It is a common, incompletely understood nonarticular, noninflammatory disorder characterized by generalized aching (sometimes severe); widespread tenderness of muscles, areas around tendon insertions, and adjacent soft tissues; muscle stiffness; fatigue; mental cloudiness; poor sleep; and a variety of other somatic symptoms. Diagnosis is clinical. Treatment includes exercise, local heat, stress management, drugs to improve sleep, and nonopioid analgesics.In fibromyalgia, any fibromuscular tissues may be involved, especially those of the occiput, neck, shoulders, thorax, low back, and thighs. There is no specific histologic abnormality. Symptoms and signs of fibromyalgia are generalized, in contrast to localized soft-tissue pain and tenderness ( myofascial pain syndrome), which is often related to overuse or microtrauma.
Fibromyalgia may be a centrally mediated disorder of pain sensitivity. The cause is unknown, but disruption of stage 4 sleep may contribute, as can emotional stress. Fibromyalgia may be precipitated by a viral or other systemic infection (eg, Lyme disease or perhaps COVID-19 infection
Symptoms and Signs of Fibromyalgia
Stiffness and pain frequently begin gradually. Fatigue, muscle strain, or overuse. Cognitive disturbances such as difficulty concentrating, mental cloudiness irritable bowel syndrome, interstitial cystitis, or migraine or tension headaches. Paresthesias may be present, typically bilaterally and often migratory. Symptoms can be exacerbated by environmental or emotional stress, poor sleep, trauma, exposure to dampness or cold. Patients may be stressed, tense, anxious, fatigued, ambitious, and sometimes depressed. Patients are not uncommonly high-achieving perfectionists. Discrete areas of muscle (tender points) often are tender when palpated. Diagnosis of Fibromyalgia Clinical evaluation Sometimes imaging Rotator cuff tendinitis
Rotator cuff tendinitis is the most common cause of shoulder pain. The rotator cuff is composed of four tendons, the supraspinatus, infraspinatus, subscapularis, and teres minor. The supraspinatus tendon is most frequently involved and the subscapularis is second. Active abduction in an arc of 40 to 120° and internal rotation cause pain ( see Rotator Cuff Injury/Subacromial Bursitis). Passive abduction causes less pain, but abduction against resistance can increase pain. Calcium deposits in the tendon just below the acromion are sometimes visible on x-ray. Ultrasonography or MRI may help with further evaluation (eg, if the diagnosis is otherwise unclear) and with treatment decisions (eg, presence of significant tears that might require surgical interventions).Bicipital tendinitis Pain in the biceps tendon is aggravated by shoulder flexion or resisted supination of the forearm. Examiners can elicit tenderness proximally over the bicipital groove of the humerus by rolling (flipping) the bicipital tendon under their thumb.Volar flexor tenosynovitis (digital flexor tendinitis)
Volar flexor tenosynovitis ( digital flexor tendinitis) is a common musculoskeletal disorder that is often overlooked. Pain occurs in the palm on the volar aspect of the thumb or other digits and may radiate distally. Palpation of the tendon and sheath elicits tenderness; swelling and sometimes a nodule are present. The affected digit may rest in a flexed position, and passive extension elicits pain. In later stages, the digit may lock when it is flexed, and forceful extension may cause a sudden release with a snap (trigger finger).Gluteus medius tendinitis
Patients with trochanteric bursitis almost always have gluteus medius tendinitis. In patients with trochanteric bursitis, palpation over the lateral prominence of the greater trochanter elicits tenderness. Patients often have a history of chronic pressure on the joint, trauma, a change in gait (eg, due to osteoarthritis, stroke, or leg-length discrepancy), or inflammation at this site (eg, in rheumatoid arthritis).Treatment of Tendinitis and Tenosynovitis
Rest or immobilization, heat or cold, followed by exercise
High-dose nonsteroidal anti-inflammatory drugs (NSAIDs)
Sometimes corticosteroid injection
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