The diagnosis of muscle pain is done in the clinic with an old-fashioned physical examination.
Diagnosing Myofascial Pain.
Diagnosing myofascial pain is relatively easy, once the language of pain is understood and the common misinterpretations are corrected. Patients make the first mistake by assigning an organ to the site of their pain. Pain felt in the lower part of the abdomen (supra-pubic) associated with the feeling of urinary urgency is presented by the patient to her physician as: “I have a bladder infection because I have bladder pain and have to urinate often,” This invariably results in a diagnosis of bladder infection being made, even if the urine testing and culture is negative and a course of antibiotics does not relieve the symptoms.
Muscle pain is usually referred to sites away from the actual muscle. This is especially true in the arms and legs, almost always resulting in a diagnosis of arthritis (joint pain) being made. Some muscles are quite tricky and many of them “gang up” in groups of up to five muscles, all projecting pain into the same area.
Studying the textbooks on muscle pain and years of experience has enabled me to quite readily find the sore muscles quite easily in most patients. Finding that last holdout muscle and switching it off still comes as a great relief to me. I feel a great sense of joy when is see my patient smile or cry as their pain finally subsides.
A careful history and examination of muscles known to cause the presenting pattern of pain is the key to making a diagnosis of myofascial pain. There are no tests (imaging or biochemistry) that can be used to confirm the diagnosis. Sometimes, postural changes noted in the skeletal images, such as a straightened neck curvature, will point to muscle spasm.