Disease, aging and inactivity will make your muscles atrophied.There will be less nutrient absorption and blood flow as your muscles shrink. Estimating muscle atrophy with girth measurements was more accurate in the male versus the female subjects. Symptoms vary, and treatment may include physical therapy, functional electric stimulation, or surgery. Dr., MD E. Stålberg. The initial manifestation is weakness and atrophy of the muscles of the lower leg, which gradually spreads upwards but always spares the quadriceps even when the other muscles are severely affected. The quadriceps are such a power house in the lower extremities. They contract together to help flex (or lift up) the hip and extend (or straighten) the knee. Early quadriceps strength loss after total knee arthroplasty. There is also a tendency to brace the affected joint to alleviate pain and all this can lead to atrophy of the muscles from reduced use. The truth is — all of the exercises provided by your PT/strength coach can probably help you to re-build quad strength…. J Sport Health Sci. The initial manifestation is weakness and atrophy of the muscles of the lower leg, which gradually spreads upwards but always spares the quadriceps even when the other muscles … Results: Preoperatively, all 19 patients demonstrated significant atrophy of the ipsilateral compared with the contralateral quadriceps muscle (P = 1.8 x 10(-7)) on muscle ultrasound, which persisted at 5 months follow up (P = 0.009). The main cause of muscle wasting is a lack of physical activity. The anterior cruciate ligament also termed the ACL in short is a tough band in the knee connecting the femur to the tibia bones; that controls the forward movement of the knee joint. Am J Phys Med Rehabil. 2005 May;87(5):1047-53. doi: 10.2106/JBJS.D.01992. The Relationship Between Quadriceps Muscle Atrophy and Proprioception Function in Knee Osteoarthritis Patients. Proximal lower limb amyotrophy. 8 in people with ACL deficiency, though no relation between atrophy and strength was identified. However, an important determinant of this weakness is arthrogenic muscle inhibition (AMI) - an ongoing neural inhibition that prevents the quadriceps muscles from being fully activated [12–14]. This includes neurodegenerative condi ... Read More. From - Evidence Informed Muscle Manual - https://prohealthsys.com/central/ for more trusted resources, patient forms and video content Tear (partial) of rectus femoris. Clipboard, Search History, and several other advanced features are temporarily unavailable. selective atrophy of type 1 muscle fibers [8,9], selective atrophy of type 2 fibers in the lateral vastus muscle [10] ... and quadriceps muscle of the affected and contralateral healthy limb. There was improvement in hip pain postoperatively and a significant improvement in the TUG test (P = 0.007). Increased Muscle Strength Limits Postural Sway During Daily Living Activities in Total Hip Arthroplasty Patients. 1 One theory is that pain causes reflex inhibition of the quadriceps, which in time induces an atrophic response within the muscle with subsequent loss of muscle size. The quadriceps femoris muscle in 20–70‐year‐old subjects: Relationship between knee extension torque, electrophysiological parameters, and muscle fiber characteristics . For this reason, it is important to learn how to strengthen this muscle group for a complete recovery. selective atrophy of type 1 muscle fibers [8,9], selective atrophy of type 2 fibers in the lateral vastus muscle [10] ... and quadriceps muscle of the affected and contralateral healthy limb. The contours and strength of the other skeletal muscles were normal. These muscles are utilized in jumping, climbing and standing from a seated position. Twelve patients had ipsilateral needle quadriceps biopsy for muscle morphology and bilateral quadriceps muscle thickness ultrasound preoperatively, 5 days and 4 weeks postoperatively and a further muscle thickness measurement at 5 months. Muscle atrophy is when muscles waste away. Inclusion body myositis patients often have visible atrophy of the vastus medialis and vastus lateralis, the medial (inner) and lateral (outer) muscles on either side of the thigh. Oddly, people who have hypochondria related to MS or ALS have somehow formulated the idea that an early sign of muscle atrophy is some little depression or groove in the muscle. According to this study it seems that quadriceps muscle atrophy plays an important role as a poor prognostic factor of knee ligament … Prevention and treatment information (HHS). Muscle-specific atrophy of the quadriceps femoris with aging. Quadriceps: Atrophy with normal strength. To determine whether additional muscle fibre wasting of the ipsilateral vastus lateralis muscle occurs in the early postoperative period after total hip arthroplasty for osteoarthritis of the hip and whether there is an improvement in preoperative measures of quadriceps muscle thickness, strength, pain and function over a 5-month postoperative period. Femoral neuropathy Diabetic amyotrophy; L3-L4 radiculopathy Lumbo-Sacral plexopathies: Especially neoplastic Quadriceps atrophy Inclusion body myositis. The quads often become weak after an injury is sustained or surgery is performed on the lower leg or thigh. Quadriceps: Atrophy with normal strength. Muscle atrophy can occur due to poor nutrition, age, and genetics. Quadriceps dysfunction after anterior cruciate ligament (ACL) reconstruction is common and may affect return to sport due to resulting muscle atrophy and muscle weakness. The quad has been shown to exhibit a 12% reduction in cross sectional area, representing atrophy, in patients with knee arthritis. This study examined the roles of atrophy and activation failure in quadriceps weakness after anterior cruciate ligament reconstruction.Case series.Twenty patients six months post-anterior cruciate ligament reconstruction participated. Muscle Atrophy. Privacy, Help Atrophy simply means to shrink in size. Atrophy of the quadriceps muscle in children with a painful hip. 54 years experience Neurosurgery. Kent-Braun and Le Blanc, Muscle Nerve 19: 861-69, 1996. 3. Miyoshi muscular dystrophy 3. However, many injuries contribute to the quadriceps atrophy. Find the cause: Many conditions, in addition to aging (which normally is accompanied by mild cortical atrophy) can lead to this. quadriceps atrophy treatment. 3 doctors agree. These alterations could be caused by hypo activity and an altered anatomical axis of the diseased limb and increased overload of the healthy limb. In clinical reexamination the patients with quadriceps atrophy were placed significantly more often in groups of fair or poor healing than the patients with normal quadriceps muscle, and they had also more posttraumatic osteoarthritic changes in the injured knee. For instance, most athletic people have strong quadricep muscles from frequent exercise, so when those muscles atrophy and you experience knee instability, it can be especially frustrating. 3 doctors agree. This atrophy may persist despite the patient's ability to return to athletic competition. … Fractures of the femur lead to immobilization of the limb. 2016 May 17;17:212. doi: 10.1186/s12891-016-1070-3. Lorsque le nombre de ces fibres diminue, le muscle perd en volume et en force, ce qui conduit à une amyotrophie . Muscle atrophy is defined as the wasting, or loss, of muscle mass. Quadriceps-dominant muscle atrophy was marked in the elderly women with radiographic osteoarthritis. 8600 Rockville Pike It’s usually caused by a lack of physical activity. Winther SB, Foss OA, Klaksvik J, Husby VS. Am J Phys Med Rehabil. Author information: (1)Department of Pediatric Radiology, Sophia Children's Hospital, Rotterdam, The Netherlands. Methods: Robben SG (1), Lequin MH, Meradji M, Diepstraten AF, Hop WC. Due to pain at the knee associated with osteoarthritis, there could be an inhibitory reflex that reduces the limbs function. Atrophy simply means to shrink in size. Quadriceps muscle wasting is a common clinical observation in patients with lower limb disease, injury, or as a result of immobilisation. CROGVQuadriceps muscle atrophy. The tone of the quadriceps plays a vital role in strengthening the knee joint. Il s'agit des muscles dont la contraction est volontaire tel que le biceps, le triceps, le quadriceps ou les abdominaux. IF they’re being performed properly. BMC Musculoskelet Disord. Gout; Rheumatoid arthritis. December 2019; Surabaya Physical … Muscle atrophy is the loss of skeletal muscle mass. Quadriceps muscle atrophy. This joint is called the patellofemoral joint. There is significant ipsilateral quadriceps atrophy and weakness with 2A and 2B fibre atrophy preoperatively in patients with osteoarthritis of the hip with exacerbation and further atrophy of all three fibre types 5 days postoperatively. Patellofemoral dysfunction is commonly eCollection 2018. A 30-year-old female asked: what is the treatment of mild cortical atrophy? Quadriceps muscle atrophy and long-term recovery after knee ligamentous injury.Quadriceps: Atrophy with normal strength. The quadriceps are made-up of 4 different muscles which are the rectus femoris, vastus lateralis, vastus intermedius and vastus medialis which merge to form one strong tendon known as the patella tendon. They contract together to help flex (or lift up) the hip and extend (or straighten) the knee. Tear (partial) of rectus femoris Causes Trauma: Usually 2° with muscle stretch Spontaneous: Middle or late age.Muscle atrophy can occur due to poor nutrition, age, and genetics. Ikeda T, Jinno T, Masuda T, Aizawa J, Ninomiya K, Suzuki K, Hirakawa K. Hong Kong Physiother J. Unspecified diagnosis codes like M62.559 are acceptable when clinical information is unknown or not available about a particular condition. As well as being a direct cause of quadriceps weakness [ 13 ], AMI may contribute to muscle atrophy [ 15 ] and, in more severe cases, can prevent effective quadriceps strengthening [ 16 – 18 ]. Dr. Edward Smith answered. Patients did note significant improvement in pain postoperatively and improvement on functional assessment with the TUG test. Quadriceps muscle atrophy. Muscle atrophy in the quadriceps; If this is your first visit, be sure to check out the FAQ by clicking the link above. When a disease or injury makes it difficult or impossible for you … Thus, in conjunction with our ongoing studies of aging skeletal muscle, we thought it was necessary to address this issue in an aging population. Preoperatively, all 19 patients demonstrated significant atrophy of the ipsilateral compared with the contralateral quadriceps muscle (P = 1.8 x 10(-7)) on muscle ultrasound, which persisted at 5 months follow up (P = 0.009). There was distinct symmetrical atrophy of the entire quadriceps femoris muscle in both legs (Fig. Recently, using similar MRI methodology to that used in the present study, it has been shown, in a nonaging model of human muscle atrophy, that the individual muscles of the quadriceps femoris atrophy to varying degrees . Atrophy of the quadriceps musculature is frequently associated with chronic knee instability. Please enable it to take advantage of the complete set of features! Muscle atrophy is when muscles waste away. It can be caused by immobility, aging, malnutrition, medications, or a wide range of injuries or diseases that impact the musculoskeletal or nervous system. But the absence of gravity makes working in a spacecraft physically undemanding. However, you should speak with your healthcare team before … Maezawa K, Nozawa M, Yuasa T, Gomi M, Igarashi E, Sato H, Sugimoto M, Kaneko K. J Orthop. You may have to register before you can post: click the register link above to proceed. Renal failure. Nowhere in the annals of medical literature is muscle denting named as a sign of wasting muscle tissue or atrophy, or any kind of disease. Muscle atrophy leads to muscle weakness and causes disability. We assessed whether quadriceps muscle weakness and atrophy are associated with a differential expression profile of epigenetic events in patients with advanced COPD (chronic obstructive pulmonary disease). To assess quadriceps muscle atrophy, patients lay supine in a MRI scanner (Philips Achieva 3T Quasar Dual, Philips Electronics, Andover, MA, USA) for simultaneous, bilateral thigh scans. 0. To start viewing messages, select the forum that you want to visit from the selection below. Rectus femoris muscle atrophy. Dr. Edward Smith answered. However, it is difficult for clinicians to assess for quadriceps atrophy in people with bilateral symptoms. Ultrasound changes to intramuscular architecture of the quadriceps following intramedullary nailing. This includes neurodegenerative condi ... Read More. Atrophy of the quadriceps musculature is frequently associated with chronic knee instability. There are two main factors associated with loss of quad strength in patients with knee arthritis – atrophy and muscle inhibition. Quadriceps: Muscle atrophy. Purpose: To systematically review the available literature regarding the impact of perioperative and postoperative interventions on quadriceps atrophy and loss of strength after ACL reconstruction. Other therapeutic strategies may have to be developed to reverse disuse muscle atrophy. Your email address will not be published. This atrophy may persist despite the patient's ability to return to athletic competition. 2018 Jul 11;10:31-39. doi: 10.2147/ORR.S153451. These alterations could be caused by hypo activity and an altered anatomical axis of the diseased limb and increased overload of the healthy limb. Corresponding Author. Disorders of the patellofemoral joint comprise a large portion of the chronic knee complaints that are managed in orthopaedic and physical therapy clinics. Knee 2016 (in review). L’amyotrophie, ou myatrophie, est une atrophie musculaire, c’est-à-dire une diminution du volume musculaire. of quadriceps muscle weakness: atrophy and activation failure 16. 2020 Mar;9(2):152-159. doi: 10.1016/j.jshs.2019.07.001. The main symptoms are pain and tenderness at the top of the kneecap that gets worth with exercise, and weakness. Bethesda, MD 20894, Copyright Quadriceps atrophy begins once this is injured and has been found to be present even close to 6 months following its repair. For this reason, it is important to learn how to strengthen this muscle group for a complete recovery. Postoperative hemoglobin and recovery of hip muscle strength after total hip arthroplasty. 0 comment. There are two main factors associated with loss of quad strength in patients with knee arthritis – atrophy and muscle inhibition. The upper limb muscles become weak as the stage of the disease advances. Preoperative predictors for outcomes after total hip replacement in patients with osteoarthritis: a systematic review. Abnormality of the musculature of the thigh. Quadriceps Atrophy and Inhibition. Endocrine: Hyperparathyroidism; Diabetes; Anabolic steroids. Aims: The quads often become weak after an injury is sustained or surgery is performed on the lower leg or thigh. 8 Tendon and periosteal reflexes were normal, particularly the patellar reflexes. As an athlete or a weekend warrior, you most likely have strong quadricep muscles from frequent exercise. Recently, using similar MRI methodology to that used in the present study, it has been shown, in a nonaging model of human muscle atrophy, that the individual muscles of the quadriceps femoris atrophy to varying degrees . When the muscles aren’t used, you can lose 1 to 3% of muscle mass per day. J Appl Physiol 90: 2070–2074, 2001.— We examined the size of the four muscles of the quadriceps femoris in young and old men and women to assess whether the vastus lateralis is an appropriate surrogate for the quadriceps femoris in human studies of aging skeletal muscle. While the medical term is muscle atrophy, most of us refer to it as muscle Abnormality of the musculature of the lower limbs. Exercises for people with knee arthritis. Therefore, patellofemoral pathology refers to problems that affect the joint formed between the patella and the femur. [HPO:curators] Skip to search form Skip to main content > Semantic Scholar's Logo. Muscle atrophy is the loss of skeletal muscle mass. quadriceps muscle atrophy with girth measurements is somewhat inaccurate, girth measurements probably remain clinically useful. Quad atrophy is usually associated with chronic knee instability, which can be even more alarming. Similar magnitudes of quadriceps atrophy were reported by Lorentzon et al. eCollection 2018 Sep. Could the tendon degeneration and the fatty infiltration of the gluteus medius affect clinical outcome in total hip arthroplasty? Symptoms vary, and treatment may include physical therapy, functional electric … The authors concluded that muscle atrophy alone did not cause quadriceps weakness suggesting, instead, that incomplete volitional muscle activation may contribute. These are the muscles located on the front of (anterior aspect) the thigh. Some features of the site may not work correctly. However, clinical variations are known. Mizner et al. Search. The contributions of muscle atrophy and failure of voluntary muscle activation. And that can be a big IF. 2020 Jul;99(7):608-612. doi: 10.1097/PHM.0000000000001382. Quadriceps muscle atrophy. Accessibility Walking required great caution because the patient constantly had to maintain extension of the knees. However, there was no improvement in muscle strength on dynamometry. So, that’s not where this article is going to focus. Chulsomlee K, Sa-Ngasoongsong P, Kulachote N, Sirisreetreerux N, Tuntiyatorn P, Vasaruchapong S, Thamyongkit S, Jarungvittayakon C, Wongsak S, Kawinwonggowit V. Orthop Res Rev. Seven additional patients and five age-matched control subjects had bilateral quadriceps muscle ultrasound thickness preoperatively, 6 weeks and 5 months postoperatively, with assessment of quadriceps muscle dynamometry, pain scores and Timed Up and Go (TUG) test. 0 comment. 0. Your email address will not be published. You’ll probably also receive exercises from your PT or strength coach to help you build strength and avoid muscle atrophy in the quadriceps. Patellofemoral pathologies present with knee pain. For instance, quadriceps spa… The quadriceps (or quads) describe the four muscles located on the front of the thigh. Departments of Clinical Neurophysiology, S‐751 85 Uppsala. The syndrome occurs in about 2-10% of susceptible patients, especially in patients who receive more than 3.3 Gy to the spinal cord. You are currently offline. Quadriceps are part of a complex mechanism that allows your knee to straighten. 3. Muscle atrophy and activation failure may contribute. On Earth, we must constantly use certain muscles to support ourselves against the force of gravity. Quadriceps Atrophy and Inhibition. For instance, most athletic people have strong quadricep muscles from frequent exercise, so when those muscles atrophy and you experience knee instability, it can be especially frustrating. Muscle morphology preoperatively showed type 2A and 2B muscle fibre atrophy on needle muscle biopsy, with further atrophy of all three fibre types (P = 0.029) at 5 days postoperatively associated with a fibre type shift from type 1 to 2A fibres (P = 0.0011) at 1 month. J Sports Med Phys Fitness. The ICD-10-CM code M62.559 might also be used to specify conditions or terms like atrophy of quadriceps femoris muscle or o/e- quadriceps muscle wasting. A 30-year-old female asked: what is the treatment of mild cortical atrophy? Abnormality of the lower limb. Is a Quadriceps Dent Really Atrophy? Abnormality of limbs. MedGen UID: 413750 • Concept ID: C2750076 • Disease or Syndrome. 54 years experience Neurosurgery. The quadriceps is composed of four main muscles (quadriceps is derived from Latin, “four heads”). This often leads to an inhibitory signal and reduced activation of the quadriceps. Clinicians should realize that very small reductions in thigh girth (1%) may be an indicator of significant reductions in muscle bulk (13%), in individuals with prolonged joint pain and disability. To our knowledge, the current study is the first to investigate and identify atrophy of each portion of the quadriceps muscle (VMO, VM, VL, VI, and RF) between limbs of people with unilateral PFP, 27 and the results showed that atrophy of the quadriceps, as defined by a difference between limbs of at least 8.5%, is common, with a prevalence of 45% in those with unilateral PFP. Quadriceps-sparing autosomal recessive hereditary inclusion body myopathy is characterized by a relatively early onset during the second or third decade of life. The most typical presentation is … Epub 2018 Mar 27. Cerqueira MS, Do Nascimento JDS, Maciel DG, Barboza JAM, De Brito Vieira WH. It results from vascular damage and white matter necrosis in the spinal cord. Purpose: To systematically review the available literature regarding the impact of perioperative and postoperative interventions on quadriceps atrophy and loss of strength after ACL reconstruction. This kind of muscle atrophy is called “quad activation failure” in the medical community, but you also might hear it called “quad not firing” or “quad shut down.” Limb muscle weakness Calf muscle hypertrophy Difficulty running Quadriceps muscle atrophy Elevated alkaline phosphatase Limb-girdle muscular dystrophy Muscle fiber inclusion [mendelian.co] & biceps atrophy Muscle pain in 85% No cardiorespiratory involvement Most remain ambulatory CK 4-80 x ULN Bx Dystrophic Patients with asymptomatic hyperCKemia were 61 and [slideplayer.com] Show info. The rectus femoris, which goes straight down the thigh to the kneecap, is often relatively spared. However, many injuries contribute to the quadriceps atrophy. 2018 Jun;38(1):23-31. doi: 10.1142/S1013702518500038. In vastus lateralis (VL) of sedentary severe COPD patients (n=41), who were further subdivided into those with (n=25) and without (n=16) muscle … Muscle Atrophy Living and working in space is mentally strenuous. Muscle atrophy leads to muscle weakness and causes disability. Vadalà AP, Mazza D, Desideri D, Iorio R, Fedeli G, Scrivano M, Serlorenzi P, Ferretti A. Int Orthop. Effect of exercise therapy combined with branched-chain amino acid supplementation on muscle strengthening in persons with osteoarthritis. Thus, in conjunction with our ongoing studies of aging skeletal muscle, we thought it was necessary to address this issue in an aging population. 2 Whether the loss of size is due to a decrease of muscle fibre area (atrophy) or a loss of … Epigenetic mechanisms regulate muscle mass and function in models of muscle dysfunction and atrophy. 1 One theory is that pain causes reflex inhibition of the quadriceps, which in time induces an atrophic response within the muscle with subsequent loss of muscle size. Effects of blood flow restriction without additional exercise on strength reductions and muscular atrophy following immobilization: A systematic review. 1); these muscles were paretic. These muscles, commonly called antigravity muscles, include the calf muscles, the quadriceps and the muscles of the back and neck. The quadriceps is a large group of muscles positioned on the front part of the thigh. However, an important determinant of this weakness is arthrogenic muscle inhibition (AMI) - an ongoing neural inhibition that prevents the quadriceps muscles from being fully activated [12–14]. Sign In Create Free Account. Designed for researchers requiring standardized outcome measures this video demonstrates 31 standardized knee examination techniques. Muscular atrophy involving the quadriceps muscle. The quad has been shown to exhibit a 12% reduction in cross sectional area, representing atrophy, in patients with knee arthritis. 2018 Aug 16;15(3):886-888. doi: 10.1016/j.jor.2018.08.016. Note that these causes will lead to localized atrophy of the affected thigh and not the other. In a multivariate analysis, the risk of incident radiographic osteoarthritis of the knee was significantly increased among women with a higher hamstrings/quadriceps cross-sectional area ratio. Physiotherapy after meniscus repair surgery, 10 tested tips that will make living with a fracture cast tolerable, Tibia shaft fracture rehabilitation following non-operative management, https://physio4ug.com/wp-content/uploads/2021/03/wp-1617106077765.mp4. Quadriceps muscle atrophy1,2 and quadriceps weak-ness3,4 persist following ACL reconstruction (ACLR) even though a majority of patients undergo structured rehabilitation5 focused on restoration of lower extrem-ity strength and function. Epub 2019 Jul 5. Epub 2019 Dec 18. It can be caused by immobility, aging, malnutrition, medications, or a wide range of injuries or diseases that impact the musculoskeletal or nervous system. In postradiation plexopathy, patients develop asymmetric and often painless muscle weakness … Hofstede SN, Gademan MG, Vliet Vlieland TP, Nelissen RG, Marang-van de Mheen PJ. Spinal muscular atrophy 5q: Type III & IV; Lower extremity Dominant; GM2 gangliosidosis, Late onset. Quadriceps muscle atrophy1,2 and quadriceps weak-ness3,4 persist following ACL reconstruction (ACLR) even though a majority of patients undergo structured rehabilitation5 focused on restoration of lower extrem-ity strength and function. Quadriceps weakness can be caused by various injuries to the knee or hips, acquired myopathies (diseases that affect muscle tissue) such as Lyme disease and poliomyelitis, inherited myopathies such as certain muscular dystrophies and stroke, or neurological diseases such as multiple sclerosis or Bell’s palsy. 2020 Jul;99(7):636-644. doi: 10.1097/PHM.0000000000001352. Quadriceps tendonitis is a common cause of activity-related anterior knee pain. Quadriceps Atrophy; what is causing this? reconstruction. Methods • Motion capture data collected in the OSU Movement Analysis and Performance Lab • 7 healthy subjects (4M/3F, 21.9 ±23. [aafp.org] Causes. quadriceps femoris muscle atrophy during first 12 weeks following ACL . The exact cause for this is not known but it’s central and peripheral mechanisms are implicated. Find the cause: Many conditions, in addition to aging (which normally is accompanied by mild cortical atrophy) can lead to this. Spontaneous: Middle or late age. The quadriceps are made-up of 4 different muscles which are the rectus femoris, vastus lateralis, vastus intermedius and vastus medialis which merge to form one strong tendon known as the patella tendon. Careers. quadriceps atrophy treatment. This immobilization is associated with reduction in muscle size due to disuse. The proton density-weighted images had the following parameters: repetition time 200-3000ms, echo time 35ms, slice thickness 6mm, gap between slices 6mm, matrix 364×180, and field of view 480×281mm. As well as being a direct cause of quadriceps weakness [ 13 ], AMI may contribute to muscle atrophy [ 15 ] and, in more severe cases, can prevent effective quadriceps strengthening [ 16 – 18 ]. 11. Aside from the joint between the thigh bone (femur) and the shin bone, there also exists a joint between the Patella bone also termed the knee cap with the femur. Quadriceps weakness persists after anterior cruciate ligament reconstruction. Although a more specific code is preferable, unspecified codes should be used when such … Several treatments can help fight muscle atrophy. Shrinking of these muscles could follow many causes which may include; in some cases there are episodes of immobilization to alleviate pain. VSalon currently allows unregistered guests to view the forum. • Quadriceps weakness is one of the earliest and most common symptoms of OA1 • Two sources of muscle weakness: • Atrophy • Decrease in number or size of muscle fibers • Reduced voluntary activation • Inability to recruit (activate) all of the muscle’s motor units2 (groupings of muscle fibers) 9 2.
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