Diagnosis of Muscle pain

Muscle pain Diagnosis: Book Excerpts

• Differential Diagnosis - Myalgia
• Differential Diagnosis - Muscle Weakness – Distal
• Differential Diagnosis - Muscle Weakness – Proximal
• History and physical examination - Muscle weakness
• History and physical examination - Muscle weakness
• History - Muscle weakness
• History and physical examination - Muscle weakness

Diagnosis of Muscle pain: medical news summaries:

The following medical news items are relevant to diagnosis and misdiagnosis issues for Muscle pain:

• Baby boy dies from bacterial meningitis
• Connective tissue disease frequently misdiagnosed or undiagnosed
• Lupus awareness increasing
• Research indicates that chronic fatigue syndrome is not a psychiatric disorder
• Rules for sore muscles
• Thyroid disorder underdiagnosed and misdiagnosed
• More news »

Diagnostic Tests for Muscle pain: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about diagnostis of Muscle pain.

Myalgia: Differential Diagnosis
(In a Page: Signs and Symptoms)

• 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

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Muscle Weakness – Distal: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

• Guillain-Barré syndrome (GBS)
  –Acute, acquired, or monophasic
  –Ascending weakness and parasthesias
• Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)
• Compression neuropathy
  –Trauma
  –Neoplasm (e.g., plexiform neurofibroma in neurofibromatosis type 1)
• Charcot-Marie-Tooth
  –Defect in peripheral myelin protein
  –Causes distal segmental demyelination
  –Manifested by distal muscle atrophy and weakness
• Drug-induced
  –Phenytoin
  –Isoniazid
  –Nitrofurantoin
  –Vincristine
  –Zidovudine
• Spinal muscular atrophy
• Juvenile segmental spinal muscular atrophy
• Miller-Fisher syndrome
  –Clinical triad of ataxia, ophthalmoplegia, and areflexia
• Tick paralysis
• Juvenile amyotrophic lateral sclerosis
• Giant axonal neuropathy
• Vitamin B12 deficiency
• Toxic neuropathy
  –Arsenic
  –Lead
  –Mercury
  –Thallium
  –Glue sniffing
• Uremic neuropathy
• Idiopathic axonal neuropathy
• Hereditary distal myopathy
• Inclusion body myopathy
• Rheumatoid arthritis
• Refsum disease
• Metachromatic leukodystrophy
• Krabbe disease
• Cockayne syndrome
• Conversion reaction
  –Usually fluctuating and unpredictable

Workup and Diagnosis

• History
  –Acute vs chronic, associated sensory findings, associated systemic/neurologic abnormalities
  –Family history (family members may not be affected to same degree)
  –Toxic exposures
• Physical exam
  –Abnormal gait can be the presenting symptom of either proximal or distal leg weakness
  –Stumbling, especially with foot eversion or dorsiflexion
  –Weakness of the hand muscles (e.g., difficulty writing, opening jars, or working with tools)
  –Inspect muscle for atropy, hypertrophy, fasciculations, myotonia, cogwheeling
  –Palpate muscles for tenderness
  –Mirror movements, hypotonia, spasticity/rigidity
  –Assess strength and power with push/pull testing, functional hop in place, knee bends, posture
  –Pronator drift, standing on toes/heels, symmetry
  • Labs
    –Serum CK
    –In neuropathic disorders, CK is usually normal or mildly increased; moderate to severe elevation of CK suggests myopathy
  • Electromyogram/nerve conduction studies
    –Demonstrate the extent, chronicity, and categorization
  • Muscle biopsy
    –Histochemistry, EM, enzymatic/genetic testing

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Muscle Weakness – Proximal: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

• Duchenne and Becker muscular dystrophy
• Spinal muscular atrophy
• Spinal cord disorders
  –Trauma
  –Myelitis
  –Neoplasm
  –AVM
  –Hemorrhage
  –Tansverse myelitis
• Limb-girdle myasthenia
• Dermatomyositis
• Congenital myopathies
  –Central core disease
  –Myotubular
  –Nemaline (rod)
  –Congenital fiber-type disproportion
• Facioscapulohumeral syndrome
• Limb-girdle muscular dystrophies
• Glycogen storage myopathies
• Endocrine myopathies
  –Hypo- and hyperthyroidism
  –Hyperparathyroidism
  –Adrenalism
• Polymyositis
• GM2 gangliosidosis
• Pompe disease
  –Glycogen storage disease type II
  –Acid maltase deficiency
• McArdle disease
• Carnitine deficiency
• Fatty acid oxidation defects
• Mitochondrial disorders
• Steroid-induced myopathy
• Slow channel syndrome
• Toxins
  –Organophosphates
  –Aminoglycosides
  –Tetrodotoxin (pufferfish)
• Conversion reaction
• Myasthenia gravis

Workup and Diagnosis

• History: Age upon reaching developmental milestones, abnormal gait, toe walking, easy fatigability, muscle cramps, facial weakness, cardiac, respiratory, GI problems, dark urine
• Physical exam: Muscle mass, texture and tenderness, scoliosis, cardiac exam, skin rashes, joint contractures
• Neurologic exam
  –Muscle strength and tone
  –Gowers sign
  –Mental status, eye movements
  –Facial movements, tongue fasciculations
  –Muscle stretch reflexes and sensory responses
  –Stance and gait
  –Spinal cord disorders, examine dermatomal sensory loss, anal wink, cremasteric reflex
• Labs: Muscle enzymes (CPK, aldolase); electrolytes, TSH, lactate, pyruvate, carnitine; ANA, RF, genetic testing for muscular dystrophy and spinal muscular atrophy; hexosaminidase, acetylcholine receptor antibodies, myoglobin in urine (muscle breakdown)
• EMG/nerve conduction studies
  –Differentiates dysfunction of the anterior horn cell, muscle, or neuromuscular junction
• Muscle biopsy for metabolic, inflammatory, and congenital myopathies; distinguishes myopathy from anterior horn cell disease
• MRI of the spine for spinal cord disorder
• Tensilon test for myasthenia

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Muscle weakness: History and physical examination
(Handbook of Signs & Symptoms (Third Edition))

Begin by determining the location of the patient’s muscle weakness. Ask if he has difficulty with specific movements such as rising from a chair. Find out when he first noticed the weakness; ask him whether it worsens with exercise or as the day progresses. Also ask about related symptoms, especially muscle or joint pain, altered sensory function, and fatigue.

Obtain a medical history, noting especially chronic disease, such as hyperthyroidism; musculoskeletal or neurologic problems, including recent trauma; a family history of chronic muscle weakness, especially in males; and alcohol and drug use.

Focus your physical examination on evaluating muscle strength. Test all major muscles bilaterally. (See Testing muscle strength, pages 418 and 419.) When testing, make sure that the patient’s effort is constant; if it isn’t, suspect pain or other reluctance to make the effort. If the patient complains of pain, ease or discontinue testing and have him try the movements again. Remember that the patient’s dominant arm, hand, and leg are somewhat stronger than their nondominant counterparts. Besides testing individual muscle strength, test for range of motion (ROM) at all major joints (shoulder, elbow, wrist, hip, knee, and ankle). Also test sensory function in the involved areas, and test deep tendon reflexes (DTRs) bilaterally.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Muscle weakness: History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))

Begin by determining the location of the patient’s muscle weakness. Ask if he has difficulty with specific movements, such as rising from a chair. Find out when he first noticed the weakness; ask him whether it worsens with exercise or as the day progresses. Also ask about related symptoms, especially muscle or joint pain, altered sensory function, and fatigue.

Obtain a medical history, noting especially chronic disease such as hyperthyroidism; musculoskeletal or neurologic problems, including recent trauma; family history of chronic muscle weakness, especially in males; and alcohol and drug use.

Focus your physical examination on evaluating muscle strength. Test all major muscles bilaterally. (See Testing muscle strength, pages 530 and 531.) When testing, make sure the patient’s effort is constant; if it isn’t, suspect pain or other reluctance to make the effort. If the patient complains of pain, ease or discontinue testing and have him try the movements again. Remember that the patient’s dominant arm, hand, and leg are somewhat stronger than their nondominant counterparts. Besides testing individual muscle strength, test for range of motion at all major joints (shoulder, elbow, wrist, hip, knee, and ankle). Also test sensory function in the involved areas, and test deep tendon reflexes bilaterally.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Muscle weakness: History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Determine the location of the patient’s muscle weakness. Ask if he has difficulty with specific movements such as rising from a chair. Find out when he first noticed the weakness; ask him whether it worsens with exercise or as the day progresses. Also ask about related symptoms, especially muscle or joint pain, altered sensory function, and fatigue.

Obtain a medical history, noting especially chronic disease such as hyperthyroidism; musculoskeletal or neurologic problems, including recent trauma; family history of chronic muscle weakness, especially in males; and alcohol and drug use.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Muscle weakness: History and physical examination
(Nursing: Interpreting Signs and Symptoms)

Begin by determining the location of the patient's muscle weakness. Ask if he has difficulty with specific movements such as rising from a chair. Find out when he first noticed the weakness; ask him whether it worsens with exercise or as the day progresses. Also ask about related symptoms, especially muscle or joint pain, altered sensory function, and fatigue.

Obtain a medical history, noting especially chronic disease, such as hyperthyroidism; musculoskeletal or neurologic problems, including recent trauma; a family history of chronic muscle weakness, especially in males; and alcohol and drug use.

Focus your physical examination on evaluating muscle strength. Test all major muscles bilaterally. (See Testing muscle strength, pages 410 and 411.) When testing, make sure that the patient's effort is constant; if it isn't, suspect pain or other reluctance to make the effort. If the patient complains of pain, ease or discontinue testing and have him try the movements again. Remember that the patient's dominant arm, hand, and leg are somewhat stronger than their nondominant counterparts. Besides testing individual muscle strength, test for range of motion (ROM) of all major joints (such as shoulder, elbow, wrist, hip, knee, and ankle). Also test sensory function in the involved areas, and test deep tendon reflexes (DTRs) bilaterally.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

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