Dr Keerthi Sree Reddy Endoori_KIMS

A 45 year old male patient,agricultural labourer by occupation presented to the KIMS General Medicine OPD with the complaints of difficulty in standing up from sitting position since 6 months and history of weakness in the upper limbs hindering his daily activities since 5 months. He was apparently asymptomatic 6 months back then he developed proximal muscle weakness in the lower limbs ,initially in the right lower limb followed by left lower limb. He had difficulty in getting up from sitting posture and he also complained of tightness initially in the right lower limb followed by the left. After a month, he had difficulty in performing his daily activities with both his hands such as holding the instruments for work on the field. He says this was followed by his inability to lift his left hand above his head initially followed by weakness even in the right hand. He gives history of slippage of footwear since 3-4months and also He is unable to button and unbutton his sh