Abstract

BACKGROUND AND HISTORY

It’s the middle of the clinic. Your next patient has a bulging set of case notes and struggles in to the room on two elbow crutches with a hand-written list of 15 somatic complaints. The worst symptom is progressive right leg weakness that has become so bad that any work has been impossible for six months. You have already noted some physical signs. The right leg is dragged like a sack of potatoes and when the patient climbs on the bed the leg is hauled on with both hands. On direct testing there is some ‘collapsing weakness’ even after you’ve cajoled and encouraged the patient. The reflexes are normal. How are you going to clinch the diagnosis of functional weakness? Can Hoover’s sign help you?

Time to get some definitions straight. In this article we will use the term functional weakness to refer to medically unexplained weakness