What are the most common causes of proximal shoulder girdle and hip girdle aches pains and weakness? How are they differentiated?
Six diseases are responsible for >90% of diffuse, proximal aches or weakness. The first step is to decide the dominant clinical finding—pain or weakness. To determine if true weakness is present, the examiner should ask the patient to ignore any pain that may occur during muscle strength testing so that a true measure of muscle strength can be determined. Often patients can provide a brief full strength effort and then giveaway when pain is the predominant cause. Although patients with fibromyalgia syndrome and polymyalgia rheumatica may complain of weakness in addition to pain, they are not truly weak on physical examination.