Mentally strong people are not trying to manage it all. You have to do all the dirty work for him or not be with him at all. Theyre happy with their efforts, and they arent afraid to talk about Their lack of assertiveness pushes them to adopt a secondary position in a group job, for example. Diagnosis is clinical. A rectal examination is done to check for heme-positive stool. We feel weak precisely because we are in the process of resisting being vulnerable. If patients have difficulty climbing stairs, combing hair, and standing up with predominantly proximal muscle weakness and intact sensation, suspect myopathy. Disproportionate impairment of fine finger dexterity (eg, fine pincer movements, playing the piano) with relatively preserved grip strength indicates selective disruption of the corticospinal (pyramidal) tract. Hereditary motor neuropathies often go unrecognized in families because of variable, incomplete phenotypic expression. Learn more about the MSD Manuals and our commitment to Global Medical Knowledge. The history helps differentiate weakness from fatigue, defines the time course of the illness, and gives clues to the anatomic pattern of weakness. var e=[];d(a);return e}function q(a){a=a.getAttribute(f);return"string"===typeof a&&""!==a}var f="data-run-module",x="runnerBoxElementProp"+(new Date).getTime(),c=function(){if("function"===typeof window.requestAnimationFrame)return window.requestAnimationFrame;for(var a=["ms","moz","webkit","o"],b=null,c=0;c