eMedicine Specialties > Rheumatology > Soft Tissue and Regional Rheumatic Disease

Nonarticular Rheumatism/Regional Pain Syndrome: Differential Diagnoses & Workup

Author: Daniel Muller, MD, PhD, Department of Internal Medicine, Section of Rheumatology, Associate Professor, University of Wisconsin at Madison
Contributor Information and Disclosures

Updated: Nov 5, 2007

Differential Diagnoses

Ankylosing Spondylitis and Undifferentiated Spondyloarthropathy
Polymyositis
Gout
Reactive Arthritis
Hepatitis C
Reflex Sympathetic Dystrophy
HIV Disease
Rheumatoid Arthritis
Hypothyroidism
Sjogren Syndrome
Lyme Disease
Systemic Lupus Erythematosus
Lymphoma, Non-Hodgkin
Metastatic Cancer, Unknown Primary Site
Polymyalgia Rheumatica

Other Problems to Be Considered

Multiple Sclerosis
Hyperparathyroidism
Sleep apnea syndrome
Cervical spondylosis
Psychogenic rheumatism
Depression

Workup

Laboratory Studies

  • Obtain the following studies to screen for systemic disease. All should yield results within the reference range.
    • CBC count
    • Erythrocyte sedimentation rate (ESR)
    • Thyroid-stimulating hormone (TSH)
    • Electrolytes, calcium, alanine aminotransferase (ALT), creatinine
  • If indicated by history findings or abnormalities found on physical examination, the following studies may be obtained. All should yield results within the reference range unless the patients has a coexistent systemic illness.
    • Antinuclear antibody (ANA) for systemic autoimmune disease (Many false-positive tests have been reported.)
    • Rheumatoid factor (RF) for rheumatoid arthritis or immune complex disease
    • Creatine kinase (CK) for myositis
    • HIV serology
    • Lyme serology for Lyme disease (enzyme-linked immunosorbent assay [ELISA] screen and, if positive, Western blot to confirm)
    • Prolactin for panhypopituitarism
    • Urinalysis for renal disease
    • Hepatitis C antibody

Imaging Studies

  • Plain radiographs may show calcific tendonitis. However, these may or may not correlate with clinical symptoms.
  • MRI can be used to delineate rotator cuff disruption at the shoulder and to distinguish tendinitis from intra-articular synovitis. Otherwise, imaging is not necessary unless indicated by history findings or abnormalities found on physical examination.

Other Tests

  • No other tests are necessary unless indicated by history findings or abnormalities found on physical examination.
  • True muscle weakness may prompt electromyography (EMG) and nerve conduction velocity (NCV) studies. Compression neuropathies can be diagnosed using NCV studies.
  • History of loud snoring, respiratory pauses, and excessive daytime sleepiness requires a sleep study to exclude sleep apnea syndrome.

Procedures

  • No procedures are necessary unless indicated by history findings or abnormalities found on physical examination.
  • Swollen bursae or tendon sheaths should be aspirated if infection or gout is suspected.

Histologic Findings

In most cases, characteristic histologic changes do not warrant biopsy.

More on Nonarticular Rheumatism/Regional Pain Syndrome

Overview: Nonarticular Rheumatism/Regional Pain Syndrome
Differential Diagnoses & Workup: Nonarticular Rheumatism/Regional Pain Syndrome
Treatment & Medication: Nonarticular Rheumatism/Regional Pain Syndrome
Follow-up: Nonarticular Rheumatism/Regional Pain Syndrome
Multimedia: Nonarticular Rheumatism/Regional Pain Syndrome
References
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Further Reading

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Keywords

nonarticular rheumatism, regional pain syndrome, soft tissue rheumatic pain syndrome, myofascial pain syndrome, repetitive strain injury, cumulative movement disorders, tendonitis, bursitis, neurovascular entrapment, multiple tendonitis and bursitis syndrome, fibromyalgia, fibrositis, FMS, temporomandibular joint syndrome, flatfoot, hypermobility syndrome, lateral epicondylitis, tennis elbow, carpal tunnel syndrome, thoracic outlet syndrome, regional myofascial pain syndrome, temporomandibular joint syndrome, multiple bursitis-tendonitis syndrome, enthesitis, golfer's elbow, entrapment syndrome, meralgia paresthetica, tarsal tunnel syndrome

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Contributor Information and Disclosures

Author

Daniel Muller, MD, PhD, Department of Internal Medicine, Section of Rheumatology, Associate Professor, University of Wisconsin at Madison
Daniel Muller, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American College of Rheumatology, and American Holistic Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Robert E Wolf, MD, PhD, Professor Emeritus, Department of Medicine, Louisiana State University Health Sciences Center at Shreveport; Chief, Rheumatology Section, Medical Service, Overton Brooks Veterans Administration Medical Center of Shreveport
Robert E Wolf, MD, PhD is a member of the following medical societies: American College of Rheumatology, Arthritis Foundation, and Society for Leukocyte Biology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Elliot Goldberg, MD, Dean of the Western Pennsylvania Clinical Campus, Professor, Department of Medicine, Temple University School of Medicine
Elliot Goldberg, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, and American College of Rheumatology
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD, Professor of Medicine, Temple University School of Medicine; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital
Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, and Phi Beta Kappa
Disclosure: medifocus Honoraria Review panel membership; health dialogs Honoraria Consulting; West Penn Allegheny Health System None Board membership

 
 
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