Nonarticular Rheumatism/Regional Pain Syndrome Workup

Updated: Aug 24, 2023
  • Author: Evan Dombrosky, MD; Chief Editor: Herbert S Diamond, MD  more...
  • Print
Workup

Laboratory Studies

Obtain the following studies to screen for systemic disease. All should yield results within the reference range.

  • Complete blood cell count (CBC)
  • Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)
  • Thyroid-stimulating hormone (TSH)
  • Electrolytes, calcium, transaminases, 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 patient has a coexistent systemic illness:

  • Antinuclear antibody (ANA) for systemic autoimmune disease (however, 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 kidney disease
  • Hepatitis C antibody
Next:

Imaging Studies

Plain radiographs are often unremarkable. They may show calcific tendonitis, but that or may not correlate with clinical symptoms.

Magnetic resonance imaging (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.

Previous
Next:

Other Tests

No other tests are necessary unless indicated by history findings or abnormalities found on the clinical evaluation, such as the following:

  • True muscle weakness may prompt electromyography (EMG) and nerve conduction velocity (NCV) studies. Compression neuropathies can be diagnosed using NCV studies.
  • Patients with a history of loud snoring, respiratory pauses, and excessive daytime sleepiness require a sleep study to exclude sleep apnea syndrome. Clinicians can consider a lower threshold to refer for sleep studies in those with otherwise unexplained fibromyalgia.
Previous
Next:

Procedures

No procedures are necessary unless indicated by history findings or abnormalities found on physical examination. Swollen bursae or tendon sheaths may be aspirated if infection or crystal disease such as gout is suspected.

Previous