Myalgia

Myalgia: Excerpt from In a Page: Signs and Symptoms

Myalgia, or muscle pain, is an extremely common complaint. Determine whether the pain is temporally related to trauma, exercise, associated illness, and/or medications.

Differential Diagnosis

• Acute muscle overuse/excessive physical exertion
  –Usually due to exercising poorly conditioned muscles
• Systemic febrile illness (e.g., influenza)
• Drugs/medications (e.g., statins)
• Electrolyte disturbances
  –Especially abnormalities of potassium, calcium, or magnesium
• Chronic overuse syndromes
  –Frequently related to occupational or vocational activities
• Myopathies
  –Metabolic: Usually result in muscle pain related to exercise
  –Dystrophies (e.g., mitochondrial myopathies)
  –Inflammatory (e.g., polymyositis, dermatomyositis)
  –Toxic (e.g., alcohol, cocaine, statins)
  –Infectious muscle disease (viral, bacterial, parasitic)
  • Trauma
  • Muscle ischemia (e.g., claudication in patients with peripheral vascular disease)
  • Rheumatologic disorders
    –Polymyalgia rheumatica: Especially pain around the shoulders, back, and hips
    –Fibromyalgia: Diffuse muscle and soft tissue pain with many areas of point tenderness; regionally restricted areas of pain may be referred to as myofascial pain
  • Endocrine disturbances
    –Thyroid disease
    –Parathyroid disease
    –Adrenal disease
    –Diabetes mellitus (muscle infarcts)
  • Muscle pain must also be differentiated from pain of associated or nearby structures (e.g., tendons, ligaments, bone, connective tissue)
  • Rhabdomyolysis

  Workup and Diagnosis

  • History and physical examination
    –History should focus on the temporal events surrounding the occurrence of myalgias (e.g., post-exercise, new vocational or avocational activities, onset of pain coinciding with initiation of new medications)
    –Focal versus generalized
    –Note abnormal urine (e.g., myoglobinuria causes tea-colored urine in rhabdomyolysis)
    –Physical exam should be directed at determining whether muscular weakness and features of systemic illness are present
  • Labs may include electrolytes (including calcium), BUN/ creatinine, glucose, creatine kinase, aldolase, creatinine, urinalysis, myoglobin, thyroid function tests, ESR, and CBC
  • Electromyography may be helpful in identifying evidence of myopathy
  • Imaging (usually MRI) may be necessary, especially in suspected focal muscle pathology
  • Muscle biopsy may be useful in the evaluation of suspected inflammatory myopathies, muscular dystrophies, or metabolic myopathies

  Treatment

  • Remove offending drugs or identified toxins
  • Correct electrolyte imbalance, especially sodium, potassium, calcium, or magnesium abnormalities
  • Overuse injury is generally treated by rest, followed by gradual conditioning exercises
  • Severe muscle trauma may require surgical treatment
  • Fluids and other measures to protect renal function are necessary in rhabdomyolysis with myoglobinuria
  • Appropriate treatment of an underlying endocrine disorder may improve muscle pain
  • Treat infectious causes with appropriate antimicrobials
  • Rheumatologic causes may respond to steroids or immunosuppressive therapy
  • Inflammatory myopathies may be treated with steroids or other immunosuppressive therapies
  • Claudication may be treated with exercise programs, medications such as pentoxifylline or cilostazol, or with endovascular or surgical procedures

Book Source Details

• Book Title: In a Page: Signs and Symptoms
• Author(s): Scott Kahan, Ellen G. Smith
• Year of Publication: 2004
• Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

More About Muscle pain

• Back to disease: Muscle pain: Introduction
• Next Book Extract About Muscle pain: Muscle Weakness – Distal (In A Page: Pediatric Signs and Symptoms)
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: In a Page: Signs and Symptoms Authors: Scott Kahan, Ellen G. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2004 ISBN: 1-4051-0368-X

 » Next page: Muscle Weakness – Distal (In A Page: Pediatric Signs and Symptoms)

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