Comprehensive HPI Template for Weakness
A thorough HPI for a patient presenting with weakness should include specific details about onset, duration, progression, distribution, and associated symptoms to identify the underlying cause and guide appropriate management. 1
Chief Complaint
- Document patient's exact description of weakness in their own words
Characteristics of Weakness
Temporal Features
- Onset: Sudden vs. gradual
- Duration: Acute, subacute, or chronic
- Pattern: Constant, intermittent, fluctuating, progressive
- Timing: Time of day when weakness is worse (morning vs. evening)
- Progression: Improving, worsening, or stable
Distribution of Weakness
- Generalized vs. focal
- Proximal vs. distal
- Symmetric vs. asymmetric
- Upper vs. lower extremities
- Specific muscle groups affected
Severity
- Impact on activities of daily living
- Functional limitations (e.g., difficulty climbing stairs, rising from chair, lifting objects)
- Use of Medical Research Council scale for objective strength assessment
Associated Symptoms
- Sensory symptoms (numbness, tingling, pain)
- Visual disturbances (diplopia, blurred vision, ptosis)
- Speech or swallowing difficulties (dysarthria, dysphagia)
- Respiratory symptoms (dyspnea, orthopnea)
- Orthostatic symptoms (lightheadedness, syncope)
- Cognitive changes
- Bowel/bladder dysfunction
Exacerbating/Alleviating Factors
- Activity/exercise (improves or worsens)
- Rest (improves or worsens)
- Time of day
- Temperature/weather changes
- Specific positions or movements
- Medications
Medical History
- Cardiovascular disease (heart failure, arrhythmias)
- Renal disease (chronic kidney disease, dialysis)
- Endocrine disorders (thyroid disease, diabetes)
- Neurological conditions
- Rheumatologic/autoimmune disorders
- Recent infections or illnesses
- Recent trauma or surgery
- Malignancy history
Medication History
- Current medications (especially those associated with weakness)
- Recent medication changes
- Use of corticosteroids 2
- Use of statins, antibiotics, chemotherapy
- Over-the-counter medications
- Supplements and herbal remedies
Social History
- Alcohol use
- Tobacco use
- Illicit drug use
- Occupational exposures
- Recent travel
- Diet and nutritional status
Family History
- Neuromuscular disorders
- Genetic conditions
- Cardiovascular disease
- Endocrine disorders
Psychosocial Assessment
- Presence of psychosocial stressors
- Symptoms of depression or anxiety
- Sleep patterns
- Caregiver observations of functional changes 1
Review of Systems
- Constitutional: Fever, weight changes, fatigue
- Cardiovascular: Chest pain, palpitations, edema
- Respiratory: Shortness of breath, cough
- Gastrointestinal: Nausea, vomiting, diarrhea
- Neurological: Headache, dizziness, coordination problems
- Musculoskeletal: Joint pain, muscle pain, cramping
This comprehensive template ensures collection of all relevant information needed to distinguish true weakness from fatigue or asthenia 3, determine the pattern and distribution of weakness 4, and identify potential causes ranging from neurologic to metabolic to medication-induced 5, 6.