Muscle Atrophy and Hypertrophy
Muscle atrophy is usually caused by interruption of axonal flow (axonal neuropathies, motor neuron diseases, etc.). If weakness is out of proportion to atrophy, conduction block due to demyelinating neuropathy should be suspected. Chronic myopathies and immobility may also cause atrophy, but no EMG evidence of denervation or myopathy is respectively found. The pattern of atrophy is often helpful to localize the lesion. Atrophy of the interossi and preservation of the bulk of the thenar muscles suggest ulnar neuropathy, but atrophy of both would suggest a C8 or plexus pathology. Muscle enlargement may be due to tissue replacement (fatt, amyloid), which can be confirmed by EMG and MRI, or may be due to real muscle hypertrophy from excessive discharges (neuromyotonia).