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Myalgia

Myalgia is a common clinical symptom of many patients especially in adults. The occurrence of muscular pain - Myalgia has predisposing factors such as viral infections, trauma or even conditions that are related to muscular dystrophy and dehydration. The identification of myalgia in association with other symptoms paves a clear diagnostic path to treat this disease.


Myalgia in some cases if untreated can be fatal as it is closely associated with the motor and sensory response of the patient. Consistent muscular weakness in a person can lead to a variety of medical complications. Myalgia associated with viral infections has to be treated immediately as it may interfere with day to day activities of the person. The etiologies related to myalgia can be of various types such as myopathy and myositis respectively. Fibromyalgia can lead to morbidity if not diagnosed and treated at an early stage. In many cases antimalarial drugs, corticosteroids have also been reported to cause myalgia. The most common group of drugs recommended for myalgia are analgesics such as acetaminophen.

CK blood test

A Creatinine Kinase test is a blood test that measures the levels of Creatinine phosphokinase (CPK). It is an enzyme found predominantly in the heart tissue, brain and skeletal muscle. The CK blood test is commonly used to diagnose the existence of heart muscle damage. The CK blood test result shows an increase above normal in a person's blood test about six hours after the start of a heart attack.


It reaches its peak in about 18 hours and returns to normal in 24 to 36 hours. When the total CPK level is substantially elevated, then it is indicative of injury or stress to heart, brain or skeletal areas. The small amount of CPK that is normally in the blood comes from the muscles. The CPK blood test also helps in cost-effective management of people with suspected coronary atherosclerosis. It also evaluates the extent of muscle damage caused by drugs, trauma or immobility.


Abnormal CK-MB (one of three CK isoenzymes) or troponin levels are associated with Myocyte Necrosis and the diagnosis of Myocardial infarction. The Cardiac Markers of Cardiac Myocyte Necrosis (damage to the Cardiac muscle cells), myoglobin, CK, CK-MB and troponin I and T are primarily used to identify acute Myocardial Infarction.


It is used in early detection of dermatomyositis and polymyositis. It is also used to distinguish malignant hyperthermia from a post operative infection. It helps to discover carriers of muscular dystrophy.

The normal range for Creatinine Kinase (CK or CPK) blood test:
Male: 38 - 174 units/L
Female: 96 - 140 units/L

Increased levels of CK also can be found in viral myositis and hypothyroidism. Higher than normal CPK levels is indicative of the following conditions:



CK MB

Serum CKMB levels are tested to check for myocardial injury. It is another important cardiac marker. The primary source of CKMB is myocardium although it is also found in skeletal muscle. Typically CKMB tests have now been replaced by Troponin test. But in cases of abnormal Troponin assay results or suspected re-infarction in the hospital, the CKMB serum test is still used.


High levels of CK MB are noticed in cases of polymyositis and rhabdomyolysis. Patients suffering pulmonary embolism, hypothyroidism, and muscular dystrophy or carbon monoxide poisoning can also show higher levels of serum CKMB. The reference range is about 56.2 pg/mL.



Myopathy

Myopathy or muscular disease that includes muscle inflammation and muscle weakness. Myopathies affecting the skeletal muscle can have many origins - inherited, drug induced or endocrine issues. Mostly a Myopathy is transitory in nature and rarely results in complete loss of function. Muscular Dystrophy is possibly an exception in that it can be severe and sometimes even fatal if it occurs early in life.


Genetic Myopathies

These inherited Myopathies occur due to a genetic defect in the synthesis of a protein. There are many kinds in genetic Myopathies:


  • Central Core Disease : Weakness in the muscles affecting hips and legs resulting in problems in running, jumping and climbing stairs

  • Centronuclear Myopathy or Myotubular Myopathy : Weakness in the muscles affecting face, legs, arms and the trunk resulting in drooping upper eyelids, facial weakness or foot drop

  • Myotonia Congenita : Muscles in the face, arms or legs are affected and result in muscular stiffness (myotonia) after contracting of muscles - usually after a trigger in the form of stress, fatigue, cold or a long period of no motion

  • Nemaline Myopathy : Weakness in the muscles of arms, legs and the trunk resulting in poor or absent reflexes, long or narrow face, abnormal facial features

  • Paramyotonia Congenita : Stiffness of muscles in the face, forearms and hands

  • Periodic Paralysis : Temporary muscle weakness episodes in hypokalemic form (low calcium) as a result of vigorous exercises, intake of food high in carbohydrates, stress, alcohol, insulin, pregnancy or infection. In the hyperkalemic form (high calcium) it can occur as a result of vigorous exercises, stress, pregnancy, skipping food, high potassium levels or steroids

  • Mitochondrial Myopathies : Progressive weakness of muscles in the eye (ocular myopathy) or arms and the legs or multisystem issues


Endocrine related Myopathies : Hormone deficiency can cause Myopathies. Hyperthyroid Myopathy is the result of excess secretion of thyroxine from the thyroid gland affecting muscles in the shoulders, hips or eyes. Hypothyroid Myopathy occurs when too little hormone is secreted and results in stiffness, cramps and weakness of legs and arms muscles.


Inflammatory Myopathies : Some Myopathies result in inflamed, weakened or wasted muscles. Dermatomyositis affects the connective tissue and the severity of the affected muscle loss can result in crippling movement.

Chronic muscle inflammation is called as Myositis. It is usually caused due to allergic reaction, infectious disease or rheumatism. Sometimes Myopathies are hereditary. Symptoms of Myopathy can also include cramps, spasms and stiffness. There is progressive deterioration in muscle strength resulting in pain and fatigue on walking and tripping and falling. This is not due to nerve dysfunction. Some patients might notice facial weakness, foot drop, droopy eyelids and poor reflexes in affected muscles.


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Bibliography / Reference

Collection of Pages - Last revised Date: November 12, 2019