Nonarticular Rheumatism/Regional Pain Syndrome Workup

Updated: Dec 06, 2015
  • Author: David Rabago, MD; Chief Editor: Herbert S Diamond, MD  more...
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Workup

Laboratory Studies

See the list below:

  • 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 patient 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
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Imaging Studies

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  • 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.
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Other Tests

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  • 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.
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Procedures

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  • 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.
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Histologic Findings

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

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