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MSD Manuals

CONSUMER VERSION

* This is the Consumer Version. *

DOCTORS: Tap here for the
Professional Version

Weakness
byMichaelC.Levin,MD
Weaknessreferstolossofmusclestrength.Thatis,peoplecannotmoveamusclenormally
despitetryingashardastheycan.However,thetermisoftenmisused.Manypeoplewith
normalmusclestrengthsaytheyfeelweakwhentheyfeeltired(seeFatigue)orwhentheir
movementislimitedbecauseofpainorjointstiffness.
Forapersontointentionallymoveamuscle(calledavoluntarymusclecontraction),thebrain
mustgenerateasignalthattravelsapathwayfrom
Thebrain
Throughnervecellsinthebrainstemandspinalcord
Throughnervesfromthespinalcordtothemuscles(calledperipheralnerves)
Acrosstheconnectionbetweennerveandmuscle(calledaneuromuscularjunction)
Also,theamountofmuscletissuemustbenormal,andthetissuemustbeabletocontractin
responsetothesignalfromthenerves.Therefore,trueweaknessresultsonlywhenonepartof
thispathwaybrain,spinalcord,nerves,muscles,ortheconnectionsbetweenthemis
damagedordiseased.
Weaknessmaydevelopsuddenlyorgradually.Weaknessmayaffectallofthemusclesinthe
body(calledgeneralizedweakness)oronlyonepartofthebody.Forexample,dependingon
wherethespinalcordisdamaged,spinalcorddisordersmaycauseweaknessonlyofthelegs.
Symptomsdependonwhichmusclesareaffected.Forexample,whenweaknessaffectsmuscles
ofthechest,peoplemayhavedifficultybreathing.Whenweaknessaffectsmusclesthatcontrol
theeyes,peoplemayhavedoublevision.Completemuscleweaknesscausesparalysis.People
mayhaveothersymptomsdependingonwhatiscausingtheweakness.Weaknessisoften
accompaniedbyabnormalitiesinsensation,suchastingling,apinsandneedlessensation,and
numbness.

Causes
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Becausemalfunctioninthesamepartofthesignalpathwaycausessimilarsymptomsregardless
ofcause,themanycausesofmuscleweaknessareusuallygroupedbythelocationofthecause
(seeTable:SomeCausesandFeaturesofMuscleWeakness).Thatis,causesaregroupedas
thosethataffectthebrain,spinalcord,peripheralnerves,muscles,orconnectionsbetween
nervesandmuscles.However,somedisordersaffectmorethanonelocation.

Commoncauses
Causesdifferdependingonwhetherweaknessisgeneralizedoraffectsonlyspecificmuscles.
Themostcommoncausesofgeneralizedweaknessare
Adecreaseingeneralphysicalfitness(calleddeconditioning),whichmayresultfrom
illnessand/oradecreaseinphysicalreserves(frailty),suchasmusclemass,bonedensity,
andtheheart'sandlungs'abilitytofunction,especiallyinolderpeople
Lossofmuscletissue(wasting,oratrophy)duetolongperiodsofinactivityorbedrest,as
occursinanICU
Damagetonervesduetoasevereillnessorinjury,suchassevereorextensiveburns
Certainmuscledisorders,suchasthoseduetoalowlevelofpotassium(hypokalemia),
consumptionoftoomuchalcohol,oruseofcorticosteroids
Drugsusedtoparalyzemusclesforexample,tokeeppeoplefrommovingduringsurgery
orwhileonaventilator
Themostcommoncausesofweaknessinspecificmusclesare
Strokes(themostcommoncauseofweaknessaffectingonesideofthebody)
Apinchednerve,asoccursincarpaltunnelsyndrome
Arupturedorherniateddiskinthespine
Pressureon(compressionof)thespinalcord,ascanresultfromcancerthathasspreadto
thespinalcord
Multiplesclerosis

Lesscommoncauses
Manyotherconditionssometimescauseweakness(seeTable:SomeCausesandFeaturesof
MuscleWeakness).Forexample,electrolyteabnormalities(suchasalowlevelofmagnesiumor
calcium)cancauseweaknessthatsometimescomesandgoes,aswellasmusclecrampingand
twitches.

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Fatigue
Manypeoplereportweaknesswhentheirproblemisactuallyfatigue(Fatigue).Common
causesoffatigueincludeasevereillness,cancer,achronicinfection(suchasHIVinfection,
hepatitis,ormononucleosis),heartfailure,anemia,chronicfatiguesyndrome,fibromyalgia,
andmooddisorders(suchasdepression).

Evaluation
First,doctorstrytodeterminewhetherpeopleareweakorsimplytired.Ifpeopleareweak,
doctorsthendeterminewhethertheweaknessissevereenoughorworseningquicklyenoughto
belifethreatening.

Warningsigns
Inpeoplewithweakness,thefollowingsymptomsarecauseforconcern:
Weaknessthatdevelopsoverafewdaysorless
Difficultybreathing
Difficultyraisingtheheadwhilelyingdown
Difficultychewing,talking,orswallowing
Lossoftheabilitytowalk

Whentoseeadoctor
Peoplewhohaveanywarningsignshouldgotoanemergencydepartmentimmediately.
Immediatemedicalattentioniscrucialbecauseweaknessaccompaniedbyawarningsigncan
worsenquicklyandcausepermanentdisabilityorbefatal.Peoplewithoutwarningsignsshould
calltheirdoctor.Thedoctorcandecidehowquicklytheyneedtobeseenbasedontheir
symptomsandotherdisorderstheyhave.Formostofthesepeople,adelayofafewdaysisnot
harmful.
Iftheweaknessworsensgradually(overmonthstoyears),peopleshoulddiscusstheproblem
withtheirdoctorattheirnextroutinevisit.

Whatthedoctordoes
Doctorsfirstaskquestionsabouttheperson'ssymptomsandmedicalhistory.Doctorsthendoa
physicalexamination.Whattheyfindduringthehistoryandphysicalexaminationoften
suggestsacauseandtheteststhatmayneedtobedone(seeTable:SomeCausesandFeatures
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ofMuscleWeakness).
Doctorsaskpeopletodescribeindetailwhattheyareexperiencingasweakness.Doctorsask
Whentheweaknessbegan
Whetheritbegansuddenlyorgradually
Whetheritisconstantorisworsening
Whichmusclesareaffected
Whetherandhowtheweaknessaffectstheabilitytodocertainactivities,suchas
breathing,brushingtheirteethorhair,speaking,swallowing,standingupfromaseated
position,climbingstairs,andwalking
Whethertheyhaveothersymptomsthatindicatemalfunctionofthenervoussystem,such
asspeechorvisionproblems,lossofsensationormemory,orseizures
Whatseemstobesuddenweaknessissometimesgradualweakness,butpeopledonotnoticeit
untiltheycannolongerdosomething,suchaswalkingortyingtheirshoes.
Basedonthedescriptionofweakness,doctorscanoftenidentifythemostlikelycauses,asfor
thefollowing:
Amuscledisorder:Weaknessbeginninginthehipsandthighsortheshoulders(thatis,
peoplehavedifficultystandinguporliftingtheirarmsoverhead)andnoeffecton
sensation
Aperipheralnervedisorder:Weaknessbeginninginthehandsandfeet(thatis,people
havedifficultyliftingacup,writing,orsteppingoveracurb)andlossofsensation
Doctorsalsoaskaboutothersymptoms,whichmaysuggestoneormorepossiblecauses.For
example,ifpeoplewithbackpainandahistoryofcancerreportweaknessinaleg,thecause
maybecancerthathasspreadandputpressureonthespinalcord.
Peopleareaskedaboutsymptomsthatsuggestfatigueoranotherproblem,ratherthantrue
muscleweakness.Peoplewithtruemuscleweaknessoftenreportdifficultydoingspecifictasks,
andtheweaknessfollowsapattern(forexample,becomesworseafterwalking).Fatiguetends
tocausemoregeneralsymptomsanddoesnotfollowaparticularpattern.Thatis,itispresent
allthetimeandaffectsthewholebody.Doctorsaskaboutrecentorcurrentdisordersthat
commonlycausefatigue,suchasanyrecentsevereillnessoramooddisorder(suchas
depression).
Doctorsaskaboutpastandcurrentuseofdrugs,includingalcoholandrecreationaldrugs.
Whetherfamilymembershavehadsimilarsymptomscanhelpdoctorsdeterminewhetherthe
causeishereditary.
Duringthephysicalexamination,doctorsfocusonthenervoussystem(neurologicexamination
seePhysicalExamination)andmuscles.Doctorstestthecranialnerves(whichconnectthe
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brainwiththeeyes,ears,face,andvariousotherpartsofthebody),forexample,bychecking
eyemovements,theabilitytospeakclearly,andtheabilitytorotatethehead.
Doctorsobservehowthepersonwalksandcheckforothersignsthatthenervoussystemis
malfunctioning,suchaslossofcoordinationorsensation.Musclesarecheckedforsizeand
unusualunintendedmovements(suchasinvoluntarytwitchesandshaking).Doctorsnotehow
smoothlymusclesmoveandwhetherthereisinvoluntaryresistancetomovement(detected
whendoctorstrytomoveamusclethattheyhaveaskedthepersontorelax).
Reflexesarechecked.Reflexesareautomaticresponsestoastimulus.Forexample,doctors
testthekneejerkreflexbygentlytappingthemuscletendonbelowthekneecapwitharubber
hammer.Normally,thekneethenjerksinvoluntarily(seeReflexes).Thisevaluationhelps
doctorsidentifywhichpartofthenervoussystemisprobablyaffected,asforthefollowing:
Thebrainorspinalcord:Ifreflexesareveryeasytotriggerandarestrong
Thenerves:Ifreflexesarehardtotriggerandaresloworabsent
Musclestrengthistestedbyaskingthepersontopushorpullagainstresistanceortodo
maneuversthatrequirestrength,suchaswalkingontheheelsandtiptoesorstandingup.
Ageneralphysicalexaminationisdonetolookforothersymptomsthatmaysuggestacause,
suchasdifficultybreathing.
Generally,ifthehistoryandphysicalexaminationdonotdetectspecificabnormalitiesthat
suggestabrain,spinalcord,nerve,ormuscledisorder,thecauseislikelytobefatigue.

Some Causes and Features of Muscle Weakness

Cause

CommonFeatures*

Tests

Headaches,personalitychanges,confusion,difficulty
concentrating,drowsiness,lossofbalanceand
coordination,andparalysisornumbness

MRIorCTofthebrain

Braindisorders

Braintumors

Sometimesseizures
Usuallyothersymptomsofnervoussystemmalfunction
(suchaslossofsensation,lossofcoordination,and
visionproblems)
Multiplesclerosis(affectsthe
brain,spinalcordorboth)

Weaknessthat
Tendstocomeandgo

MRIofthebrain
Sometimesaspinaltap
(lumbarpuncture)

Sometimesaffectsdifferentpartsofthebody
Isworseinhotweather
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Symptomsthatoccursuddenly:
Weaknessorparalysis,usuallyononesideofthe
body
Abnormalitiesinorlossofsensationononeside
ofthebody
Stroke

Difficultyspeaking,sometimeswithslurred
speech

Adoctorsexamination
CTorMRIofthebrain

Confusion
Dimness,blurring,orlossofvision,particularly
inoneeye
Dizzinessorlossofbalanceandcoordination
Spinalcorddisorders

Acutetransversemyelitis
(suddenspinalcord
inflammation),oftendueto
Multiplesclerosis
Inflammationofblood
vessels

Tingling,numbness,andmuscleweaknessthat
Occurrapidly(overhourstoafewdays)
Startinthefeetandmoveupward
Usuallyabandliketightnessaroundthechestorabdomen
Oftendifficultypassingurine

MRIofthespinalcord
Aspinaltap

Certaininfectionssuchas Whenaninjuryissevere,lossofbowelandbladder
Lymediseaseorsyphilis controland/orreducedsexualresponse,including
erectiledysfunctioninmen
Compressionofthespinalcord
thatdevelopssuddenly(acute),as
mayresultfrom
Foracute,symptomsthatdevelopinhoursordays
Abscesses(pocketsof
pus)

Forchronic,symptomsthatarepresentforweeksto
months

Hematomas(pocketsof
blood)

Weaknessorparalysisofthelegsandsometimesarms
andlossofsensation

Injuriesoftheneckor
back

Withabscesses,infections,ortumors,tendernesstothe
touchoverthecompressedarea

MRIofthespinalcord

Somecancers

Compressionofthespinalcord
thatdevelopsslowly(chronic),as
mayresultfrom
Cervicalspondylosis
(degenerationofthe
vertebraldisksdueto

Whenaninjuryissevere,lossofbowelandbladder

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arthritis)
Spinalstenosis
(narrowingofthe
passagewayforthespinal
cord)duetoarthritis

controland/orreducedsexualresponse,including
erectiledysfunctioninmen

MRIofthespinalcord

Sometumors
UsuallyMRIorCTofthe
spinalcord

Compressionofaspinalnerve
rootbyaruptureddisk

Usuallyelectromyography
(stimulatingmusclesand
Weakness,numbness,orbothinonelegorarm
recordingtheirelectrical
Usuallybackorneckpainthatshootsdownthelegorarm activity)
Sometimesnerve
conductionstudies
(measuringhowfast
nervestransmitsignals)

Caudaequinasyndrome,caused
bypressureonseveralspinal
nerveroots,asmayresultfrom
Arupturedorherniated
disk
Spreadofcancertothe
spine

Weaknessinbothlegs
Lossoffeelingintheupperinnerpartofthethighs,the
buttocks,bladder,genitals,andtheareabetweenthem
(saddlearea)

MRIofthespinalcord

Usuallypaininthelowerback
Lossofbowelandbladdercontroland/orreducedsexual
response,includingerectiledysfunctioninmen
Usuallyothersymptomsofnervoussystemmalfunction
(suchaslossofsensation,lossofcoordination,and
visionproblems)

Multiplesclerosis(affectsthe
brain,spinalcord,orboth)

Weaknessthat
Tendstocomeandgo

MRIofthebrainand
spinalcord
Sometimesaspinaltap

Sometimesaffectsdifferentpartsofthebody
Isworseinhotweather

Disordersthataffecttheperipheralnervesandthebrainorspinalcord
Progressivemuscleweaknessthat
Oftenstartsinthehands
Sometimesaffectsonesidemorethantheother
Amyotrophiclateralsclerosis
(ALS)

Electromyographyand
sometimesnerve
conductionstudies

Clumsiness,involuntarymusclecontractions,andmuscle OftenMRIofthespinal
cordtoruleoutspinal
cramps
corddisordersthatcan
causesimilarsymptoms
Droolinganddifficultyspeakingandswallowing

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Asthedisorderprogresses,difficultybreathingand
eventuallydeath
Musclesthattireeasilyandprogressivemuscleweakness
Postpoliosyndrome

Sometimesmuscletwitchingandlossofmuscletissue
Inpeoplewhohavehadpolio

Electromyographyand
sometimesnerve
conductionstudies

Disordersthatsimultaneouslyaffectmanynerves(polyneuropathies)
Weaknessandoftenlossofsensationthat
GuillainBarrsyndrome

Usuallybegininbothlegs
Thenprogressupwardtothearms

Electromyographyand
nerveconductionstudies
Aspinaltap

Whensevere,difficultyswallowingandbreathing
Nervedamagecausedby
Excessiveuseofalcohol
Electromyographyand
nerveconductionstudies

Diabetes
Drugs(suchas
vincristine,cisplatin,or
statins)
Infections(suchas
diphtheria,hepatitisC,
HIVinfection,Lyme
disease,orsyphilis)
Sarcoidosis

Muscleweaknessthat
Oftenbeginsinbothfeet
Thenaffectsthehands
Thenprogressesupthelegsandarms

Severeillness(especially Lossofsensation,typicallybeforemusclesbecomeweak
intheintensivecareunit)
Toxicsubstances(suchas
leadormercury)

Othertestsdependingon
thedisordersuspected,
suchas
Urineteststo
checkfortoxins
Bloodteststo
checkforcertain
antibodiesorto
measuresugar,
vitamin,ordrug
levels
Sometimesa
spinaltap

Vitamindeficiency(such
asthiamin,vitaminB6 ,or
vitaminB12 deficiency)
Disordersthataffecttheconnectionsbetweennervesandmuscles(neuromuscularjunctiondisorders)

Botulism(duetothebacteria
Clostridiumbotulinum)

Atfirst,oftenadrymouth,droopingeyelids,vision
problems(suchasdoublevision),difficultyswallowing
andspeaking,andrapidlyprogressivemuscleweakness,
oftenbeginninginthefaceandmovingdownthebody

Bloodorstoolteststo
checkfortoxinsproduced
bythebacteria

Sometimes
Whencontaminatedfoodisthesource,nausea,vomiting, electromyographyor
examinationofastool
stomachcramps,anddiarrhea

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Nochangesinsensation

sampletocheckfor
bacteria

Myastheniagravis

Weakanddroopingeyelids,doublevision,difficulty
speakingandswallowing,andweaknessinthearmsand Useofadrug
(edrophoniumtest)tosee
legs
whetheritimproves
Excessiveweaknessofaffectedmusclesthat
musclestrengthafter
musclesareused
Occursaftermusclesareused
Bloodteststocheckfor
Disappearswhentheyarerested
certainantibodiesand/or
electromyography
Recurswhentheyareusedagain

Organophosphate(insecticide)
poisoning

Tearingoftheeyes,blurredvision,increasedsalivation, Adoctorsexamination
sweating,coughing,vomiting,frequentbowelmovements
Sometimesbloodteststo
andurination,andweakmusclesthattwitch
identifythetoxin

Disordersthataffectmuscles(myopathies)
Adoctorsexamination
Weaknessthattendstofirstcausedifficultyliftingthe
armsoverheadorstandingup

Stoppinganydrugthat
cancausemuscle
malfunction

Musclemalfunctionduetouseof
alcohol,corticosteroids,or
Sometimes
Useofadrugthatcancausemuscledamage
variousotherdrugs
electromyography
Whenduetouseofalcoholorcertainotherdrugs,muscle
Bloodteststomeasure
achesandpains
levelsofmuscleenzymes
thatleakfromdamaged
musclesintotheblood

Muscleachesandpainsthatareworsenedbymovement,
Viralinfectionsthatcausemuscle especiallywalking
inflammation
Sometimesfever,arunnynose,cough,sorethroat,and/or
fatigue

Sometimesonlya
doctorsexamination
Musclebiopsy(removal
ofapieceofmuscletissue
forexaminationundera
microscope)

Conditionsthatcausegeneralized
musclewasting:
Burns
Cancer
Lackofusedueto
prolongedbedrestor
immobilizationinacast

Lossofmuscletissue

Adoctorsexamination

Inpeoplewithobviousevidenceoftheproblem

Sepsis(infectionofthe
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bloodstream)
Starvation
Weaknessthat
Electrolyteabnormalities
(includingalowlevelof
potassium,magnesium,or
calcium)duetocertaindisorders
oruseofdiuretics

Affectsthewholebody
Maycomeandgo

Bloodteststomeasurethe
levelofpotassiumand
otherelectrolytes

Isoftenaccompaniedbymusclecrampingand
twitches
Athoroughfamilyhistory
todeterminewhetherany
Maystartduringinfancy,childhood,oradulthood familymembershavehad
asimilardisorder
Dependingonthetype,mayprogressrapidly,
Genetictesting
causingearlydeath

Progressivemuscleweaknessthat
Musculardystrophies
(suchasDuchennemuscular
dystrophyandlimbgirdle
musculardystrophy)

Musclebiopsy
Insometypes,anabnormallycurvedspine(scoliosis)
andweaknessofthespinalmuscles,whichoftendevelop
Xraysofthespineto
duringchildhood
checkforscoliosis

*Featuresincludesymptomsandresultsofthedoctor'sexamination.Featuresmentionedaretypicalbutnotalways
present.
Symptomsvarydependingonthelocation(level)ofthedamage.Areasthataresuppliedbythepartsofthespinalcord

belowthedamagedpartareaffected(seefigureonseeWhereIstheSpinalCordDamaged?).
Sensationisusuallynotaffected.

CT=computedtomographyMRI=magneticresonanceimaging.

Testing
Ifpeoplehavesevereorrapidlyprogressinggeneralizedweaknessoranyproblemsbreathing,
doctorsfirstdoteststoevaluatethestrengthoftherespiratorymuscles(pulmonaryfunction
testsseePulmonaryFunctionTesting(PFT)).Resultsofthesetestshelpdoctorsestimatethe
riskofsudden,severemalfunctionofthelungs(acuterespiratoryfailure).
Othertestingisdonebasedonwheredoctorsthinktheproblemis:
Abraindisorder:Magneticresonanceimaging(MRI)or,ifMRIisnotpossible,computed
tomography(CT)
Aspinalcorddisorder:MRIor,whenMRIisnotpossible,CTmyelographyand
sometimesaspinaltap(lumbarpuncture)
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Aperipheralnervedisorder(includingpolyneuropathies)oraneuromuscularjunction
disorder:Electromyographyandusuallynerveconductionstudies
Amuscledisorder(myopathy):Electromyography,usuallynerveconductionstudies,and
possiblyMRI,measurementofmuscleenzymes,musclebiopsy,and/orgenetictesting.
Occasionally,MRIisnotavailableorcannotbedoneforexample,inpeoplewhohavea
pacemaker,anotherimplantedmetaldevice,orothermetal(suchasshrapnel)intheirbody.In
suchcases,anothertestissubstituted.
ForCTmyelography,CTisdoneafteraneedleisinsertedintothelowerbacktoinjecta
radiopaquedyeintothefluidthatsurroundsthespinalcord.Forelectromyography,small
needlesareinsertedintoamuscletorecorditselectricalactivitywhenthemuscleisatrestand
whenitiscontracting.Nerveconductionstudiesuseelectrodesorsmallneedlestostimulatea
nerve.Thendoctorsmeasurehowfastthenervetransmitssignals.
Ifpeoplehavenosymptomsbesidesweaknessandnoabnormalitiesaredetectedduringthe
examination,testresultsareusuallynormal.However,doctorssometimesdocertainblood
tests,suchas
Acompletebloodcellcount(CBC)
Measurementoflevelsofelectrolytes(suchaspotassium,calcium,andmagnesium),sugar
(glucose),andthyroidstimulatinghormone
Erythrocytesedimentationrate(ESR),whichcandetectinflammation
Bloodtestsaresometimesdonetoevaluatekidneyandliverfunctionandtocheckforthe
hepatitisvirus.

Treatment
Ifthecauseisidentified,itistreatedifpossible.Ifweaknessbegansuddenlyandcauses
difficultybreathing,aventilatormaybeused.
Physicalandoccupationaltherapycanhelppeopleadapttopermanentweaknessand
compensateforlossoffunction.Physicaltherapycanhelppeoplemaintainandsometimes
regainstrength.

Essentials for Older People

Aspeopleage,theamountofmuscletissueandmusclestrengthtendtodecrease.These
changesoccurpartlybecauseolderpeoplemaybecomelessactivebutalsobecausethe
productionofthehormonesthatstimulatemuscledevelopmentdecreases.Thus,forolder
people,bedrestduringanillnesscanhaveadevastatingeffect.Comparedwithyoungerpeople,
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olderpeoplestartoutwithlessmuscletissueandstrengthatthebeginningoftheillnessand
losemuscletissuemorequicklyduringtheillness.
Drugsareanothercommoncauseofweaknessinolderpeoplebecauseolderpeopletakemore
drugsandaremoresusceptibletosideeffectsofdrugs.
Whenevaluatingolderpeoplewhoreportweakness,doctorsalsofocusonconditionsthatdo
notcauseweaknessbutinterferewithbalance,coordination,vision,ormobilityorthatmake
movementpainful(suchasimpairedvisionorarthritis).Olderpeoplemaymistakenlydescribe
theeffectsofsuchconditionsasweakness.

KEY POINTS
Manypeoplemistakenlysaytheyfeelweakwhentheyreallymeantheyaretiredortheir
movementislimitedbecauseofpainand/orstiffness.
Truemuscleweaknessresultsonlywhenonepartofthepathwaynecessaryforvoluntary
musclemovement(frombraintomuscles)malfunctions.
Ifweaknessbecomessevereoverafewdaysorlessorifpeoplehaveanywarningsign(see
Warningsigns,theyshouldseeadoctorimmediately.
Often,doctorscandeterminewhethertheproblemistruemuscleweaknessandcan
identifythecausebasedonthepatternofsymptomsandresultsofthephysical
examination.
Physicaltherapyisusuallyhelpfulinmaintainingstrengthnomatterwhatthecauseof
weaknessis.

Symptoms and Diagnosis of Brain, Spinal Cord, and Nerve

Disorders
Introduction to Symptoms and Diagnosis of Brain, Spinal Cord, and Nerve Disorders
Medical History
Physical Examination
Tests for Brain, Spinal Cord, and Nerve Disorders
Memory Loss
Muscle Cramps
Numbness
Weakness
Numbness

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