Muscle Pain Myalgia

DIAGNOSTIC APPROACH TO MUSCLE PAIN (continued)

Investigations

Serum creatine kinase (muscle enzyme)

- elevated in muscle necrosis, high levels result in myoglobinuria

Imaging (occasionally used)

Ultrasound, MR or CT in suspected muscle hacmatoma, abscess or tumour. Radionuclide (Gallium or in suspected muscle abscess, Technitium)

Electromyography (EMG)

Will confirm presence of myopathy (rarely more specific)

Muscle biopsy (needle or open) Essential in diagnosis of

- inflammatory myopathies

- metabolic myopathies Helpful in collagen vascular disease

Ischaemic lactate test

Measurement of post exercise changes in serum lactate Reduced response in - metabolic myopathies (disorders of glycolytic pathway)

Following extensive investigation, in a significant number of cases no cause of myalgia is found. Most disorders are covered in relevant sections. Those that are not are briefly described.

Fibromyalgia

A common condition of uncertain pathology in which generalised muscle pain with localised tender areas occurs without objective clinical or laboratory abnormalities. Psychiatric symptoms commonly co-exist.

Malignant hyperpyrexia Characterised by a sudden rise in body temperature whilst undergoing general anaesthesia, usually with halothane or succinylcholine. Certain hereditary myopathic disorders, e.g. myotonic dystrophy, central core disease - are unduly prone to this condition.

Muscle abscess

Commonly Staphylococcal due to local trauma or blood-borne in debilitated persons.

Polymyalgia Rheumatica Proximal muscle pain encountered in the elderly and often associated with giant cell arteritis. The ESR is elevated and the EMG is normal. Muscle biopsy shows type 2 fibre loss. Steroids are effective.

Muscle tumours

These are rare. Mixed pathologically and of varying degrees of malignancy

Benign myalgic encephalomyelitis (ME) Characterised by exercise induced muscle pain. A puzzling disorder often occurring after viral illness, associated with fatigue, without clear diagnostic criteria and merging with depressive symptoms.

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