Symptom Finder - Generalized Musculoskeletal Pain
MUSCULOSKELETAL PAIN, GENERALIZED
The mnemonic VINDICATE is extremely useful in developing a list of possible causes of musculoskeletal pain.
V—Vascular disorders include periarteritis nodosa, SBE, and polymyalgia rheumatica, which also could be classified under collagen disorders.
I—Infectious diseases include brucellosis, poliomyelitis, influenza, leptospirosis, measles, dengue fever, epidemic myalgia, trichinosis, cysticercosis, malaria, and toxoplasmosis. Almost any febrile illness may begin with generalized myalgia.
N—Neoplastic diseases that may cause generalized myalgia are those that are associated with fever such as Hodgkin lymphoma and leukemia.
D—Deficiency disorders associated with myalgia are rickets and osteomalacia.
I—Intoxication with lead, alcohol, lithium, and drugs such as vincristine, amphotericin B, cimetidine, and amphetamines may cause generalized myalgia.
C—Congenital disorders such as McArdle syndrome (type V glycogen storage disease), porphyria, and myoglobinuria may cause generalized myalgia.
A—Autoimmune disorders include periarteritis nodosa, lupus erythematosus, rheumatic fever, Guillain–Barré syndrome, and dermatomyositis.
T—Trauma causing muscular hemorrhages or injury is usually associated with focal myalgia and cramps, but after prolonged exercise, there may be generalized myalgia. Prolonged anxiety and tension may cause myalgia by the same mechanism. However, it is unlikely that the entity fibromyalgia is a disease.
E—Endocrine and electrolyte disorders bring to mind hypothyroidism, hypoparathyroidism, prolonged corticosteroid therapy, hyperaldosteronism, hyponatremia, hypokalemia, and hypocalcemia
Approach to the Diagnosis
On history and physical examination one may find the history of the use of
alcohol and/or drugs, signs of fever, paralysis, or psychiatric
symptomatology. Collagen disease will show certain telltale symptoms
and signs. The laboratory workup includes a CBC, urinalysis,
sedimentation rate, ANA test, chemistry panel, and electrolytes. Febrile
agglutinins, ASO titers, Trichinella antibody titer, and protein
electrophoresis may be indicated. It may be wise to consult a neurologist,
endocrinologist, or infectious disease specialist.
Other Useful Tests
1. NCV (neuropathy, radiculopathy)
2. EMG (myopathy, radiculopathy)
3. Muscle biopsy (collagen disease, myopathy)
4. Spinal tap (Guillain–Barré syndrome, neurosyphilis, multiple sclerosis)
5. RA test
6. 24-hour urine calcium, sodium, or potassium level (endocrine
disorder, electrolyte disorder)
7. Urine aldosterone (primary aldosteronism)
8. Serum PTH assay (hypoparathyroidism)
9. Urine porphyrin and porphobilinogen levels (porphyria)
10. Urine myoglobin (muscle injury)
The mnemonic VINDICATE is extremely useful in developing a list of possible causes of musculoskeletal pain.
V—Vascular disorders include periarteritis nodosa, SBE, and polymyalgia rheumatica, which also could be classified under collagen disorders.
I—Infectious diseases include brucellosis, poliomyelitis, influenza, leptospirosis, measles, dengue fever, epidemic myalgia, trichinosis, cysticercosis, malaria, and toxoplasmosis. Almost any febrile illness may begin with generalized myalgia.
N—Neoplastic diseases that may cause generalized myalgia are those that are associated with fever such as Hodgkin lymphoma and leukemia.
D—Deficiency disorders associated with myalgia are rickets and osteomalacia.
I—Intoxication with lead, alcohol, lithium, and drugs such as vincristine, amphotericin B, cimetidine, and amphetamines may cause generalized myalgia.
C—Congenital disorders such as McArdle syndrome (type V glycogen storage disease), porphyria, and myoglobinuria may cause generalized myalgia.
A—Autoimmune disorders include periarteritis nodosa, lupus erythematosus, rheumatic fever, Guillain–Barré syndrome, and dermatomyositis.
T—Trauma causing muscular hemorrhages or injury is usually associated with focal myalgia and cramps, but after prolonged exercise, there may be generalized myalgia. Prolonged anxiety and tension may cause myalgia by the same mechanism. However, it is unlikely that the entity fibromyalgia is a disease.
E—Endocrine and electrolyte disorders bring to mind hypothyroidism, hypoparathyroidism, prolonged corticosteroid therapy, hyperaldosteronism, hyponatremia, hypokalemia, and hypocalcemia
Approach to the Diagnosis
On history and physical examination one may find the history of the use of
alcohol and/or drugs, signs of fever, paralysis, or psychiatric
symptomatology. Collagen disease will show certain telltale symptoms
and signs. The laboratory workup includes a CBC, urinalysis,
sedimentation rate, ANA test, chemistry panel, and electrolytes. Febrile
agglutinins, ASO titers, Trichinella antibody titer, and protein
electrophoresis may be indicated. It may be wise to consult a neurologist,
endocrinologist, or infectious disease specialist.
Other Useful Tests
1. NCV (neuropathy, radiculopathy)
2. EMG (myopathy, radiculopathy)
3. Muscle biopsy (collagen disease, myopathy)
4. Spinal tap (Guillain–Barré syndrome, neurosyphilis, multiple sclerosis)
5. RA test
6. 24-hour urine calcium, sodium, or potassium level (endocrine
disorder, electrolyte disorder)
7. Urine aldosterone (primary aldosteronism)
8. Serum PTH assay (hypoparathyroidism)
9. Urine porphyrin and porphobilinogen levels (porphyria)
10. Urine myoglobin (muscle injury)