Approach to the patient with myalgia
- Robert H Shmerling, MD
Robert H Shmerling, MD
- Section Editor — Diagnostic Issues in Rheumatology
- Associate Professor of Medicine
- Harvard Medical School
Myalgia, or muscle pain, is a common complaint among adults presenting for medical care. In fact, nearly everyone will experience muscle soreness at some point in their life. Unusually excessive exertion, trauma, and viral infections are among the most common causes. While many causes are benign and self-limited, myalgia may be the harbinger of disorders associated with significant morbidity.
A thorough review of the patient's history and a complete physical examination can usually narrow the list of potential causes of myalgia to a manageable few. For persistent or severe myalgia without a known cause, selected testing may be necessary to identify or exclude specific diagnoses and to direct treatment.
It is important to differentiate myalgia from myopathy (muscle disease) and myositis (muscle inflammation). Although myopathy and myositis may cause myalgia, most individuals with myalgia have neither. It is also useful to separate diffuse from localized symptoms. This review will discuss the approach to myalgia as a presenting symptom to a primary care clinician, focusing on etiology, history, physical examination, laboratory studies, and management. Specific disorders characterized by prominent myalgia are covered elsewhere. (See "Differential diagnosis of fibromyalgia" and "Myopathies of systemic disease" and "Drug-induced myopathies".)
The etiologies of myalgias can be divided based upon diffuse versus focal symptoms.
Diffuse myalgias — The most common causes of diffuse myalgia are (table 1):
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- Diffuse myalgias
- Localized myalgias
- Serious conditions
- - Muscle symptoms
- - Associated symptoms
- - Other history
- Physical examination
- - Muscle examination
- - General physical examination
- Laboratory studies
- Other studies
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS