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How to cure muscle weakness with a normal electromyography?

This Premium Q&A, reviewed and published, features a real conversation between an iCliniq user and a physician.

Patient's Query

Hi doctor,

I have had muscle weakness for a while. I took an electromyography (EMG) test, which was normal, with no ANA (Antinuclear Antibody). Simple tasks like combing my hair weaken my muscles. I had a history of rhabdo.

Kindly help.

Answered by Dr. Mrinal Kumar Acharya

Hi,

Welcome to icliniq.com.

I understand your concern.

There could be several causes for your muscle weakness. Firstly, one should be able to distinguish it from fatiguability. Do you take any medications regularly? It could be due to myopathy or neuromuscular junction disorder. A thorough neurological clinical examination is necessary. Have you checked your serum CPK (Creatine phosphokinase) level? An electromyography (EMG) that maintains a normal value is possible in neuromuscular junction disorders.

I hope this has helped you.

Thank you.

Patient's Query

Hi doctor,

Thank you for the reply.

I can function normally, but I get tired quickly and then remain sore for longer. I saw a neurologist who performed an EMG (nerve test followed by needles in the leg muscle). I had my CK levels checked several times last year because I had rhabdo, and they were all normal. As a result, no additional tests have been requested by the doctor. However, you have informed me that I may still have a myopathy, so my question is:

  • What other steps can I take to convince the neurologist?
  • Would a muscle biopsy be a better course of action?

Please assist. There is no medication, but all of these issues became apparent after a year of taking the tablet Ciprofloxacin.

Thank you.

Answered by Dr. Mrinal Kumar Acharya

Hi,

Welcome back to icliniq.com.

I understand your concern.

Some metabolic myopathies can have normal CPK (creatine phosphokinase) and electromyography (EMG) levels. Have you had your thyroid function checked? Due to your history of rhabdomyolysis, I cannot exclude myopathy from my differential diagnosis. A muscle biopsy is useful for evaluating muscle disorders, but it is an invasive procedure. Therefore, I recommend muscle MRI (magnetic resonance imaging) before muscle biopsy because it can provide a diagnostic clue and help identify a site for muscle biopsy. Above all, you should have a repetitive nerve stimulation (RNS) test to rule out neuromuscular junction disorders such as myasthenia.

You can always come back and reach me at icliniq.com.

Thank you.

Answered byDr. Mrinal Kumar Acharya

Medically reviewed byiCliniq medical review team

Published At November 4, 2022
Reviewed AtJune 1, 2026

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Mrinal Kumar Acharya
Dr. Mrinal Kumar Acharya

Neurology

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