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Making sense of the clinical spectrum of limb girdle muscular dystrophies
  1. Satish V Khadilkar1,
  2. Bhagyadhan A Patel2,
  3. Jamshed A Lalkaka3
  1. 1Department of Neurology, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
  2. 2Department of Neurology, Sterling Hospitals, Ahmedabad, Gujarat, India
  3. 3Department of Neurology, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
  1. Correspondence to Professor Satish V Khadilkar, Department of Neurology, Bombay Hospital Institute of Medical Sciences, Mumbai 400 020, India; khadilkarsatish{at}


The expansion of the spectrum of limb girdle muscular dystrophies (LGMDs) in recent years means that neurologists need to be familiar with the clinical clues that can help with their diagnosis. The LGMDs comprise a group of genetic myopathies that manifest as chronic progressive weakness of hip and shoulder girdles. Their inheritance is either autosomal dominant (LGMD1) or autosomal recessive (LGMD2). Their prevalence varies in different regions of the world; certain ethnic groups have documented founder mutations and this knowledge can facilitate the diagnosis. The clinical approach to LGMDs uses the age at onset, genetic transmission and clinical patterns of muscular weakness. Helpful clinical features that help to differentiate the various subtypes include: predominant upper girdle weakness, disproportionate respiratory muscle involvement, distal weakness, hip adductor weakness, ‘biceps lump’ and ‘diamond on quadriceps’ sign, calf hypertrophy, contractures and cardiac involvement. Almost half of patients with LGMD have such clinical clues. Investigations such as serum creatine kinase, electrophysiology, muscle biopsy and genetic studies can complement the clinical examination. In this review, we discuss diagnostic clinical pointers and comment on the differential diagnosis and relevant investigations, using illustrative case studies.

  • limb girdle muscular dystrophies
  • calpainopathy
  • dysferlinopathy
  • sarcoglycanopathy
  • clinical pattern

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  • Contributors SVK: Formatting manuscript, analysis of data, critical analysis and review of literature. BAP: Acquiring data, formatting manuscript and review of literature. JAL: Formatting manuscript and critical analysis.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Commissioned; externally peer reviewed. This paper was reviewed by Jon Walters, Swansea, UK.

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