Myalgia

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of muscle aches

‍GeneralizedLocalized to ‍

Severity is ‍mildmoderatesevere

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍fatigue

‍weakness

‍joint pain

‍swelling

‍redness

‍stiffness

‍headache, ‍diffuse, ‍persistentintermittent, ‍pressurethrobbing, ‍mild

‍nausea

‍loss of appetite

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional

‍depression

‍anxiety

‍shortness of breath

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild



Contributing factors:

‍recent vigorous exercise

‍prolonged immobilization

‍trauma

‍recent viral infection

no history of: ‍fibromyalgia, ‍polymyalgia rheumatica, ‍influenza, ‍hypothyroidism, ‍autoimmune diseases, ‍vitamin D deficiency

no use of: ‍statin, ‍corticosteroids, ‍new medication





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Musculoskeletal: joints ‍ ‍normal, ‍limited ROM





ASSESSMENT:

‍Myalgia due to overexertion ‍likelysuspectedpossible

DDx: overexertion, viral infection, fibromyalgia, statin-induced myopathy, hypokalemia, hypocalcemia, polymyositis, dermatomyositis, hypothyroidism, chronic fatigue syndrome, dehydration, rhabdomyolysis, lupus, rheumatoid arthritis, Lyme disease, medication side effect (e.g., statins, fibrates, antipsychotics), vitamin D deficiency, neuromuscular disorders, HIV, stress-related muscle tension





PLAN:

Investigations:

- Blood work: ‍CBC, ‍creatinine, ‍electrolytes, ‍LFTs, ‍uric acid, ‍CRP, ‍ESR, ‍CK, ‍TSH, ‍vitamin D, ‍vitamin B12, ‍ferritin, ‍calcium, ‍magnesium, ‍phosphate, ‍albumin

- Urinalysis

- X-ray of the affected area

- Bone scan

Treatments:

- Rest and hydration

- Heat or cold therapy

- ‍Acetaminophen

- ‍NSAIDs

- ‍Muscle relaxants

- Reassess medications that may be causing muscle aches (statins, corticosteroids, aromataze inhibitors)

- Physical therapy

- Massage therapy

- ‍Vitamin D supplement

- ‍Magnesium supplement

Further care:

- Referral to rheumatologist

- Referral to neurologist

- Follow-up in ‍ ‍weeksmonths

- Return if pain worsens, if new symptoms develop such as weakness or numbness, or if symptoms do not improve with treatment