Does muscle bioenergetic abnormality cause peripheral fatigue in ME/CFS?

In the historical literature, the hallmark of myalgic encephalomyelitis (ME) was marked muscle fatigability often in response to minor degrees of exercise. Muscle cramps, fasciculations (twitching) and extreme muscle tenderness were also common findings. As Dr Ramsay said in the Postgraduate Medical Journal in 1978,

This was sometimes obvious as the patients winced even on light palpitation of the affected muscle; but much more frequently it took the form of minute foci of muscle tenderness which had to be carefully sought and for no ostensible reason were generally found in the trapezii and gastrocnemii.

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