Painful, non-articular condition of unknown cause, involving muscles. Common and results in significant disability and handicap, 90% female, 40-50yo.
- p/c: pain/tenderness locations
- o Insertion of nuchal muscles into the occiput
- o Upper border of trapezius midportion
- o Muscle attachments to upper medial border of scapula
- o Anterior aspects of C5, C7 intertransverse spaces
- o 2nd rib space ~3cm lateral to sternal border
- o Muscle attachments to lateral epicondyle at the elbow
- o Upper outer quadrant of gluteal muscle
- o Muscle attachements just posterior to greater trochanter
- o Medial fat pad of the knee proximal to the joint line
- Pain is usually worsened by stress, cold or activity and is associated with morning stiffness
- Paraesthesiae of hands and feet, analgesics and NSAIDs are ineffective, sleep patterns are poor (wake exhausted), anxiety and depression are present, unexplained headaches, urinary frequency, abdo pain…
- Ix: exclude hypothyroid, SLE, Sjogren’s, psoriatic arthritis, inflammatory myopathy, hyperparathyroidism, osteomalacia. Check FBC, ESR, TFT, U&E, Ca2, CK, PO4, ANA, RhF, and immunoglobulins.
- Diagnostic criteria: Hx of widespread pain (L and R side, above and below waist, with axial pain AND pain in >11 of the 18 tender points above.
- Mx: MDT, support and reassurance, low dose amitriptyline 25-75mg nocte may help sleep and pain. SSRI (sertraline 25-50mg OD) may help anxiety/depression, graded exercise regimes can improve lethargy/mood/malaise, CBT, steroid injection to trigger points.