8 to 12 weeks. Recurrent epicondylitis may
require surgical repair.
See also OSTEOARTHRITIS; TENDONITIS.
fascia The fibrous membrane that covers con-
nective tissue. Deep fasciae enclose, support, and
separate MUSCLEstructures deep within the body.
Superficial fasciae support the SKINand connect
the skin to inner layers of tissue. Fascia has high
tensile STRENGTH and a sheetlike appearance. It
varies in thickness, depending on its location and
purpose. Fasciae throughout the body are suscep-
tible to INFECTION, INFLAMMATION, and traumatic
injury.
See also CONTRACTURE; FIBROMYALGIA NECROTIZING
FASCIITIS; PLANTAR FASCIITIS.
fibromyalgia A chronic condition of PAINfelt in
the muscles and connective tissues throughout the
body, with accompanying fatigue and multiple
trigger points (areas on the body where the slight-
est touch activates a severe pain response). Char-
acteristically people experience a constant level of
discomfort with pressure or contact causing overt
pain in the shoulders, chest, back, hips, and knees.
Many people also experience stiffness in the areas
of pain, similar to the stiffness of RHEUMATOID
ARTHRITISor OSTEOARTHRITIS. However, there is no
JOINT INFLAMMATION or deterioration with fibro-
myalgia. Fibromyalgia may persist for months to
years. About 6 million Americans have fibromyal-
gia, the majority of whom are women.
Researchers believe fibromyalgia develops through
a convergence of multiple factors.
Symptoms and Diagnostic PathThe symptoms of fibromyalgia are widely variable,
making diagnosis somewhat of a challenge for
many people. Some people have periods of weeks
to months without any symptoms, interlaced with
periods of weeks to months with symptoms severe
enough to prevent normal activity. Other people
have a clear path of symptom onset, persistence,
and improvement that spans months to years.
Characteristic symptoms of fibromyalgia include
- MUSCLEpain throughout the body
- sleep disturbances such as insomnia and REST-
LESS LEGS SYNDROME- fatigue
- gastrointestinal symptoms that suggest IRRITABLE
BOWEL SYNDROME(IBS), such as frequent NAUSEA
and DIARRHEA - DEPRESSION, anxiety, and mood swings
- headaches
- hypersensitivity to sensory stimulation (sight,
sound, touch, taste, smell)
The diagnostic path begins with a comprehen-
sive medical examination including general BLOOD
and urine tests, a NEUROLOGIC EXAMINATION, and
detailed PERSONAL HEALTH HISTORY. The doctor may
conduct further tests to rule out other conditions
that can cause similar symptoms, such as rheuma-
toid arthritis and SYSTEMIC LUPUS ERYTHEMATOSUS
(SLE). However, there are no tests that can confirm
the diagnosis of fibromyalgia. Doctors typically fol-
low clinical guidelines for reaching a diagnosis of
fibromyalgia that include the presence of these
key signs:- diagnostic tests rule out other possible causes
for the symptoms - point tenderness (discomfort or pain with mild
pressure) at a minimum of 11 places on the
body - widespread, persistent aching or pain in the
muscles and joints for at least three months
The diagnosis also considers factors researchers
believe may be precipitating, such as recent INFEC-
TIONor injury, the existence of any AUTOIMMUNE
DISORDERS, and family history of fibromyalgia.
Symptoms generally begin between ages 30 and
50.Treatment Options and Outlook
Treatment efforts focus on relieving symptoms to a
degree that allows participation in regular activi-
ties and satisfactory QUALITY OF LIFEwith the pre-
sumption that symptoms will persist indefinitely.
Though the condition may eventually go away, in
most people the course of fibromyalgia is unpre-
dictable though symptoms do not worsen. Treat-
ment is a process of finding the combination of
approaches that most effectively relieves symp-
toms. Common treatment options includefibromyalgia 321