Muscle Pain Flashcards
Myalgia
muscle pain
Myopathy
muscle disease
Myositis
muscle inflammation
cramps
painful, involuntary muscle contraction
contractures
failure of muscles to relax, assoc w/glycolytic and neurologic disease
Etiologies
Range from benign to life-threatening
Dematomyositis and Polymyositis
Immune-mediated inflammatory myopathy; insidious onset of mild myalgias in 25-50% of pts + symmetric, proximal weakness (deltoids, neck, hiops -> difficulty climbing stairs, carrying heavy loads); may p/w dysphagia, ILD, polyarthritis; skin changes seen in DM but no PM
Pyomyositis
Skeletal muscle infection, typically from hematogenous source assoc w/ trauma, HIV, IVDU, malnutrition, most frequently caused by S. aureus
DD of myalgias
Infectious Pain syndromes Rheumatologic Metabolic Endocrine Medications Localized Nocturnal leg cramps
Infectious - Myalgias
Viral (enterovirus, hepatitis, B/C, influenza, dengue, HIV), bacterial (s. aureus, s viridans), spirochetes, necrotizing fasciitis
Pain syndromes - Myalgias
Fibromyalgia, chronic fatigue syndrome
Rheumatologic - Myalgias
PMR, polymyositis/dermatomyositis, RA, SLE, spondyloarthropathy, vasculitis
Metabolic - Myalgias
Scurvy, metabolic myopathy, vit d deficiency
Endocrine - Myalgias
adrenal insufficiency, hypothyroidism, neuropathy
Medications - Myalgias
Statins, antipsychotics, fibrates, colchicine, AZT, cocaine, methadone, labetalol, cimetidine, CsA, cipro, bisphosphonates, aromatase inhibitors, alcohol and antidepressant withdrawal
Localized - Myalgias
Exercise/overus, trauma, pyomyositis, infarction, compartment syndrome, bursitis, necrotizing fasciitis, muscle strain/sprain
Nocturnal leg cramps - Myalgias
Foot d/o (flat feet), prolonged sitting/standing, diuretics, HD, pregnancy, spinal stenosis, PD, radiculopathy, exercise, meds, claudication, decrease mag and ca, neuropathy, DVT
Pain out of proportion to exam
nec fasciitis/cellulitis/myositis, compartment syndrome
Sudden onset
acute bacterial or viral illness
Gradual onset
Statins, hep c, endocrinopathy, pain syndrome, PM/D
Joint involvement
PMR, RA
Fever, HA, malaise
Viral infection (influenza), pyomyositis
Weakness
PM/DM, hypothyroidism, statin-induced
Dysphagia, dyspnea
Dermatomyositis, polymyositis
Red/brown urine + weakness
Rhabdomyolysis (increase serum CK, increase urine myoglobing)
Redness, swelling, asymmetry
Pyomyositis, compartment syndrome
Delayed reflexes
Hypothyroidism
Hyperpigmentation
adrenal insuff
Malar rash
SLE
Erythema migrans
Lyme
Mechanic hands
Polymyositis
Gottrons papules
Occur on dorsal MCP and IP joints
Dermatomyositis
Gottron sign
Papules/patches/macules on elbows, knees, ankles
Dermatomyositis
Facial erythema
Dermatomyositis
Heliotrope eruption on upper eyelids
Dermatomyositis
Workup
CBC, U/A, Cr, LFTs; consider Ca, albumin, phos, TSH, CK, 25OH vit D, BCx, ESR, CRP, ANA, RF, Anti-CCP, ACTH stimulation test; imaging generally reserved for eval of inflammatory muscle disease, pyomyositis, muscle infarction; EMG used to dx myopathy (along w/nerve conduction studies): bx occasionally necessary
Dermatomyositis/polymyositis workup
Increase CK, LDH; + ANA, + anti-Jo1; CXR to evaluate for ILD; consider muscle or skin bx, EMG, MRI
Pyomyositis workup
CT or MRI, BCx; high index of suspicion (& r/o necrotizing fasciitis
Management
medication-induced
Stop medication, may take mos to wks to resolve
Management
Chronic fatigue syndrome
Cognitive behavioral therapy and graded exercise RX (no evidence for meds or diet changes)
Management
Dematomyositis/polymyositis
Glucorticoids (1mg/kg [max dose = 80mg] -> taper after 4-6 weeks); comanagement w/rheum +/- derm; physical therapy; SLP eval if dysphagia present; PCP Ppx if long-term high dose steroids used
Management
Pyomyositis
Abx (assess risk of MRSA infection) and/or drainage