Differential Diagnosis of Myalgias

Abstract

Myalgias belong to the most frequent neuromuscular complaints. They may be due to organic and functional (psychosomatic) diseases. A purposeful differential diagnosis requires the differentiation of acute, chronic, and recurrent, focal and generalised, exercise-induced and not exercise-induced myalgias. Thoroughly collecting the patient's history, including his family history, and general and neurological examination are mandatory. The physician has to search for trigger and tender points, determine the activity of the creatine kinase and several other laboratory parameters, and perform an electromyography. Optional are muscle imaging and - depending on the actual findings - a Muscle biopsy, pathobiochemical, and molecular genetic investigations. In the case of a Suspicion of functional abnormalities a psychiatric or psychosomatic examination is needed. The present review tabulates the most important aetiologies of myalgias.