Comprehensive HPI Template for Generalized Weakness
A thorough history of present illness for generalized weakness should follow a structured approach that systematically evaluates onset, duration, progression, associated symptoms, and exacerbating/alleviating factors to identify the underlying cause.
Chief Complaint
- Document the patient's exact words describing their weakness
- Clarify if the complaint is true weakness (loss of muscle strength) versus fatigue, tiredness, or asthenia
Characterization of Weakness
Onset and Timing
- When did the weakness begin? (sudden vs. gradual onset)
- Time of day when weakness is most prominent (morning vs. evening)
- Progression pattern (stable, worsening, fluctuating, episodic)
- Duration of symptoms (acute, subacute, chronic)
Distribution Pattern
- Location of weakness (proximal vs. distal, symmetric vs. asymmetric)
- Ascending vs. descending pattern
- Focal, regional, or generalized distribution
- Specific muscle groups affected (limbs, face, trunk, respiratory muscles)
Severity Assessment
- Impact on activities of daily living
- Degree of functional limitation (mild, moderate, severe)
- Need for assistive devices
- Changes in independence level
Associated Symptoms
Neurological Symptoms
- Sensory changes (numbness, tingling, paresthesias)
- Visual disturbances (diplopia, blurred vision, ptosis) 1
- Speech or swallowing difficulties (dysarthria, dysphagia) 1
- Balance problems or coordination issues
- Cognitive changes
Systemic Symptoms
- Fever or infectious symptoms
- Fatigue distinct from weakness
- Weight changes (loss or gain)
- Sleep disturbances
- Dyspnea or respiratory symptoms 1
- Pain (location, character, severity)
Autonomic Symptoms
- Orthostatic symptoms (lightheadedness, syncope) 1
- Bowel/bladder dysfunction
- Sweating abnormalities
- Sexual dysfunction
Exacerbating and Alleviating Factors
- Relationship to activity/exercise (improves or worsens with exertion)
- Effect of rest or sleep
- Relationship to meals or fasting
- Environmental factors (temperature, humidity)
- Positional changes (standing, sitting, lying down)
- Diurnal variation (morning vs. evening symptoms)
Relevant Medical History
Past Medical History
- Previous episodes of similar weakness
- Known neurological disorders
- Cardiovascular disease (heart failure, arrhythmias) 1
- Endocrine disorders (thyroid disease, diabetes)
- Renal disease (chronic kidney disease, dialysis) 1
- Autoimmune conditions
- Recent infections or vaccinations
- Recent surgeries or hospitalizations
Medication History
- Complete list of current medications
- Recent medication changes
- Over-the-counter medications and supplements
- History of steroid use
- Chemotherapy or immunosuppressive agents
Family History
- Family members with similar symptoms
- Hereditary neuromuscular disorders
- Autoimmune diseases
- Endocrine disorders
Social and Environmental Factors
- Occupational exposures to toxins
- Recent travel history
- Alcohol and substance use
- Dietary habits and recent changes
- Exercise routine and recent changes
- Psychosocial stressors
Review of Systems Focused on Weakness
- Constitutional: fever, weight changes, fatigue
- Neurological: coordination, balance, sensory changes
- Cardiovascular: chest pain, palpitations, edema
- Respiratory: shortness of breath, cough 1
- Gastrointestinal: nausea, vomiting, diarrhea, constipation
- Musculoskeletal: joint pain, muscle pain, cramping
- Psychiatric: depression, anxiety, sleep disturbances 1
Patient and Informant Perspectives
- Patient's understanding of their symptoms
- Impact on quality of life
- Caregiver observations of functional changes 1
- Discrepancies between patient and caregiver reports (may indicate lack of insight) 1
Documentation of Physical Findings
- Objective strength testing results (Medical Research Council scale)
- Distribution of weakness (proximal vs. distal)
- Presence of atrophy or fasciculations
- Reflexes (hyporeflexia, hyperreflexia, normal)
- Sensory examination findings
- Cranial nerve abnormalities
This template provides a comprehensive framework for evaluating patients with generalized weakness, helping clinicians distinguish between neurologic, muscular, metabolic, and other systemic causes while documenting key information needed for diagnosis and management.