Orthopaedics & Rheumatology \ Myalgias and Arthralgias Flashcards
A 40-year-old woman presents to your office with complaints of chronic pain and fatigue over the last year. On examination, she has multiple areas of soft tissue tenderness, but no tenderness at the joints. What is the suspected diagnosis?
Fibromyalgia syndrome (FMS)
Criteria for the diagnosis of FMS
- Generalized pain for more than three months
- pain on left and right sides of the body
- pain above and below the waist
- pain must involve the axial skeleton
- Pain, not just tenderness, at 11 or more of 18 defined trigger points sites
How do you test the trigger points in FMS?
Digital palpation with an approximate force of 4 kg on each of 18 trigger point sites
What other symptoms do patients with FMS often describe?
- Sleep disturbance
- short-term memory loss
- fatigue
- depression and anxiety
- migraine or tension headaches
- substernal chest pain
- paresthesias in hands and feet
What are the lifestyle changes that can help in the treatment of FMS?
- Reassurance that disease is not life-threatening
- stretching
- exercise
- weight loss
- FMS support group or visit to established FMS clinic
What medications can be used to treat FMS?
- Tricyclic antidepressants, such as amitriptyline
- NSAIDs for short course (no corticosteroids or narcotics)
- selective serotonin reuptake inhibitor (SSRI) if severe depression
- topical analgesic agents applied to tender points
Pain that persists after an original injury and is out of proportion to the initial injury is characteristic of what syndrome?
Complex regional pain syndrome (CRPS)
What is the classification of CRPS?
Type 1 (reflex sympathetic dystrophy): no identifiable nerve lesion (30%)
Type 2 (causalgia): nerve lesion (70%)
Who is commonly affected by CRPS?
- Women >> men
- smokers
- individuals between 30 and 50 years
What are some of the hallmarks of CRPS?
- Allodynia
- hyperpathia
- hyperesthesia
- sleep disturbance
- pain described as “burning or throbbing”
What physical examination signs support the diagnosis of CRPS?
- Swelling
- hypersensitivity
- contracture
- overly hot or cold
- atrophy of skin and soft tissue
What is the treatment of CRPS?
- Physical therapy for ROM
- adaptive modalities
- oral medications
- psychological counseling
- biofeedback
What medications can help in the treatment of CRPS?
- Antidepressants
- anticonvulsants
- calcium-channel blockers
