What Is Alcoholic Myopathy?

Key Takeaways

• Alcoholic myopathy is a condition caused by alcohol abuse, leading to muscle weakness, cramps and pain.
• There are two types of alcoholic myopathy: acute and chronic.
• Up to 60% of individuals with alcohol use disorder may develop alcoholic myopathy, making it one of the most common muscle disorders in the Western Hemisphere.
• Physical signs include painless weakness of proximal muscles, muscle atrophy and, in acute cases, painful muscle weakness and cramps.
• Diagnosis involves a comprehensive evaluation, including medical history, physical examination and possibly blood tests, EMG and muscle biopsies.
• Treatment focuses on reducing or abstaining from alcohol, addressing nutritional deficiencies, and starting physical therapy.
• Early intervention can prevent the progression of alcoholic myopathy and improve overall muscle function.

What Is Alcoholic Myopathy?

Alcoholic myopathy is a debilitating condition characterized by muscle weakness, cramps and pain. It is a direct consequence of alcohol misuse that can make performing everyday tasks challenging.

The condition is a form of toxic myopathy, where the body reacts adversely to long-term and/or heavy exposure to alcohol. 

This reaction causes abnormal muscle tissue breakdown, which manifests physically as muscle atrophy and clinically as diminished muscle functionality.

The diagnosis of alcoholic myopathy involves a comprehensive evaluation, including a detailed medical and family history, to identify symptoms and assess the extent of alcohol use.

Alcoholic Myopathy Types

Alcoholic myopathy can manifest in two forms:

• Acute alcoholic myopathy is often associated with a recent episode of heavy drinking and presents with rapid onset muscle damage and weakness, which may resolve within days or weeks. 

• Chronic alcoholic myopathy develops over a prolonged period of excessive alcohol consumption and is marked by a gradual loss of muscle mass, particularly Type II muscle fibers and overall muscle strength.

Alcoholic Myopathy Prevalence

It is estimated that between 40% to 60% of individuals with alcohol use disorder may develop some form of alcoholic myopathy. In fact, it is considered one of the most common muscle disorders in the Western Hemisphere.

Physical Symptoms of Alcoholic Myopathy

Alcoholic myopathy manifests through various physical symptoms that are indicative of muscle damage, such as:

• Progressive muscle weakness: Weakened muscles closest to the body’s midline, leading to difficulties with tasks that require upper arm strength and stability.

• Muscle atrophy: The wasting away of muscle tissue, contributing to a noticeable decrease in muscle mass and strength.
• Pain and cramps: These may be constant or intermittent, and they can manifest as a deep muscular ache or sharp pain that may worsen with movement.

• Swelling and tenderness: Swollen, tender muscles contribute to discomfort and limited mobility.
• Fatigue: Patients with alcoholic myopathy may experience fatigue due to the body’s reduced ability to generate energy within the muscles. This is worsened by nutritional deficiencies often seen in chronic alcoholism.

• Gait disturbance: Problems with walking and balance, often caused by weakness in the muscles that support the lower body. This can manifest as shuffling or dragging of the feet and a reduced ability to perform automatic movements.

Causes of Alcoholic Myopathy

The main cause of alcoholic myopathy is alcohol consumption. Alcohol can lead to muscle wasting and weakness, which can then progress to the following complications:

• Reduced physical activity in alcoholics contributes to muscle wasting.
• Chronic alcohol consumption leads to direct toxic effects on muscle fibers.
• Nutritional deficiencies, particularly low protein and vitamins, associated with alcoholism.
• Oxidative stress from alcohol metabolism damages muscle tissue.
• Alcohol-induced inflammation contributes to muscle weakness and atrophy.
• Altered protein synthesis and muscle repair due to alcohol’s interference with normal metabolism.
• Mitochondrial dysfunction caused by alcohol impairs muscle energy production.
• Hormonal imbalances, especially decreased testosterone and increased cortisol, affect muscle mass.

How Alcoholic Myopathy is Diagnosed

Diagnosing this condition involves a comprehensive physical examination, detailed medical history and specific diagnostic tests.

Physical Examination

During the physical examination, healthcare providers look for specific signs that may indicate alcoholic myopathy. These include muscle weakness, wasting, swelling and tenderness.

A thorough examination may also include

• Checking vital signs
• Observation
• Palpation
• Percussion
• Auscultation

Medical History

A comprehensive medical history helps healthcare providers understand a patient’s past health issues and family health history. The medical history will ask about the patient’s social history, which sheds light on lifestyle factors such as alcohol and drug use.

The medical history also informs the treatment plan and ensures that healthcare providers avoid interventions that may cause harm due to past adverse reactions or allergies.

Diagnostic Tests

Diagnostic tests help in differentiating alcoholic myopathy from other neuromuscular disorders. These tests generally fall into the following categories: 

• Non-invasive tests include blood tests to measure enzyme levels, such as creatine kinase (CK), which may be elevated in myopathic conditions. Imaging studies like MRI and ultrasound can visualize muscle inflammation and edema associated with alcoholic myopathy.
• Invasive diagnostic methods may involve electromyography (EMG) to assess electrical activity in muscles and nerve conduction studies to evaluate the function of peripheral nerves.

• Muscle biopsy may be performed in some cases to examine muscle tissue directly under a microscope. It provides definitive evidence of muscle damage and the extent of fibrosis or atrophy. The biopsy can also help rule out other muscle diseases.

Treatment Options for Alcoholic Myopathy

• Alcohol abstinence: Continued drinking worsens muscle damage and impairs recovery. Stopping alcohol consumption can lead to gradual improvement in muscle strength and function. However, recovery times vary depending on the extent of damage.
• Nutritional support: Many people with alcoholic myopathy suffer from malnutrition, with deficiencies in protein, vitamins (like thiamine and vitamin D), and minerals (like magnesium). Supplementing these nutrients and ensuring a balanced diet can aid in muscle regeneration.

• Physical therapy and exercise: Regular, low-impact exercises such as walking, swimming, and resistance training can help rebuild muscle strength and prevent further atrophy. For severe cases, supervised physical rehabilitation may be necessary.
• Treating underlying conditions: Resolving hormonal imbalances, liver disease, or peripheral neuropathy can improve muscle function. Medications like corticosteroids may be prescribed to reduce muscle inflammation, but these are typically used cautiously due to their side effects.

Alcoholic Myopathy Treatment Starts with Getting Help for Addiction

For those seeking addiction or mental health treatment, The Recovery Village Indianapolis Drug and Alcohol Rehab stands as a beacon of hope.

Located within the heart of Indy, we offer an array of treatment options, including medical detox and inpatient rehab for substance use and a residential rehab program for mental health disorders. 

When you or a loved one are ready to embark on the path to recovery, our Recovery Advocates are here, ready to assist. Reach out to learn more about our tailored treatment programs, designed to cater to your specific needs and situation.