SCREENING AND DIAGNOSIS

The hallmark of the diagnosis is the history and physical examination. During the physical portion of the examination process the attending specialists will feel (palpate) the muscles, check flexibility and evaluate muscle tone and strength. In the case of spinal muscle involvement the physical examination should include palpation of spinal segments and application of various orthopedic tests in an attempt to determine if there is an underlying spinal disorder which might be triggering chronic muscle tightness or reactive muscular spasm/guarding leading to myalgia and/or myofascitis.

The diagnostic workup may include blood tests to assess for conditions known to be associated with fascial and/or muscle involvement. Specialized blood tests may also be performed to test for muscle damage fiber damage. There are a variety of muscle biomarkers which can be used for this purpose such as creatine phosphokinase (CPK), myoglobin an aldolase. If an underlying muscle disease or nerve damage is suspected the diagnostic assessment may include the use of nerve conduction studies and needle electromyography (EMG). Diagnostic imaging such as magnetic resonance imaging may be used to rule out muscle tumors, muscle tears, bleeding in muscle (hematoma) and with special software evaluate the chemistry of the muscle (magnetic resonance spectroscopy-MRS).

PROGNOSIS

The prognosis of myalgia and myofascitis is very dependant upon the underlying casue. If either condition is associated with an overuse syndrome or an isolated injury the prognosis is often good. Full recovery is usually expected.  If the condition is related to a systemic cause or a chronic disease process the prognosis is more guarded. Full recovery cannot always be expected. There may be remission of related symptoms but the likelihood for reoccurrence is high.

COMPLICATIONS

Whenever inflammation occurs within connective tissues and muscle there is proliferation and activation of specialized calls “fibroblasts�. They help repair and patch injured area. A good analogy would be placing a patch on a leaky tire. Inflammation and prolonged immobilization of involved tissues and excessive fibroblast activity can lead to the development of too much scar tissue and inflexible scar tissue (adhesions). This can result in a loss of flexibility of fascia and muscles.

Timely care and a treatment approach that promotes early tissue movement (mobilization) will help prevent the development of restricted mobility. Another potential complication is chronic pain. The longer information and pain lingers the greater the risk for developing a chronic pain syndrome. In a limited number of cases this may result in physical disability. Chronic spinal muscle stiffness of hypertonicity can contribute to chronic spinal segment dysfunction.