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Approach to the patient with myalgia

Robert H Shmerling, MD
Section Editor
Mark D Aronson, MD
Deputy Editor
Daniel J Sullivan, MD, MPH


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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Literature review current through: Nov 2017. | This topic last updated: Apr 25, 2016.
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  1. Gumber SC, Chopra S. Hepatitis C: a multifaceted disease. Review of extrahepatic manifestations. Ann Intern Med 1995; 123:615.
  2. Lormeau C, Falgarone G, Roulot D, Boissier MC. Rheumatologic manifestations of chronic hepatitis C infection. Joint Bone Spine 2006; 73:633.
  3. Archard LC, Bowles NE, Behan PO, et al. Postviral fatigue syndrome: persistence of enterovirus RNA in muscle and elevated creatine kinase. J R Soc Med 1988; 81:326.
  4. Bratton RL, Whiteside JW, Hovan MJ, et al. Diagnosis and treatment of Lyme disease. Mayo Clin Proc 2008; 83:566.
  5. González-Juanatey C, González-Gay MA, Llorca J, et al. Rheumatic manifestations of infective endocarditis in non-addicts. A 12-year study. Medicine (Baltimore) 2001; 80:9.
  6. Misra UK, Kalita J, Maurya PK, et al. Dengue-associated transient muscle dysfunction: clinical, electromyography and histopathological changes. Infection 2012; 40:125.
  7. Salvarani C, Cantini F, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. Lancet 2008; 372:234.
  8. Pease CT, Haugeberg G, Morgan AW, et al. Diagnosing late onset rheumatoid arthritis, polymyalgia rheumatica, and temporal arteritis in patients presenting with polymyalgic symptoms. A prospective longterm evaluation. J Rheumatol 2005; 32:1043.
  9. Caso F, Rigante D, Vitale A, et al. Monogenic autoinflammatory syndromes: state of the art on genetic, clinical, and therapeutic issues. Int J Rheumatol 2013; 2013:513782.
  10. Meeus M, Nijs J, Meirleir KD. Chronic musculoskeletal pain in patients with the chronic fatigue syndrome: a systematic review. Eur J Pain 2007; 11:377.
  11. Siddiqi SA, Thompson PD. How do you treat patients with myalgia who take statins? Curr Atheroscler Rep 2009; 11:9.
  12. Jacobson TA. Toward "pain-free" statin prescribing: clinical algorithm for diagnosis and management of myalgia. Mayo Clin Proc 2008; 83:687.
  13. Eisele S, Garbe E, Zeitz M, et al. Ciprofloxacin-related acute severe myalgia necessitating emergency care treatment: a case report and review of the literature. Int J Clin Pharmacol Ther 2009; 47:165.
  14. Lambrinoudaki I, Vlachou S, Galapi F, et al. Once-yearly zoledronic acid in the prevention of osteoporotic bone fractures in postmenopausal women. Clin Interv Aging 2008; 3:445.
  15. Yamamoto Y, Iwase H. Safety profiles of aromatase inhibitors and selective estrogen-receptor modulators in the treatment of early breast cancer. Int J Clin Oncol 2008; 13:384.
  16. Conte P, Frassoldati A. Aromatase inhibitors in the adjuvant treatment of postmenopausal women with early breast cancer: Putting safety issues into perspective. Breast J 2007; 13:28.
  17. Rosenbaum JF, Zajecka J. Clinical management of antidepressant discontinuation. J Clin Psychiatry 1997; 58 Suppl 7:37.
  18. Testa M, Navazio FM, Neugebauer J. Recognition, diagnosis, and treatment of mitochondrial myopathies in endurance athletes. Curr Sports Med Rep 2005; 4:282.
  19. DiMauro S, Gurgel-Giannetti J. The expanding phenotype of mitochondrial myopathy. Curr Opin Neurol 2005; 18:538.
  20. Lyman D. Undiagnosed vitamin D deficiency in the hospitalized patient. Am Fam Physician 2005; 71:299.
  21. Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc 2003; 78:1463.
  22. Fain O. Musculoskeletal manifestations of scurvy. Joint Bone Spine 2005; 72:124.
  23. Muratori P, Granito A, Pappas G, et al. Autoimmune liver disease 2007. Mol Aspects Med 2008; 29:96.
  24. Punzi L, Betterle C. Chronic autoimmune thyroiditis and rheumatic manifestations. Joint Bone Spine 2004; 71:275.
  25. Bazzichi L, Rossi A, Giuliano T, et al. Association between thyroid autoimmunity and fibromyalgic disease severity. Clin Rheumatol 2007; 26:2115.
  26. Shapiro MS, Trebich C, Shilo L, Shenkman L. Myalgias and muscle contractures as the presenting signs of Addison's disease. Postgrad Med J 1988; 64:222.
  27. Corruble E, Guelfi JD. Pain complaints in depressed inpatients. Psychopathology 2000; 33:307.
  28. Vaccarino AL, Sills TL, Evans KR, Kalali AH. Multiple pain complaints in patients with major depressive disorder. Psychosom Med 2009; 71:159.
  29. Alvarez-Nemegyei J, Canoso JJ. Evidence-Based Soft Tissue Rheumatology IV: Anserine Bursitis. J Clin Rheumatol 2004; 10:205.
  30. Chauhan S, Jain S, Varma S, Chauhan SS. Tropical pyomyositis (myositis tropicans): current perspective. Postgrad Med J 2004; 80:267.
  31. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 29-1997. A 54-year-old diabetic woman with pain and swelling of the leg. N Engl J Med 1997; 337:839.
  32. Bennett R. Myofascial pain syndromes and their evaluation. Best Pract Res Clin Rheumatol 2007; 21:427.
  33. Naderi AS, Farsian FN, Palmer BF. Diabetic muscle necrosis. J Diabetes Complications 2008; 22:150.
  34. Mammen AL, Amato AA. Statin myopathy: a review of recent progress. Curr Opin Rheumatol 2010; 22:644.
  35. Fernandez G, Spatz ES, Jablecki C, Phillips PS. Statin myopathy: a common dilemma not reflected in clinical trials. Cleve Clin J Med 2011; 78:393.