Possible Causes of Limb Pain: When to See a Specialist?

Possible causes of limb (arms and legs) soreness include:

Hello, doctor.
Recently, for about a month and a half, I have not engaged in any vigorous exercise, and my daily work does not involve long periods of fixed posture.
I only walk about 4,000 to 8,000 steps during my workday.
However, I frequently experience soreness in my limbs and on both sides of my jaw just below my ears.
The soreness occurs in the following areas: (1) the inner side of the forearm near the wrist, (2) the inner side of the forearm near the elbow bend, (3) the outer side of the upper arm near the deltoid, (4) the inner thigh near the knee bend, and (5) the central part of the inner calf.
The pain fluctuates; when it is present, if I carry a 2L to 5L bottle of juice or milk for a short period of 10 to 20 minutes, I experience significant soreness.
The pain relief patches I use, which contain L-Menthol, Glycol Salicylate, and N-Vanillylnonamide, are effective.
However, the soreness in my thigh tends to decrease after walking for a while, resulting in only mild discomfort.
During the past month, I took a week and a half off to rest, but the soreness persisted, fluctuating in intensity.
Sometimes I wake up in the morning with soreness, while other times I feel normal in the morning but start to feel sore in the afternoon.
Recently, the frequency of these episodes has increased over the past two weeks.
However, when I am not experiencing pain, I do not feel any significant weakness when testing my lifting strength.
I would like to ask the doctor what possible causes there might be.
Is it possible that this could be a symptom of polymyositis? Should I first consult a rehabilitation specialist, a rheumatologist, or another specialty for diagnosis?

yú, 30~39 year old female. Ask Date: 2017/03/11

Dr. Yin Xinbei reply Rehabilitation

It is more likely to be myofascial pain syndrome, while polymyositis is more severe and less common.
It is advisable to first consult a rheumatologist to rule out more serious issues such as polymyositis.
However, rheumatologists tend to favor pharmacological treatment.
If there are no rheumatological issues, it is recommended to see a rehabilitation specialist to address the pain.

Reply Date: 2017/03/11

More Info

When experiencing unexplained limb pain, especially when it persists over a period of time without any obvious cause, it’s essential to consider a range of potential underlying issues. Based on your description, the pain you are experiencing in various areas of your limbs, including the inner elbow, outer upper arm, inner thigh, and central calf, could be attributed to several factors.

Possible Causes of Limb Pain
1. Muscle Strain or Overuse: Even if you believe you haven’t engaged in any strenuous activity, repetitive motions or even minor activities can lead to muscle strain. This can occur from lifting objects, even if they seem light, especially if done repeatedly or with improper technique.

2. Tendinitis: Inflammation of the tendons, often due to overuse, can lead to pain in specific areas. For example, tendinitis in the elbow (often referred to as "tennis elbow" or "golfer's elbow") can cause pain on the inner or outer side of the elbow.

3. Myofascial Pain Syndrome: This condition involves trigger points in the muscles that can refer pain to other areas. The pain can be persistent and may vary in intensity.

4. Nerve Compression or Entrapment: Conditions such as carpal tunnel syndrome or ulnar nerve entrapment can cause pain and discomfort in the arms and hands. Similarly, issues in the lumbar spine can lead to referred pain in the legs.

5. Fibromyalgia: This chronic condition is characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas. It often accompanies sleep disturbances and can lead to a decreased quality of life.

6. Inflammatory Conditions: Conditions such as polymyalgia rheumatica or even early signs of autoimmune diseases can manifest as limb pain. While you mentioned the possibility of polymyositis, this condition typically presents with muscle weakness rather than just pain.

7. Vascular Issues: Poor circulation or vascular conditions can also lead to pain in the limbs, especially after activity.

When to See a Specialist
Given the complexity of your symptoms, it would be prudent to consult a specialist. Here are some recommendations on which specialists to consider:
- Rheumatologist: If you suspect an autoimmune condition or inflammatory arthritis, a rheumatologist can provide a comprehensive evaluation and necessary blood tests to rule out conditions like rheumatoid arthritis or lupus.

- Physiatrist (Rehabilitation Specialist): A physiatrist can help assess your functional abilities and develop a rehabilitation plan tailored to your needs. They can also provide insights into physical therapy options that may alleviate your symptoms.

- Orthopedic Specialist: If there is a concern about musculoskeletal issues, an orthopedic doctor can evaluate your joints, tendons, and muscles for any structural problems.

- Neurologist: If there are signs of nerve involvement, a neurologist can conduct nerve conduction studies and other tests to determine if there is any nerve damage or compression.

Diagnostic Steps
Before seeing a specialist, it may be beneficial to keep a detailed log of your symptoms, including when they occur, their intensity, and any activities that seem to exacerbate or alleviate the pain. This information can be invaluable for your healthcare provider in making a diagnosis.

In conclusion, while your symptoms could stem from various causes, it’s essential to seek a thorough evaluation from a specialist who can guide you through the diagnostic process and develop an appropriate treatment plan. Early intervention can lead to better outcomes and improved quality of life.

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