Patients who develop severe Covid-19 may exhibit neuromuscular symptoms such as muscle weakness after illness. Photo: Bigstock
The Covid-19 has accumulated a series of symptoms that appear even after the infectious period of the disease. The most recent are muscle lesions, or myopathies, which are characterized by symptoms of muscle weakness or even pain.
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A study published in the journal JAMA Neurology in early June evaluated skeletal muscle samples from 43 people who died from complications from Covid-19, and compared them to 11 samples from people who died from other diseases. In addition to having a significantly higher degree of disease, the Covid-19 group also showed more signs of degeneration of muscle fibers.
In addition, this group also had more signs of myositis or muscle inflammation. According to Maria Tereza de Moraes Souza Nascimento, neurologist and neurophysiologist at INC hospital, in Curitiba, this is a pattern of involvement of Covid-19.
“We already know that this neuropathy manifests itself with sparse nerves throughout the body, and not with all nerves at the same time. It is a manifestation resulting from inflammation of the small vessels of the nerves, due to the generalized inflammatory process that severe The Covid generates “, explains the expert.
According to Nascimento, the action of the coronavirus on this symptom is not direct, because no trace of the virus was found in the muscles. But, yes, via the inflammatory storm that is triggered by disease in more severe cases of Covid-19.
According to the neurologist, it is common to see post-Covid-19 patients seeking advice because they cannot lift their hands, fingers, wrists or even feet. “Severe Covids can have neuromuscular manifestations, and they present as weakness or lack of strength in certain segments of the body. For example, weakness in the hand, foot, difficulty walking or climbing stairs. ”
Anyone who notices such effects, especially if they interfere with certain daily activities, should see a doctor. “Sometimes the person misses the opportunity to heal themselves. A patient with a dropped hand and not undergoing adequate physiotherapy may experience muscle atrophy which may be difficult to recover afterwards. The sooner you notice the motor sequelae of Covid, it is important to watch. for it. at least one neurology screening, ”advises Nascimento.
Is there muscle weakness in mild Covid-19?
Although the study mentioned above was only based on cases of Covid-19 so severe that they resulted in the death of patients, it is necessary to verify that muscle problems do not also present in those who had milder forms of the disease.
“The study is based on critically ill patients, and we see that in practice they have more difficulty recovering. But this opens an addendum to assess whether this cannot happen in milder cases as well. The patient may have some degree of muscle pain or chronic myalgia, which lowers the pain threshold a bit. [após a Covid]», Explains Anelise Carpiné, neurologist and neuro-intensivist at VITA hospital and PUCPR residency preceptor.
Still according to the specialist, this is a symptom that is difficult to control because fatigue – a very common symptom after a severe Covid-19 – can mask the pain. “When the patient resumes lighter physical activities, for example, he notices some fatigue and he can no longer even exercise to the point of seeing myalgia,” he explains.
People who suffer from weakness or muscle pain after Covid-19 should see a doctor for an evaluation. Electroneuromyography, which assesses damage to the peripheral nervous system, may be necessary. As a treatment, physiotherapy may be indicated.
“They will definitely need specialized rehabilitation. Occupational therapy, if they have symptoms in their hands; physiotherapy or physiatrist. [O tratamento] it is on a case-by-case basis, it depends on the results, ”explains neurologist Maria Tereza Nascimento.
According to the specialist, even if some time has passed, it is important for the patient to seek help. “When you get to act in the first year of any neurological injury, that’s called the golden period. But in the first six months is when you have more gains. It is always possible. to guide, to adapt the routine, to do something “, he explains.
According to Anelise Carpiné, medical neurologist, it is not yet known which people would be at greater risk of muscle problems after Covid-19, but there is a profile that can be followed.
“Probably patients with less muscle conditioning, or older age, or who already have a pain threshold, such as in myalgia. It must be a patient. [com maior risco para as dores musculares pós-Covid-19]. But it also has the degree of inflammation that is activated in the disease process, and that probably has a great correlation. “