Nonarticular Rheumatism/Regional Pain Syndrome Workup

Updated: Apr 04, 2018
  • Author: T P Sudha Rao, MD; Chief Editor: Herbert S Diamond, MD  more...
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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)

  • 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

Plain radiographs may show calcific tendonitis. However, these may 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.

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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.

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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.

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