<Go to node 4>

<End Node 3>

<End Node 4>

Myopathic EMG confirms muscle disease and excludes ALS
Repetitive nerve stimulation indicates MG
CK elevation supports myopathy

May need DNA testing for further distinction of inherited myopathies

Muscle biopsy will help distinguish many disorders

Patterns of Weakness on Neurologic Exam

Proximal > distal
PM; DM; muscular dystrophies; mitochondrial and metabolic myopathies; toxic, endocrine myopathies

Ptosis, EOMs
OPMD; mitochondrial myopathy; myotubular myopathy

Facial and scapular winging
(FSHD)

Facial, distal, quadriceps; handgrip myotonia
Myotonic muscular dystrophy

Proximal & distal (hand grip), & quadriceps
IBM

Distal
Distal myopathy

Dropped head
MG; PM; ALS; hyperparathyroid