ATP binds to the myosin head and causes the ‘ratchetting’ that results in contraction according to the sliding filament model. Creatine phosphate stores energy so ATP can be rapidly regenerated within the muscle cells from adenosine diphosphate (ADP) and inorganic phosphate ions, allowing for sustained powerful contractions that last between 5–7 seconds. Glycogen is the intramuscular storage form of glucose, used to generate energy quickly once intramuscular creatine stores are exhausted, producing lactic acid as a metabolic byproduct. Contrary to common belief, lactic acid accumulation doesnt actually cause the burning sensation we feel when we exhaust our oxygen and oxidative metabolism, but in actuality, lactic acid in presence of oxygen recycles to produce pyruvate in the liver which is known as the Cori cycle.Substrates produce metabolic fatigue by being depleted during exercise, resulting in a lack of intracellular energy sources to fuel contractions. In essence, the muscle stops contracting because it lacks the energy to do so. Diagnosis
Grading
The severity of muscle weakness can be classified into different "grades" based on the following criteria:
Grade 0: No contraction or muscle movement. Grade 1: Trace of contraction, but no movement at the joint. Grade 2: Movement at the joint with gravity eliminated. Grade 3: Movement against gravity, but not against added resistance. Grade 4: Movement against external resistance with less strength than usual. Grade 5: Normal strength. Classification
Proximal and distal
Muscle weakness can also be classified as either "proximal" or "distal" based on the location of the muscles that it affects.
Proximal muscle weakness affects muscles closest to the bodys midline, while distal muscle weakness affects muscles further out on the limbs. Proximal muscle weakness can be seen in Cushings syndrome and hyperthyroidism. True and perceived
Muscle weakness can be classified as either "true" or "perceived" based on its cause. True muscle weakness (or neuromuscular weakness) describes a condition where the force exerted by the muscles is less than would be expected, for example muscular dystrophy. Perceived muscle weakness (or non-neuromuscular weakness) describes a condition where a person feels more effort than normal is required to exert a given amount of force but actual muscle strength is normal, for example chronic fatigue syndrome.In some conditions, such as myasthenia gravis, muscle strength is normal when resting, but true weakness occurs after the muscle has been subjected to exercise. This is also true for some cases of chronic fatigue syndrome, where objective post-exertion muscle weakness with delayed recovery time has been measured and is a feature of some of the published definitions. References
Further reading
Saguil A (April 2005). "Evaluation of the patient with muscle weakness". Am Fam Physician. 71 (7): 1327–36. PMID 15832536. == External links ==