by calcium leaking out of the muscle cell. This makes less calcium available for the muscle cell. In addition, the Columbia researchers propose that an enzyme activated by this released calcium eats away at muscle fibers.<sup id="cite_ref-2" class="reference"><a href="#cite_note-2">[2]</a></sup>
</p><p><a href="/wiki/Substrate_(biochemistry)" class="mw-redirect" title="Substrate (biochemistry)">Substrates</a> within the muscle generally serve to power muscular contractions. They include molecules such as <a href="/wiki/Adenosine_triphosphate" title="Adenosine triphosphate">adenosine triphosphate</a> (ATP), <a href="/wiki/Glycogen" title="Glycogen">glycogen</a> and <a href="/wiki/Phosphocreatine" title="Phosphocreatine">creatine phosphate</a>. ATP binds to the <a href="/wiki/Myosin" title="Myosin">myosin</a> head and causes the 'ratchetting' that results in contraction according to the <a href="/wiki/Sliding_filament_mechanism" class="mw-redirect" title="Sliding filament mechanism">sliding filament model</a>. Creatine phosphate stores energy so ATP can be rapidly regenerated within the muscle cells from <a href="/wiki/Adenosine_diphosphate" title="Adenosine diphosphate">adenosine diphosphate</a> (ADP) and inorganic phosphate ions, allowing for sustained powerful contractions that last between 5–7 seconds. Glycogen is the intramuscular storage form of <a href="/wiki/Glucose" title="Glucose">glucose</a>, used to generate energy quickly once intramuscular creatine stores are exhausted, producing <a href="/wiki/Lactic_acid" title="Lactic acid">lactic acid</a> as a metabolic byproduct. Contrary to common belief, lactic acid accumulation doesn't actually cause the burning sensation felt when people exhaust their oxygen and oxidative metabolism, but in actuality, lactic acid in presence of oxygen recycles to produce <a href="/wiki/Pyruvate" class="mw-redirect" title="Pyruvate">pyruvate</a> in the liver, which is known as the <a href="/wiki/Cori_cycle" title="Cori cycle">Cori cycle</a>.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (August 2021)">citation needed</span></a></i>]</sup>
</p><p>Substrates produce metabolic fatigue by being depleted during exercise, resulting in a lack of intracellular energy sources to fuel contractions. In essence, the muscle stops contracting because it lacks the energy to do so.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (August 2021)">citation needed</span></a></i>]</sup>
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<h2><span class="mw-headline" id="Differential_diagnosis">Differential diagnosis</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Weakness&action=edit&section=2" title="Edit section: Differential diagnosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h2>
<h3><span class="mw-headline" id="True_vs._perceived_weakness">True vs. perceived weakness</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Weakness&action=edit&section=3" title="Edit section: True vs. perceived weakness"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h3>
<ul><li>True weakness (or neuromuscular) describes a condition where the force exerted by the muscles is less than would be expected, for example <a href="/wiki/Muscular_dystrophy" title="Muscular dystrophy">muscular dystrophy</a>.</li>
<li>Perceived weakness (or non-neuromuscular) describes a condition where a person feels more effort than normal is required to exert a given amount of force but actual muscle strength is normal, for example.<sup id="cite_ref-3" class="reference"><a href="#cite_note-3">[3]</a></sup></li></ul>
<p>In some conditions, such as <a href="/wiki/Myasthenia_gravis" title="Myasthenia gravis">myasthenia gravis</a>, muscle strength is normal when resting, but <i>true weakness</i> occurs after the muscle has been subjected to exercise. This is also true for some cases of <a href="/wiki/Chronic_fatigue_syndrome" class="mw-redirect" title="Chronic fatigue syndrome">chronic fatigue syndrome</a>, where objective post-exertion muscle weakness with delayed recovery time has been measured and is a feature of some of the published definitions.<sup id="cite_ref-4" class="reference"><a href="#cite_note-4">[4]</a></sup><sup id="cite_ref-5" class="reference"><a href="#cite_note-5">[5]</a></sup><sup id="cite_ref-6" class="reference"><a href="#cite_note-6">[6]</a></sup><sup id="cite_ref-7" class="reference"><a href="#cite_note-7">[7]</a></sup><sup id="cite_ref-8" class="reference"><a href="#cite_note-8">[8]</a></sup><sup id="cite_ref-9" class="reference"><a href="#cite_note-9">[9]</a></sup>
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<h3><span class="mw-headline" id="Asthenia_vs._myasthenia"><span class="anchor" id="Asthenia"></span>Asthenia vs. myasthenia</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Weakness&action=edit&section=4" title="Edit section: Asthenia vs. myasthenia"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h3>
<p><b>Asthenia</b> or <b>asthaenia</b> (<a href="/wiki/Greek_language" title="Greek language">Greek</a>: <span lang="el">ἀσθένεια</span>, literally <i>lack of strength</i> but also <i>disease</i>) is a medical term referring to a condition in which the body lacks or has lost strength either as a whole or in any of its parts. It is a poorly defined condition that can include true or primary <a href="/wiki/Muscle_weakness" title="Muscle weakness">muscle weakness</a> or perceived muscle weakness.<sup id="cite_ref-10" class="reference"><a href="#cite_note-10">[10]</a></sup> For perceived muscle weakness, asthenia has been described as the feeling of weak or tired muscles in the absence of muscle weakness, that is the muscle can generate a normal amount of force but it is perceived as requiring more effort.<sup id="cite_ref-:0_11-0" class="reference"><a href="#cite_note-:0-11">[11]</a></sup><sup id="cite_ref-12" class="reference"><a href="#cite_note-12">[12]</a></sup>
</p><p>General asthenia occurs in many chronic wasting diseases (such as tuberculosis and cancer), sleep disorders or chronic disorders of the heart, lungs or kidneys, and is probably most marked in diseases of the adrenal gland. Asthenia may be limited to certain <a href="/wiki/Organ_(anatomy)" class="mw-redirect" title="Organ (anatomy)">organs</a> or systems of organs, as in <a href="/wiki/Asthenopia" class="mw-redirect" title="Asthenopia">asthenopia</a>, characterized by ready fatiguability. Asthenia is also a side effect of some medications and treatments, such as <a href="/wiki/Ritonavir" title="Ritonavir">Ritonavir</a> (a <a href="/wiki/Protease_inhibitor_(pharmacology)" title="Protease inhibitor (pharmacology)">protease inhibitor</a> used in <a href="/wiki/HIV" title="HIV">HIV</a> treatment). <sup id="cite_ref-13" class="reference"><a href="#cite_note-13">[13]</a></sup>
</p><p>Differentiating psychogenic (perceived) asthenia and true asthenia from myasthenia is often difficult, and in time apparent psychogenic asthenia accompanying many chronic disorders is seen to progress into a primary weakness.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (August 2021)">citation needed</span></a></i>]</sup>
</p><p>Myasthenia or myasthaenia (my- from <a href="/wiki/Greek_language" title="Greek language">Greek</a>: <span lang="el">μυο</span> meaning "muscle" + -asthenia [<i><span title="Greek-language text"><span lang="el">ἀσθένεια</span></span></i>] meaning "weakness"), or simply muscle weakness, is a lack of muscle strength. The causes are many and can be divided into conditions that have either true or perceived muscle weakness. True muscle weakness is a primary symptom of a variety of skeletal muscle diseases, including muscular dystrophy and inflammatory myopathy. It occurs in <a href="/wiki/Neuromuscular_disease" title="Neuromuscular disease">neuromuscular diseases</a>, such as myasthenia gravis. Perceived muscle weakness occurs in diseases such as sleep disorders, and depression.<sup id="cite_ref-:0_11-1" class="reference"><a href="#cite_note-:0-11">[11]</a></sup>
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<h3><span class="mw-headline" id="Types">Types</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Weakness&action=edit&section=5" title="Edit section: Types"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h3>
<p>Muscle fatigue can be central, neuromuscular, or peripheral muscular. Central muscle fatigue manifests as an overall sense of energy deprivation, and peripheral muscle weakness manifests as a local, muscle-specific inability to do work.<sup id="cite_ref-14" class="reference"><a href="#cite_note-14">[14]</a></sup><sup id="cite_ref-15" class="reference"><a href="#cite_note-15">[15]</a></sup> Neuromuscular fatigue can be either central or peripheral.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (August 2021)">citation needed</span></a></i>]</sup>
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<h4><span class="mw-headline" id="Central_fatigue">Central fatigue</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Weakness&action=edit&section=6" title="Edit section: Central fatigue"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h4>
<p>The central fatigue is generally described in terms of a reduction in the <a href="/wiki/Nervous_system" title="Nervous system">neural</a> drive or nerve-based motor command to working muscles that results in a decline in the force output.<sup id="cite_ref-16" class="reference"><a href="#cite_note-16">[16]</a></sup><sup id="cite_ref-17" class="reference"><a href="#cite_note-17">[17]</a></sup><sup id="cite_ref-18" class="reference"><a href="#cite_note-18">[18]</a></sup> It has been suggested that the reduced neural drive during exercise may be a protective mechanism to prevent organ failure if the work was continued at the same intensity.<sup id="cite_ref-19" class="reference"><a href="#cite_note-19">[19]</a></sup><sup id="cite_ref-20" class="reference"><a href="#cite_note-20">[20]</a></sup> The exact mechanisms of central fatigue are unknown, though there has been considerable interest in the role of <a href="/wiki/Serotonin" title="Serotonin">serotonergic</a> pathways.<sup id="cite_ref-21" class="reference"><a href="#cite_note-21">[21]</a></sup><sup id="cite_ref-22" class="reference"><a href="#cite_note-22">[22]</a></sup><sup id="cite_ref-23" class="reference"><a href="#cite_note-23">[23]</a></sup>
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<h4><span class="mw-headline" id="Neuromuscular_fatigue">Neuromuscular fatigue</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Weakness&action=edit&section=7" title="Edit section: Neuromuscular fatigue"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h4>
<p><a href="/wiki/Nerve" title="Nerve">Nerves</a> control the contraction of muscles by determining the number, sequence, and force of muscular contraction. When a nerve experiences <a href="/wiki/Synaptic_fatigue" title="Synaptic fatigue">synaptic fatigue</a> it becomes unable to stimulate the muscle that it innervates. Most movements require a force far below what a muscle could potentially generate, and barring <a href="/wiki/Pathology" title="Pathology">pathology</a>, neuromuscular fatigue is seldom an issue.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (August 2021)">citation needed</span></a></i>]</sup>
</p><p>For extremely powerful contractions that are close to the upper limit of a muscle's ability to generate force, neuromuscular fatigue can become a limiting factor in untrained individuals. In novice <a href="/wiki/Strength_training" title="Strength training">strength trainers</a>, the muscle's ability to generate force is most strongly limited by nerve's ability to sustain a <a href="/wiki/Rate_coding" class="mw-redirect" title="Rate coding">high-frequency signal</a>. After an extended period of maximum contraction, the nerve's signal reduces in frequency and the force generated by the contraction diminishes. There is no sensation of pain or discomfort, the muscle appears to simply 'stop listening' and gradually cease to move, often <a href="/wiki/Muscle_contraction#Eccentric_contraction" title="Muscle contraction">lengthening</a>. As there is insufficient stress on the muscles and tendons, there will often be no <a href="/wiki/Delayed_onset_muscle_soreness" title="Delayed onset muscle soreness">delayed onset muscle soreness</a> following the workout. Part of the process of strength training is increasing the nerve's ability to generate sustained, high frequency signals which allow a muscle to contract with their greatest force. It is this "neural training" that causes several weeks worth of rapid gains in strength, which level off once the nerve is generating maximum contractions and the muscle reaches its physiological limit. Past this point, training effects increase muscular strength through myofibrillar or sarcoplasmic <a href="/wiki/Muscle_hypertrophy#Strength_training" title="Muscle hypertrophy">hypertrophy</a> and metabolic fatigue becomes the factor limiting contractile force.
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<h4><span class="mw-headline" id="Peripheral_muscle_fatigue">Peripheral muscle fatigue</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Weakness&action=edit&section=8" title="Edit section: Peripheral muscle fatigue"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h4>
<p>Peripheral muscle fatigue during physical work is considered<sup class="noprint Inline-Template" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Manual_of_Style/Words_to_watch#Unsupported_attributions" title="Wikipedia:Manual of Style/Words to watch"><span title="The material near this tag may use weasel words or too-vague attribution. (April 2012)">by whom?</span></a></i>]</sup> an inability for the body to supply sufficient energy or other metabolites to the contracting muscles to meet the increased energy demand. This is the most common case of physical fatigue—affecting a national<sup class="noprint Inline-Template" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Naming_conventions_(geographic_names)" title="Wikipedia:Naming conventions (geographic names)"><span title="The geographic scope near this tag is ambiguous. (April 2012)">where?</span></a></i>]</sup> average of 72% of adults in the work force in 2002. This causes contractile dysfunction that manifests in the eventual reduction or lack of ability of a single muscle or local group of muscles to do work. The insufficiency of energy, i.e. sub-optimal <a href="/wiki/Cellular_respiration" title="Cellular respiration">aerobic metabolism</a>, generally results in the accumulation of <a href="/wiki/Lactic_acid" title="Lactic acid">lactic acid</a> and other <a href="/wiki/Acid" title="Acid">acidic</a> anaerobic metabolic by-products in the muscle, causing the stereotypical burning sensation of local muscle fatigue, though recent studies have indicated otherwise, actually finding that lactic acid is a source of energy.<sup id="cite_ref-robergs_24-0" class="reference"><a href="#cite_note-robergs-24">[24]</a></sup>
</p><p>The fundamental difference between the peripheral and central theories of muscle fatigue is that the peripheral model of muscle fatigue assumes failure at one or more sites in the chain that initiates muscle contraction. Peripheral regulation therefore depends on the localized metabolic chemical conditions of the local muscle affected, whereas the central model of muscle fatigue is an integrated mechanism that works to preserve the integrity of the system by initiating muscle fatigue through muscle derecruitment, based on collective feedback from the periphery, before cellular or organ failure occurs. Therefore, the feedback that is read by this central regulator could include chemical and mechanical as well as cognitive cues. The significance of each of these factors will depend on the nature of the fatigue-inducing work that is being performed.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (August 2021)">citation needed</span></a></i>]</sup>
</p><p>Though not universally used, "metabolic fatigue" is a common alternative term for peripheral muscle weakness, because of the reduction in contractile force due to the direct or indirect effects of the reduction of substrates or accumulation of metabolites within the <a href="/wiki/Muscle_fiber" class="mw-redirect" title="Muscle fiber">myocytes</a>. This can occur through a simple lack of energy to fuel contraction, or through interference with the ability of Ca<sup>2+</sup> to stimulate <a href="/wiki/Actin" title="Actin">actin</a> and <a href="/wiki/Myosin" title="Myosin">myosin</a> to contract.
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<h2><span class="mw-headline" id="Management">Management</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Weakness&action=edit&section=9" title="Edit section: Management"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h2>
<style data-mw-deduplicate="TemplateStyles:r1097763485">.mw-parser-output .ambox{border:1px solid #a2a9b1;border-left:10px solid #36c;background-color:#fbfbfb;box-sizing:border-box}.mw-parser-output .ambox+link+.ambox,.mw-parser-output .ambox+link+style+.ambox,.mw-parser-output .ambox+link+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+style+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+link+.ambox{margin-top:-1px}html body.mediawiki .mw-parser-output .ambox.mbox-small-left{margin:4px 1em 4px 0;overflow:hidden;width:238px;border-collapse:collapse;font-size:88%;line-height:1.25em}.mw-parser-output .ambox-speedy{border-left:10px solid #b32424;background-color:#fee7e6}.mw-parser-output .ambox-delete{border-left:10px solid #b32424}.mw-parser-output .ambox-content{border-left:10px solid #f28500}.mw-parser-output .ambox-style{border-left:10px solid #fc3}.mw-parser-output .ambox-move{border-left:10px solid #9932cc}.mw-parser-output .ambox-protection{border-left:10px solid #a2a9b1}.mw-parser-output .ambox .mbox-text{border:none;padding:0.25em 0.5em;width:100%}.mw-parser-output .ambox .mbox-image{border:none;padding:2px 0 2px 0.5em;text-align:center}.mw-parser-output .ambox .mbox-imageright{border:none;padding:2px 0.5em 2px 0;text-align:center}.mw-parser-output .ambox .mbox-empty-cell{border:none;padding:0;width:1px}.mw-parser-output .ambox .mbox-image-div{width:52px}html.client-js body.skin-minerva .mw-parser-output .mbox-text-span{margin-left:23px!important}@media(min-width:720px){.mw-parser-output .ambox{margin:0 10%}}</style><table class="box-Empty_section plainlinks metadata ambox mbox-small-left ambox-content" role="presentation"><tbody><tr><td class="mbox-image"><span typeof="mw:File"><a href="/wiki/File:Wiki_letter_w_cropped.svg" class="mw-file-description"><img alt="[icon]" src="//upload.wikimedia.org/wikipedia/commons/thumb/1/1c/Wiki_letter_w_cropped.svg/20px-Wiki_letter_w_cropped.svg.png" decoding="async" width="20" height="14" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/1/1c/Wiki_letter_w_cropped.svg/30px-Wiki_letter_w_cropped.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/1/1c/Wiki_letter_w_cropped.svg/40px-Wiki_letter_w_cropped.svg.png 2x" data-file-width="44" data-file-height="31" /></a></span></td><td class="mbox-text"><div class="mbox-text-span"><b>This section is empty.</b> You can help by <a class="external text" href="https://en.wikipedia.org/w/index.php?title=Weakness&action=edit&section=">adding to it</a>. <span class="date-container"><i>(<span class="date">October 2017</span>)</i></span></div></td></tr></tbody></table>
<h2><span class="mw-headline" id="References">References</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Weakness&action=edit&section=10" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h2>
<style data-mw-deduplicate="TemplateStyles:r1217336898">.mw-parser-output .reflist{font-size:90%;margin-bottom:0.5em;list-style-type:decimal}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist">
<div class="mw-references-wrap mw-references-columns"><ol class="references">
<li id="cite_note-Rosen10-1"><span class="mw-cite-backlink"><b><a href="#cite_ref-Rosen10_1-0">^</a></b></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1215172403">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a{background-size:contain}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a{background-size:contain}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a{background-size:contain}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:#d33}.mw-parser-output .cs1-visible-error{color:#d33}.mw-parser-output .cs1-maint{display:none;color:#2C882D;margin-left:0.3em}.mw-parser-output .cs1-format{font-size:95%}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911F}html.skin-theme-clientpref-night .mw-parser-output .cs1-visible-error,html.skin-theme-clientpref-night .mw-parser-output .cs1-hidden-error{color:#f8a397}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-visible-error,html.skin-theme-clientpref-os .mw-parser-output .cs1-hidden-error{color:#f8a397}html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911F}}</style><cite id="CITEREFMarx2010" class="citation book cs1">Marx, John (2010). <i>Rosen's Emergency Medicine: Concepts and Clinical Practice</i> (7th ed.). Philadelphia, PA: Mosby/Elsevier. p. Chapter 11. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-323-05472-0" title="Special:BookSources/978-0-323-05472-0"><bdi>978-0-323-05472-0</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Rosen%27s+Emergency+Medicine%3A+Concepts+and+Clinical+Practice&rft.place=Philadelphia%2C+PA&rft.pages=Chapter+11&rft.edition=7th&rft.pub=Mosby%2FElsevier&rft.date=2010&rft.isbn=978-0-323-05472-0&rft.aulast=Marx&rft.aufirst=John&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWeakness" class="Z3988"></span></span>
</li>
<li id="cite_note-2"><span class="mw-cite-backlink"><b><a href="#cite_ref-2">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFKolata2008" class="citation news cs1">Kolata, Gina (February 12, 2008). <a rel="nofollow" class="external text" href="https://www.nytimes.com/2008/02/12/health/research/12musc.html">"Finding May Solve Riddle of Fatigue in Muscles"</a>. <i>The New York Times</i>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+New+York+Times&rft.atitle=Finding+May+Solve+Riddle+of+Fatigue+in+Muscles&rft.date=2008-02-12&rft.aulast=Kolata&rft.aufirst=Gina&rft_id=https%3A%2F%2Fwww.nytimes.com%2F2008%2F02%2F12%2Fhealth%2Fresearch%2F12musc.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWeakness" class="Z3988"></span></span>
</li>
<li id="cite_note-3"><span class="mw-cite-backlink"><b><a href="#cite_ref-3">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFRopper,_Allan_H.Samuels,_Martin_A.2009" class="citation book cs1"><a href="/w/index.php?title=Chapter_24._Fatigue,_Asthenia,_Anxiety,_and_Depressive_Reactions&action=edit&redlink=1" class="new" title="Chapter 24. Fatigue, Asthenia, Anxiety, and Depressive Reactions (page does not exist)">Ropper, Allan H.</a>; Samuels, Martin A. (2009). <i>Adams and Victor's Principles of Neurology, Ninth Edition</i>. McGraw-Hill. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0071499927" title="Special:BookSources/978-0071499927"><bdi>978-0071499927</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Adams+and+Victor%27s+Principles+of+Neurology%2C+Ninth+Edition&rft.pub=McGraw-Hill&rft.date=2009&rft.isbn=978-0071499927&rft.au=Ropper%2C+Allan+H.&rft.au=Samuels%2C+Martin+A.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWeakness" class="Z3988"></span></span>
</li>
<li id="cite_note-4"><span class="mw-cite-backlink"><b><a href="#cite_ref-4">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFPaulWoodBehanMaclaren1999" class="citation journal cs1">Paul L, Wood L, Behan WM, Maclaren WM (January 1999). "Demonstration of delayed recovery from fatiguing exercise in chronic fatigue syndrome". <i>Eur. J. Neurol</i>. <b>6</b> (1): 63–9. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1046%2Fj.1468-1331.1999.610063.x">10.1046/j.1468-1331.1999.610063.x</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/10209352">10209352</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:33480143">33480143</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Eur.+J.+Neurol.&rft.atitle=Demonstration+of+delayed+recovery+from+fatiguing+exercise+in+chronic+fatigue+syndrome&rft.volume=6&rft.issue=1&rft.pages=63-9&rft.date=1999-01&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A33480143%23id-name%3DS2CID&rft_id=info%3Apmid%2F10209352&rft_id=info%3Adoi%2F10.1046%2Fj.1468-1331.1999.610063.x&rft.aulast=Paul&rft.aufirst=L&rft.au=Wood%2C+L&rft.au=Behan%2C+WM&rft.au=Maclaren%2C+WM&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWeakness" class="Z3988"></span></span>
</li>
<li id="cite_note-5"><span class="mw-cite-backlink"><b><a href="#cite_ref-5">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFMcCullyNatelson1999" class="citation journal cs1">McCully KK, Natelson BH (November 1999). "Impaired oxygen delivery to muscle in chronic fatigue syndrome". <i>Clin. Sci</i>. <b>97</b> (5): 603–8, discussion 611–3. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1042%2FCS19980372">10.1042/CS19980372</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/10545311">10545311</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clin.+Sci.&rft.atitle=Impaired+oxygen+delivery+to+muscle+in+chronic+fatigue+syndrome&rft.volume=97&rft.issue=5&rft.pages=603-8%2C+discussion+611-3&rft.date=1999-11&rft_id=info%3Adoi%2F10.1042%2FCS19980372&rft_id=info%3Apmid%2F10545311&rft.aulast=McCully&rft.aufirst=KK&rft.au=Natelson%2C+BH&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWeakness" class="Z3988"></span></span>
</li>
<li id="cite_note-6"><span class="mw-cite-backlink"><b><a href="#cite_ref-6">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFDe_BeckerRoeykensReyndersMcGregor2000" class="citation journal cs1">De Becker P, Roeykens J, Reynders M, McGregor N, De Meirleir K (November 2000). <a rel="nofollow" class="external text" href="https://web.archive.org/web/20110812232955/http://archinte.ama-assn.org/cgi/content/full/160/21/3270">"Exercise capacity in chronic fatigue syndrome"</a>. <i>Arch. Intern. Med</i>. <b>160</b> (21): 3270–7. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1001%2Farchinte.160.21.3270">10.1001/archinte.160.21.3270</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/11088089">11088089</a>. Archived from <a rel="nofollow" class="external text" href="http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=11088089">the original</a> on 2011-08-12<span class="reference-accessdate">. Retrieved <span class="nowrap">2011-03-12</span></span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Arch.+Intern.+Med.&rft.atitle=Exercise+capacity+in+chronic+fatigue+syndrome&rft.volume=160&rft.issue=21&rft.pages=3270-7&rft.date=2000-11&rft_id=info%3Adoi%2F10.1001%2Farchinte.160.21.3270&rft_id=info%3Apmid%2F11088089&rft.aulast=De+Becker&rft.aufirst=P&rft.au=Roeykens%2C+J&rft.au=Reynders%2C+M&rft.au=McGregor%2C+N&rft.au=De+Meirleir%2C+K&rft_id=http%3A%2F%2Farchinte.ama-assn.org%2Fcgi%2Fpmidlookup%3Fview%3Dlong%26pmid%3D11088089&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWeakness" class="Z3988"></span></span>
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<li id="cite_note-7"><span class="mw-cite-backlink"><b><a href="#cite_ref-7">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFDe_BeckerMcGregorDe_Meirleir2001" class="citation journal cs1">De Becker P, McGregor N, De Meirleir K (September 2001). <a rel="nofollow" class="external text" href="https://doi.org/10.1046%2Fj.1365-2796.2001.00890.x">"A definition-based analysis of symptoms in a large cohort of patients with chronic fatigue syndrome"</a>. <i>J. Intern. Med</i>. <b>250</b> (3): 234–40. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1046%2Fj.1365-2796.2001.00890.x">10.1046/j.1365-2796.2001.00890.x</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/11555128">11555128</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J.+Intern.+Med.&rft.atitle=A+definition-based+analysis+of+symptoms+in+a+large+cohort+of+patients+with+chronic+fatigue+syndrome&rft.volume=250&rft.issue=3&rft.pages=234-40&rft.date=2001-09&rft_id=info%3Adoi%2F10.1046%2Fj.1365-2796.2001.00890.x&rft_id=info%3Apmid%2F11555128&rft.aulast=De+Becker&rft.aufirst=P&rft.au=McGregor%2C+N&rft.au=De+Meirleir%2C+K&rft_id=https%3A%2F%2Fdoi.org%2F10.1046%252Fj.1365-2796.2001.00890.x&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWeakness" class="Z3988"></span></span>
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<li id="cite_note-8"><span class="mw-cite-backlink"><b><a href="#cite_ref-8">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFCarruthersJainDe_MeirleirPeterson2003" class="citation book cs1">Carruthers, Bruce M.; Jain, Anil Kumar; De Meirleir, Kenny L.; Peterson, Daniel L.; Klimas, Nancy G.; et al. (2003). <i>Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols</i>. Vol. 11. pp. 7–115. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1300%2FJ092v11n01_02">10.1300/J092v11n01_02</a>. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-7890-2207-3" title="Special:BookSources/978-0-7890-2207-3"><bdi>978-0-7890-2207-3</bdi></a>. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://www.worldcat.org/issn/1057-3321">1057-3321</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Myalgic+Encephalomyelitis%2FChronic+Fatigue+Syndrome%3A+Clinical+Working+Case+Definition%2C+Diagnostic+and+Treatment+Protocols&rft.pages=7-115&rft.date=2003&rft.issn=1057-3321&rft_id=info%3Adoi%2F10.1300%2FJ092v11n01_02&rft.isbn=978-0-7890-2207-3&rft.aulast=Carruthers&rft.aufirst=Bruce+M.&rft.au=Jain%2C+Anil+Kumar&rft.au=De+Meirleir%2C+Kenny+L.&rft.au=Peterson%2C+Daniel+L.&rft.au=Klimas%2C+Nancy+G.&rft.au=Lerner%2C+A.+Martin&rft.au=Bested%2C+Alison+C.&rft.au=Flor-Henry%2C+Pierre&rft.au=Joshi%2C+Pradip&rft.au=Powles%2C+A.+C.+Peter&rft.au=Sherkey%2C+Jeffrey+A.&rft.au=van+de+Sande%2C+Marjorie+I.&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWeakness" class="Z3988"></span> <span class="cs1-visible-error citation-comment"><code class="cs1-code">{{<a href="/wiki/Template:Cite_book" title="Template:Cite book">cite book</a>}}</code>: </span><span class="cs1-visible-error citation-comment"><code class="cs1-code">|journal=</code> ignored (<a href="/wiki/Help:CS1_errors#periodical_ignored" title="Help:CS1 errors">help</a>)</span></span>
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<li id="cite_note-9"><span class="mw-cite-backlink"><b><a href="#cite_ref-9">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFJammesSteinbergMambriniBrégeon2005" class="citation journal cs1">Jammes Y, Steinberg JG, Mambrini O, Brégeon F, Delliaux S (March 2005). <a rel="nofollow" class="external text" href="https://doi.org/10.1111%2Fj.1365-2796.2005.01452.x">"Chronic fatigue syndrome: assessment of increased oxidative stress and altered muscle excitability in response to incremental exercise"</a>. <i>J. Intern. Med</i>. <b>257</b> (3): 299–310. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1111%2Fj.1365-2796.2005.01452.x">10.1111/j.1365-2796.2005.01452.x</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/15715687">15715687</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=J.+Intern.+Med.&rft.atitle=Chronic+fatigue+syndrome%3A+assessment+of+increased+oxidative+stress+and+altered+muscle+excitability+in+response+to+incremental+exercise&rft.volume=257&rft.issue=3&rft.pages=299-310&rft.date=2005-03&rft_id=info%3Adoi%2F10.1111%2Fj.1365-2796.2005.01452.x&rft_id=info%3Apmid%2F15715687&rft.aulast=Jammes&rft.aufirst=Y&rft.au=Steinberg%2C+JG&rft.au=Mambrini%2C+O&rft.au=Br%C3%A9geon%2C+F&rft.au=Delliaux%2C+S&rft_id=https%3A%2F%2Fdoi.org%2F10.1111%252Fj.1365-2796.2005.01452.x&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWeakness" class="Z3988"></span></span>
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<li id="cite_note-10"><span class="mw-cite-backlink"><b><a href="#cite_ref-10">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFKauffmanKemmis2014" class="citation cs2">Kauffman, Timothy L.; Kemmis, Karen (2014-01-01), Kauffman, Timothy L.; Scott, Ron; Barr, John O.; Moran, Michael L. (eds.), <a rel="nofollow" class="external text" href="https://www.sciencedirect.com/science/article/pii/B9780702045882000164">"Chapter 16 - Muscle weakness and therapeutic exercise"</a>, <i>A Comprehensive Guide to Geriatric Rehabilitation (Third Edition)</i>, Oxford: Churchill Livingstone, pp. 112–119, <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-7020-4588-2" title="Special:BookSources/978-0-7020-4588-2"><bdi>978-0-7020-4588-2</bdi></a><span class="reference-accessdate">, retrieved <span class="nowrap">2023-11-19</span></span></cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=A+Comprehensive+Guide+to+Geriatric+Rehabilitation+%28Third+Edition%29&rft.atitle=Chapter+16+-+Muscle+weakness+and+therapeutic+exercise&rft.pages=112-119&rft.date=2014-01-01&rft.isbn=978-0-7020-4588-2&rft.aulast=Kauffman&rft.aufirst=Timothy+L.&rft.au=Kemmis%2C+Karen&rft_id=https%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FB9780702045882000164&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWeakness" class="Z3988"></span></span>
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<li id="cite_note-:0-11"><span class="mw-cite-backlink">^ <a href="#cite_ref-:0_11-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-:0_11-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFSaguil2005" class="citation journal cs1">Saguil, Aaron (2005-04-01). <a rel="nofollow" class="external text" href="https://www.aafp.org/pubs/afp/issues/2005/0401/p1327.html">"Evaluation of the Patient with Muscle Weakness"</a>. <i>American Family Physician</i>. <b>71</b> (7): 1327–1336. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/15832536">15832536</a>. <q>Asthenia is a sense of weariness or exhaustion in the absence of muscle weakness.</q></cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=American+Family+Physician&rft.atitle=Evaluation+of+the+Patient+with+Muscle+Weakness&rft.volume=71&rft.issue=7&rft.pages=1327-1336&rft.date=2005-04-01&rft_id=info%3Apmid%2F15832536&rft.aulast=Saguil&rft.aufirst=Aaron&rft_id=https%3A%2F%2Fwww.aafp.org%2Fpubs%2Fafp%2Fissues%2F2005%2F0401%2Fp1327.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWeakness" class="Z3988"></span></span>
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<li id="cite_note-12"><span class="mw-cite-backlink"><b><a href="#cite_ref-12">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://patient.info/signs-symptoms/tiredness-fatigue/muscle-weakness">"Muscle Weakness and Fatigue | Causes and Treatment"</a>. <i>patient.info</i>. 2021-06-28<span class="reference-accessdate">. Retrieved <span class="nowrap">2023-11-19</span></span>. <q>Muscle tiredness: This is sometimes called asthenia. It is a sense of weariness or exhaustion that you feel when using the muscle. The muscle isn't genuinely weaker, it can still do its job but it takes you more effort to manage it.</q></cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=patient.info&rft.atitle=Muscle+Weakness+and+Fatigue+%7C+Causes+and+Treatment&rft.date=2021-06-28&rft_id=https%3A%2F%2Fpatient.info%2Fsigns-symptoms%2Ftiredness-fatigue%2Fmuscle-weakness&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWeakness" class="Z3988"></span></span>
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<li id="cite_note-13"><span class="mw-cite-backlink"><b><a href="#cite_ref-13">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://pubchem.ncbi.nlm.nih.gov/compound/ritonavir">"PubChem Compound Summary for CID 392622, Ritonavir"</a>. <i>NCBI</i>. 28 November 2022<span class="reference-accessdate">. Retrieved <span class="nowrap">28 November</span> 2022</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=NCBI&rft.atitle=PubChem+Compound+Summary+for+CID+392622%2C+Ritonavir&rft.date=2022-11-28&rft_id=https%3A%2F%2Fpubchem.ncbi.nlm.nih.gov%2Fcompound%2Fritonavir&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWeakness" class="Z3988"></span></span>
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<li id="cite_note-14"><span class="mw-cite-backlink"><b><a href="#cite_ref-14">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFGandeviaEnokaMcComasStuart1995" class="citation book cs1">Gandevia SC, Enoka RM, McComas AJ, Stuart DG, Thomas CK (1995). "Neurobiology of Muscle Fatigue". <i>Fatigue</i>. Advances in Experimental Medicine and Biology. Vol. 384. pp. 515–25. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1007%2F978-1-4899-1016-5_39">10.1007/978-1-4899-1016-5_39</a>. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-4899-1018-9" title="Special:BookSources/978-1-4899-1018-9"><bdi>978-1-4899-1018-9</bdi></a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/8585476">8585476</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Neurobiology+of+Muscle+Fatigue&rft.btitle=Fatigue&rft.series=Advances+in+Experimental+Medicine+and+Biology&rft.pages=515-25&rft.date=1995&rft_id=info%3Apmid%2F8585476&rft_id=info%3Adoi%2F10.1007%2F978-1-4899-1016-5_39&rft.isbn=978-1-4899-1018-9&rft.aulast=Gandevia&rft.aufirst=SC&rft.au=Enoka%2C+RM&rft.au=McComas%2C+AJ&rft.au=Stuart%2C+DG&rft.au=Thomas%2C+CK&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWeakness" class="Z3988"></span></span>
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<li id="cite_note-15"><span class="mw-cite-backlink"><b><a href="#cite_ref-15">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFKent-Braun_JA1999" class="citation journal cs1">Kent-Braun JA (1999). "Central and peripheral contributions to muscle fatigue in humans during sustained maximal effort". <i>European Journal of Applied Physiology and Occupational Physiology</i>. <b>80</b> (1): 57–63. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1007%2Fs004210050558">10.1007/s004210050558</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/10367724">10367724</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:22515865">22515865</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=European+Journal+of+Applied+Physiology+and+Occupational+Physiology&rft.atitle=Central+and+peripheral+contributions+to+muscle+fatigue+in+humans+during+sustained+maximal+effort&rft.volume=80&rft.issue=1&rft.pages=57-63&rft.date=1999&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A22515865%23id-name%3DS2CID&rft_id=info%3Apmid%2F10367724&rft_id=info%3Adoi%2F10.1007%2Fs004210050558&rft.au=Kent-Braun+JA&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWeakness" class="Z3988"></span></span>
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<li id="cite_note-16"><span class="mw-cite-backlink"><b><a href="#cite_ref-16">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFGandevia_SC2001" class="citation journal cs1">Gandevia SC (2001). "Spinal and supraspinal factors in human muscle fatigue". <i>Physiol. Rev</i>. <b>81</b> (4): 1725–89. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1152%2Fphysrev.2001.81.4.1725">10.1152/physrev.2001.81.4.1725</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/11581501">11581501</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Physiol.+Rev.&rft.atitle=Spinal+and+supraspinal+factors+in+human+muscle+fatigue&rft.volume=81&rft.issue=4&rft.pages=1725-89&rft.date=2001&rft_id=info%3Adoi%2F10.1152%2Fphysrev.2001.81.4.1725&rft_id=info%3Apmid%2F11581501&rft.au=Gandevia+SC&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWeakness" class="Z3988"></span></span>
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<li id="cite_note-17"><span class="mw-cite-backlink"><b><a href="#cite_ref-17">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFKayMarinoCannonSt_Clair_Gibson2001" class="citation journal cs1">Kay D, Marino FE, Cannon J, St Clair Gibson A, Lambert MI, Noakes TD (2001). "Evidence for neuromuscular fatigue during high-intensity cycling in warm, humid conditions". <i>Eur. J. Appl. Physiol</i>. <b>84</b> (1–2): 115–21. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1007%2Fs004210000340">10.1007/s004210000340</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/11394239">11394239</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:25906759">25906759</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Eur.+J.+Appl.+Physiol.&rft.atitle=Evidence+for+neuromuscular+fatigue+during+high-intensity+cycling+in+warm%2C+humid+conditions&rft.volume=84&rft.issue=1%E2%80%932&rft.pages=115-21&rft.date=2001&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A25906759%23id-name%3DS2CID&rft_id=info%3Apmid%2F11394239&rft_id=info%3Adoi%2F10.1007%2Fs004210000340&rft.aulast=Kay&rft.aufirst=D&rft.au=Marino%2C+FE&rft.au=Cannon%2C+J&rft.au=St+Clair+Gibson%2C+A&rft.au=Lambert%2C+MI&rft.au=Noakes%2C+TD&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWeakness" class="Z3988"></span></span>
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<li id="cite_note-18"><span class="mw-cite-backlink"><b><a href="#cite_ref-18">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFVandewalleMatonLe_BozecGuerenbourg1991" class="citation journal cs1">Vandewalle H, Maton B, Le Bozec S, Guerenbourg G (1991). "An electromyographic study of an all-out exercise on a cycle ergometer". <i>Archives Internationales de Physiologie, de Biochimie et de Biophysique</i>. <b>99</b> (1): 89–93. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.3109%2F13813459109145909">10.3109/13813459109145909</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/1713492">1713492</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Archives+Internationales+de+Physiologie%2C+de+Biochimie+et+de+Biophysique&rft.atitle=An+electromyographic+study+of+an+all-out+exercise+on+a+cycle+ergometer&rft.volume=99&rft.issue=1&rft.pages=89-93&rft.date=1991&rft_id=info%3Adoi%2F10.3109%2F13813459109145909&rft_id=info%3Apmid%2F1713492&rft.aulast=Vandewalle&rft.aufirst=H&rft.au=Maton%2C+B&rft.au=Le+Bozec%2C+S&rft.au=Guerenbourg%2C+G&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWeakness" class="Z3988"></span></span>
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<li id="cite_note-19"><span class="mw-cite-backlink"><b><a href="#cite_ref-19">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFBigland-RitchieWoods1984" class="citation journal cs1">Bigland-Ritchie B, Woods JJ (1984). "Changes in muscle contractile properties and neural control during human muscular fatigue". <i>Muscle Nerve</i>. <b>7</b> (9): 691–9. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1002%2Fmus.880070902">10.1002/mus.880070902</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/6100456">6100456</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:13606531">13606531</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Muscle+Nerve&rft.atitle=Changes+in+muscle+contractile+properties+and+neural+control+during+human+muscular+fatigue&rft.volume=7&rft.issue=9&rft.pages=691-9&rft.date=1984&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A13606531%23id-name%3DS2CID&rft_id=info%3Apmid%2F6100456&rft_id=info%3Adoi%2F10.1002%2Fmus.880070902&rft.aulast=Bigland-Ritchie&rft.aufirst=B&rft.au=Woods%2C+JJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWeakness" class="Z3988"></span></span>
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<li id="cite_note-20"><span class="mw-cite-backlink"><b><a href="#cite_ref-20">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFNoakes_TD2000" class="citation journal cs1">Noakes TD (2000). "Physiological models to understand exercise fatigue and the adaptations that predict or enhance athletic performance". <i>Scandinavian Journal of Medicine & Science in Sports</i>. <b>10</b> (3): 123–45. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1034%2Fj.1600-0838.2000.010003123.x">10.1034/j.1600-0838.2000.010003123.x</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/10843507">10843507</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:23103331">23103331</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Scandinavian+Journal+of+Medicine+%26+Science+in+Sports&rft.atitle=Physiological+models+to+understand+exercise+fatigue+and+the+adaptations+that+predict+or+enhance+athletic+performance&rft.volume=10&rft.issue=3&rft.pages=123-45&rft.date=2000&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A23103331%23id-name%3DS2CID&rft_id=info%3Apmid%2F10843507&rft_id=info%3Adoi%2F10.1034%2Fj.1600-0838.2000.010003123.x&rft.au=Noakes+TD&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWeakness" class="Z3988"></span></span>
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<li id="cite_note-21"><span class="mw-cite-backlink"><b><a href="#cite_ref-21">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFDavis_JM1995" class="citation journal cs1">Davis JM (1995). "Carbohydrates, branched-chain amino acids, and endurance: the central fatigue hypothesis". <i>International Journal of Sport Nutrition</i>. <b>5</b> (Suppl): S29–38. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1123%2Fijsn.5.s1.s29">10.1123/ijsn.5.s1.s29</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/7550256">7550256</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Journal+of+Sport+Nutrition&rft.atitle=Carbohydrates%2C+branched-chain+amino+acids%2C+and+endurance%3A+the+central+fatigue+hypothesis&rft.volume=5&rft.issue=Suppl&rft.pages=S29-38&rft.date=1995&rft_id=info%3Adoi%2F10.1123%2Fijsn.5.s1.s29&rft_id=info%3Apmid%2F7550256&rft.au=Davis+JM&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWeakness" class="Z3988"></span></span>
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<li id="cite_note-22"><span class="mw-cite-backlink"><b><a href="#cite_ref-22">^</a></b></span> <span class="reference-text">Newsholme, E. A., Acworth, I. N., & Blomstrand, E. 1987, 'Amino acids, brain neurotransmitters and a functional link between muscle and brain that is important in sustained exercise', in G Benzi (ed.), Advances in Myochemistry, Libbey Eurotext, London, pp. 127-133.</span>
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<li id="cite_note-23"><span class="mw-cite-backlink"><b><a href="#cite_ref-23">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFNewsholmeBlomstrand1995" class="citation book cs1">Newsholme EA, Blomstrand E (1995). "Tryptophan, 5-Hydroxytryptamine and a Possible Explanation for Central Fatigue". <i>Fatigue</i>. Advances in Experimental Medicine and Biology. Vol. 384. pp. 315–20. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1007%2F978-1-4899-1016-5_25">10.1007/978-1-4899-1016-5_25</a>. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-4899-1018-9" title="Special:BookSources/978-1-4899-1018-9"><bdi>978-1-4899-1018-9</bdi></a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/8585461">8585461</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Tryptophan%2C+5-Hydroxytryptamine+and+a+Possible+Explanation+for+Central+Fatigue&rft.btitle=Fatigue&rft.series=Advances+in+Experimental+Medicine+and+Biology&rft.pages=315-20&rft.date=1995&rft_id=info%3Apmid%2F8585461&rft_id=info%3Adoi%2F10.1007%2F978-1-4899-1016-5_25&rft.isbn=978-1-4899-1018-9&rft.aulast=Newsholme&rft.aufirst=EA&rft.au=Blomstrand%2C+E&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWeakness" class="Z3988"></span></span>
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<li id="cite_note-robergs-24"><span class="mw-cite-backlink"><b><a href="#cite_ref-robergs_24-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1215172403"><cite id="CITEREFR._RobergsF._GhiasvandD._Parker2004" class="citation journal cs1">R. Robergs; F. Ghiasvand; D. Parker (2004). "Biochemistry of exercise-induced metabolic acidosis". <i>Am J Physiol Regul Integr Comp Physiol</i>. <b>287</b> (3): R502–16. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1152%2Fajpregu.00114.2004">10.1152/ajpregu.00114.2004</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/15308499">15308499</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:2745168">2745168</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Am+J+Physiol+Regul+Integr+Comp+Physiol&rft.atitle=Biochemistry+of+exercise-induced+metabolic+acidosis&rft.volume=287&rft.issue=3&rft.pages=R502-16&rft.date=2004&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A2745168%23id-name%3DS2CID&rft_id=info%3Apmid%2F15308499&rft_id=info%3Adoi%2F10.1152%2Fajpregu.00114.2004&rft.au=R.+Robergs&rft.au=F.+Ghiasvand&rft.au=D.+Parker&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWeakness" class="Z3988"></span></span>
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</ol></div></div>
<h2><span class="mw-headline" id="External_links">External links</span><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Weakness&action=edit&section=11" title="Edit section: External links"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></h2>
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margin:0.5em 0 0.5em 0;;padding:3px"><table class="nowraplinks navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q102186689" class="extiw" title="d:Q102186689">D</a></div><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/R53">R53</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10-CM" title="ICD-10-CM">10-CM</a></b>: <a rel="nofollow" class="external text" href="https://icdcodelookup.com/icd-10/codes/R53.1">R53.1</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a></b>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=728.87">728.87</a> (<a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=728.9">728.9</a> before 10/01/03); alternatively, <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=780.79">780.79</a></li><li><b><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></b>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D018908">D018908</a></li><li><b><a href="/wiki/Diseases_Database" title="Diseases Database">DiseasesDB</a></b>: <a rel="nofollow" class="external text" href="http://www.diseasesdatabase.com/ddb22832.htm">22832</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/MedlinePlus" title="MedlinePlus">MedlinePlus</a></b>: <a rel="nofollow" class="external text" href="https://www.nlm.nih.gov/medlineplus/ency/article/003174.htm">003174</a></li></ul></div></div></td></tr></tbody></table></div>
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<ul><li><a rel="nofollow" class="external text" href="http://www.mcardlesdisease.org">McArdle's disease</a></li></ul>
<div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1061467846"></div><div role="navigation" class="navbox" aria-labelledby="Symptoms_and_conditions_relating_to_muscle" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1063604349">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Myopathy" title="Template:Myopathy"><abbr title="View this template" style=";;background:none transparent;border:none;box-shadow:none;padding:0;">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Myopathy" title="Template talk:Myopathy"><abbr title="Discuss this template" style=";;background:none transparent;border:none;box-shadow:none;padding:0;">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Myopathy" title="Special:EditPage/Template:Myopathy"><abbr title="Edit this template" style=";;background:none transparent;border:none;box-shadow:none;padding:0;">e</abbr></a></li></ul></div><div id="Symptoms_and_conditions_relating_to_muscle" style="font-size:114%;margin:0 4em">Symptoms and <a href="/wiki/Myopathy" title="Myopathy">conditions</a> relating to <a href="/wiki/Muscle" title="Muscle">muscle</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Pain" title="Pain">Pain</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Myalgia" title="Myalgia">Myalgia</a>
<ul><li><a href="/wiki/Fibromyalgia" title="Fibromyalgia">Fibromyalgia</a></li>
<li><a href="/wiki/Acute_muscle_soreness" title="Acute muscle soreness">Acute</a></li>
<li><a href="/wiki/Delayed_onset_muscle_soreness" title="Delayed onset muscle soreness">Delayed onset</a></li></ul></li></ul>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Inflammation" title="Inflammation">Inflammation</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Myositis" title="Myositis">Myositis</a>
<ul><li><a href="/wiki/Pyomyositis" title="Pyomyositis">Pyomyositis</a></li></ul></li>
<li><a href="/wiki/Edema" title="Edema">Myoedema</a> (<a href="/wiki/Hypothyroidism" title="Hypothyroidism">Hypothyroid myopathy</a>)</li></ul>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Destruction</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Muscle_weakness" title="Muscle weakness">Muscle weakness</a></li>
<li><a href="/wiki/Rhabdomyolysis" title="Rhabdomyolysis">Rhabdomyolysis</a></li>
<li><a href="/wiki/Muscle_atrophy" title="Muscle atrophy">Muscle atrophy</a>/<a href="/wiki/Amyotrophy" title="Amyotrophy">Amyotrophy</a></li></ul>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Low ATP reservoir</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Muscle_fatigue" title="Muscle fatigue">Muscle fatigue</a></li>
<li><a href="/wiki/Exercise_intolerance" title="Exercise intolerance">Exercise intolerance</a></li>
<li><a href="/w/index.php?title=Myogenic_hyperuricemia&action=edit&redlink=1" class="new" title="Myogenic hyperuricemia (page does not exist)">Myogenic hyperuricemia</a></li>
<li><a href="/wiki/Symptoms#Dynamic_and_static" class="mw-redirect" title="Symptoms">Dynamic symptoms (exercise-induced)</a></li>
<li><a href="/wiki/Sinus_tachycardia#Metabolic_myopathy" title="Sinus tachycardia"> Inappropriate rapid heart rate response to exercise (tachycardia)</a></li>
<li><a href="/wiki/Cardiovascular_fitness" title="Cardiovascular fitness">Exaggerated cardiorespiratory response to exercise (tachycardia & tachypnea)</a></li>
<li><a href="/wiki/Hitting_the_wall" title="Hitting the wall">Hitting the wall</a></li>
<li><a href="/wiki/Second_wind" title="Second wind">Second wind</a></li>
<li>(<a href="/wiki/Metabolic_myopathy" title="Metabolic myopathy">Metabolic myopathies</a></li>
<li><a href="/wiki/Diabetes" title="Diabetes">Diabetes</a></li>
<li><a href="/wiki/Hypothyroidism" title="Hypothyroidism">Hypothyroid myopathy</a></li>
<li><a href="/wiki/Hyperthyroidism" title="Hyperthyroidism">Hyperthyroid myopathy</a></li>
<li><a href="/wiki/Hypoparathyroidism" title="Hypoparathyroidism">Hypoparathyroidism</a></li>
<li><a href="/wiki/Hypokalemia" title="Hypokalemia">Hypokalemia</a></li>
<li><a href="/wiki/Hypoxia_(medical)" class="mw-redirect" title="Hypoxia (medical)">Hypoxic muscle</a></li>
<li><a href="/wiki/Pseudohypoxia" title="Pseudohypoxia">Pseudohypoxia</a></li>
<li><a href="/wiki/Intermittent_claudication" title="Intermittent claudication">Intermittent claudication</a></li>
<li><a href="/wiki/Scurvy" title="Scurvy">Scurvy</a></li>
<li><a href="/wiki/Fasting" title="Fasting">Fasting</a> / <a href="/wiki/Starvation" title="Starvation">Starvation</a></li>
<li><a href="/wiki/Alcoholism" title="Alcoholism">Alcoholism</a>)</li></ul>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Abnormal movement</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Muscle_cramp" class="mw-redirect" title="Muscle cramp">Muscle cramp</a></li>
<li><a href="/wiki/Myokymia" title="Myokymia">Myokymia</a></li>
<li><a href="/wiki/Spasm" title="Spasm">Muscle spasm</a></li>
<li><a href="/wiki/Fasciculations" class="mw-redirect" title="Fasciculations">Fasciculations</a></li>
<li><a href="/wiki/Muscle_contracture" title="Muscle contracture">Muscle contracture</a>
<ul><li><a href="/wiki/Fibrosis" title="Fibrosis">Fibrosis</a></li>
<li><a href="/wiki/Adhesion_(medicine)" title="Adhesion (medicine)">Adhesion</a></li></ul></li>
<li><a href="/wiki/Myotonia" title="Myotonia">Myotonia</a>
<ul><li><a href="/wiki/Channelopathy" title="Channelopathy">Muscle channelopathies</a></li></ul></li>
<li><a href="/wiki/Myotonia" title="Myotonia">Pseudo-myotonia</a> (<a href="/wiki/Brody_myopathy" title="Brody myopathy">Brody myopathy</a>)</li>
<li><a href="/wiki/Spasticity" title="Spasticity">Spasticity</a></li>
<li><a href="/w/index.php?title=Rippling_muscle_disease&action=edit&redlink=1" class="new" title="Rippling muscle disease (page does not exist)">Rippling muscle disease</a></li>
<li><a href="/wiki/Periodic_paralysis" title="Periodic paralysis">Periodic paralysis</a></li>
<li><a href="/wiki/Hypotonia" title="Hypotonia">Hypotonia</a> / <a href="/wiki/Hypertonia" title="Hypertonia">Hypertonia</a></li></ul>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Myositis_ossificans" title="Myositis ossificans">Myositis ossificans</a>
<ul><li><a href="/wiki/Fibrodysplasia_ossificans_progressiva" title="Fibrodysplasia ossificans progressiva">Fibrodysplasia ossificans progressiva</a></li></ul></li>
<li><a href="/wiki/Compartment_syndrome" title="Compartment syndrome">Compartment syndrome</a>
<ul><li><a href="/wiki/Anterior_compartment_syndrome_of_the_lower_leg" class="mw-redirect" title="Anterior compartment syndrome of the lower leg">Anterior</a></li></ul></li>
<li><a href="/wiki/Diastasis_(pathology)" title="Diastasis (pathology)">Diastasis of muscle</a>
<ul><li><a href="/wiki/Diastasis_recti" title="Diastasis recti">Diastasis recti</a></li></ul></li>
<li><a href="/wiki/Pseudoathletic_appearance" title="Pseudoathletic appearance">Pseudoathletic appearance</a> (<a href="/wiki/Hyperplasia" title="Hyperplasia">Muscle hyperplasia</a> / <a href="/wiki/Muscle_hypertrophy" title="Muscle hypertrophy">Muscle hypertrophy</a> / <a href="/wiki/Pseudohypertrophy" title="Pseudohypertrophy">Pseudohypertrophy</a>)</li></ul>
</div></td></tr></tbody></table></div>
<div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1061467846"></div><div role="navigation" class="navbox" aria-labelledby="Common_cold" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1063604349"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Common_cold" title="Template:Common cold"><abbr title="View this template" style=";;background:none transparent;border:none;box-shadow:none;padding:0;">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Common_cold" title="Template talk:Common cold"><abbr title="Discuss this template" style=";;background:none transparent;border:none;box-shadow:none;padding:0;">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Common_cold" title="Special:EditPage/Template:Common cold"><abbr title="Edit this template" style=";;background:none transparent;border:none;box-shadow:none;padding:0;">e</abbr></a></li></ul></div><div id="Common_cold" style="font-size:114%;margin:0 4em"><a href="/wiki/Common_cold" title="Common cold">Common cold</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Virus" title="Virus">Viruses</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Adenoviridae" title="Adenoviridae">Adenovirus</a></li>
<li><a href="/wiki/Coronavirus" title="Coronavirus">Coronavirus</a></li>
<li><a href="/wiki/Enterovirus" title="Enterovirus">Enterovirus</a></li>
<li><a href="/wiki/Rhinovirus" title="Rhinovirus">Rhinovirus</a></li></ul>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Symptom" class="mw-redirect" title="Symptom">Symptoms</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Cough" title="Cough">Cough</a></li>
<li><a href="/wiki/Fatigue" title="Fatigue">Fatigue</a></li>
<li><a href="/wiki/Fever" title="Fever">Fever</a></li>
<li><a href="/wiki/Headache" title="Headache">Headache</a></li>
<li><a href="/wiki/Anorexia_(symptom)" title="Anorexia (symptom)">Loss of appetite</a></li>
<li><a href="/wiki/Malaise" title="Malaise">Malaise</a></li>
<li><a href="/wiki/Myalgia" title="Myalgia">Muscle aches</a></li>
<li><a href="/wiki/Nasal_congestion" title="Nasal congestion">Nasal congestion</a></li>
<li><a href="/wiki/Rhinorrhea" title="Rhinorrhea">Rhinorrhea</a></li>
<li><a href="/wiki/Sneeze" title="Sneeze">Sneezing</a></li>
<li><a href="/wiki/Sore_throat" title="Sore throat">Sore throat</a></li>
<li><a class="mw-selflink selflink">Weakness</a></li></ul>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Complication_(medicine)" title="Complication (medicine)">Complications</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Acute_bronchitis" title="Acute bronchitis">Acute bronchitis</a></li>
<li><a href="/wiki/Bronchiolitis" title="Bronchiolitis">Bronchiolitis</a></li>
<li><a href="/wiki/Croup" title="Croup">Croup</a></li>
<li><a href="/wiki/Otitis_media" title="Otitis media">Otitis media</a></li>
<li><a href="/wiki/Pharyngitis" title="Pharyngitis">Pharyngitis</a></li>
<li><a href="/wiki/Pneumonia" title="Pneumonia">Pneumonia</a></li>
<li><a href="/wiki/Sinusitis" title="Sinusitis">Sinusitis</a></li>
<li><a href="/wiki/Streptococcal_pharyngitis" title="Streptococcal pharyngitis">Strep throat</a></li></ul>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Drugs</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="/wiki/Antiviral_drug" title="Antiviral drug">Antiviral drugs</a></li>
<li><a href="/wiki/Pleconaril" title="Pleconaril">Pleconaril</a> <i>(experimental)</i></li></ul>
</div></td></tr></tbody></table></div> </div>' |
Whether or not the change was made through a Tor exit node (tor_exit_node) | false |
Unix timestamp of change (timestamp) | '1714614659' |
