Both central and peripheral nervous system (PNS) manifestations of COVID-19 have been reported. A Chinese retrospective case series, on 214 hospitalized COVID-19 patients, found that 8.9% presented with peripheral nerve disease and 7% had muscular injuries. Other studies looking at the prevalence of PNS manifestations are limited and have significantly lower numbers.

The COVID-19 data is sourced from more than 700 hospitals and 7000 clinics in the US. Patients with numerous neuromuscular diagnoses were identified based on ICD-10 coding. Examples include carpal tunnel syndrome, radial nerve lesion, sciatic nerve lesion, myasthenia gravis, acute transverse myelitis, Bell’s palsy, and trigeminal neuralgia.

We reviewed a total of 598,847 patients with positive COVID-19 PCR and/or diagnosis coding. Neuromuscular complications must have been within 45 days of diagnosis to be included. Incidence of similar neuromuscular complaints was evaluated in 3,001,153 controls without COVID-19. Critical illness neuropathy was found in 35,782 COVID-positive patients and 6,281 of those without. Retrospective study limitations include temporal relationship to COVID-19 does not necessarily indicate causality and inability to confirm the coding by record review or EMG/NCS.

Incidence of neuromuscular disorders is generally lower or equivalent in COVID-19 patients than in the general population, except for critical illness neuropathy and myopathy. This finding may be explained by more COVID-19 patients being in the intensive care unit and bedbound for longer periods. It is worth noting that a small case series of COVID-related critical illness neuropathy and myopathy patients showed no histopathological or clinical differences compared to non-COVID patients. To our knowledge, this report includes an analysis of neuromuscular manifestations in one of the largest cohorts of COVID-19 patients. This can assist with risk-benefit discussions regarding treatment initiation, etiology of diagnoses, and counseling for COVID-19 questions.