Makindo Medical Notes

• Rhabdomyolysis 💥: A medical emergency where muscle breakdown releases myoglobin, which can damage the kidneys.
  Key features: Severe pain, weakness, dark "cola-coloured" urine.
  Action: Immediate hospital admission, IV hydration, electrolyte monitoring, and treatment of underlying cause.
• Myositis 🔬: Inflammation of the muscles, often autoimmune (e.g., dermatomyositis, polymyositis).
  Key features: Pain, proximal weakness, raised muscle enzymes.
  Action: Blood tests (CK, autoantibodies), EMG, and sometimes muscle biopsy. Treated with corticosteroids and immunosuppressants.
• Polymyalgia Rheumatica (PMR) ⏳: A condition of older adults causing symmetrical stiffness and pain in shoulders and hips.
  Key concern: Association with giant cell arteritis (risk of sudden blindness).
  Action: Urgent corticosteroids, ESR/CRP monitoring, and vigilance for visual symptoms.

📋 Other Causes of Myalgia

• Muscle Strain 🏋️: Localised pain after trauma or exertion; managed with RICE (rest, ice, compression, elevation), NSAIDs, and physiotherapy.
• Fibromyalgia 🌐: Widespread pain with fatigue, poor sleep, and tender points. Diagnosis is clinical, treatment includes lifestyle modification, analgesics, and sometimes antidepressants.
• Infections 🦠: Viral illnesses (e.g., influenza, COVID-19) can cause transient myositis with fever and muscle pain. Usually supportive care is enough.
• Medication-Induced Myopathy 💊: Most commonly from statins, steroids, or antiretrovirals. Improves after stopping or switching the medication.
• Autoimmune Diseases (e.g., SLE, vasculitis) 🧬: Present with systemic features (rash, arthritis, fatigue) alongside muscle pain. Require immunosuppressive treatment.

🩺 Clinical Assessment

• 🔍 History: Onset, duration, drug history, systemic features (rash, fever, fatigue).
• 🧪 Investigations: CK, LFTs, U&E, autoimmune screen, viral serology, EMG, imaging if needed.
• ⚖️ Risk factors: Medications (statins), alcohol, infections, autoimmune background.

💡 Teaching Pearl

Myalgia is common but potentially serious. Always look for red flags such as dark urine, severe weakness, fever, or systemic features. These may indicate emergencies like rhabdomyolysis, sepsis, or inflammatory myopathies that require urgent treatment.