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Early diagnosis leads to early treatment and better chances of recovery. Physicians will perform a physical examination, evaluate the patient’s medical history and request laboratory and imaging tests. Other possible conditions that could be causing the symptoms will be evaluated and ruled out. When diagnosing children, many physicians avoid using painful or invasive tests.

If a child demonstrates typical muscle weakness, elevated muscle enzymes in the blood and (in the case of dermatomyositis) characteristic rash, these tests may not be needed. In adults, proximal (closer to the body’s midline) muscle weakness on physical examination, elevated levels of enzymes derived from muscles, myopathic changes on electromyography and muscle biopsy evidence of inflammation are diagnostic criteria for polymyositis.

Physicians typically look for certain criteria before diagnosing a patient with myositis. These criteria include:

* Muscle weakness at shoulder or hips
* Increased levels of muscle enzymes in the blood
* Characteristic muscle tissue changes observed under a microscope
* Abnormal electrical activity in the muscles measured by electromyography
* In the case of dermatomyositis, characteristic rash

Physical examination pays particular attention to strength testing. Physicians typically hold a patient’s arm or leg and have the patient move it while mild resistance is applied. This can help the physician determine the degree of muscle weakness that is present.

Several tests are particularly helpful in the diagnosis of myositis. These include:

* Muscle biopsies. A small piece of muscle tissue is removed and examined for abnormal proteins and enzyme deficiencies. Muscle biopsy is the definitive test for myositis and may reveal abnormalities such as damage, inflammation, disease or infections. The particular form of myositis present can typically be identified by small differences in inflammation patterns. Muscle biopsy is particularly useful in diagnosing inclusion body myositis (IBM). Muscle biopsy is essential for establishing the diagnosis of polymyositis.

* Blood tests. Certain enzymes tests may indicate elevated levels of creatine kinase for some forms of myositis. This indicates muscle damage and may be used to help rule out other conditions. An ANA test can identify the presence of antinuclear antibodies, which may be present in some forms of myositis. Complete blood count and sedimentation rate tests are typically normal in myositis patients and may be performed to rule out other conditions. There are a few other autoantibodies that can be measured in blood (e.g., Anti-Jo1, Ati SRP).

* Electromyography (EMG). A thin electrode is inserted into a muscle and electrical activity is measured as the patient relaxes or tightens the muscle. Although EMG can be painful, it reveals abnormal muscle function and may be used to assist in ruling out other conditions.

* MRI is an imaging test used in pain diagnosis, to guide treatment and to monitor for relapse.MRI (magnetic resonance imaging). Images of the muscle are generated using magnetic and radio waves. MRI can demonstrate areas of muscle inflammation and, because large areas can be accessed, sampling errors may be avoided. This is a nonpainful and noninvasive or minimally invasive procedure.

Certain other conditions may have symptoms similar to those seen in myositis. It is important to rule these out as the cause of the symptoms so that the proper condition may be treated. These conditions include:

* Viral infections
* Scleroderma
* Systemic lupus erythematosus (SLE)
* Muscular dystrophy
* Various other myopathies (muscle diseases)
* Exposure to toxins
* Drug reaction
* Hypothyroidism

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Diagnostic tests aren’t usually necessary to confirm the cause of your back pain. However, if you do see your doctor for back pain, he or she will examine your back and assess your ability to sit, stand, walk and lift your legs. He or she may also test your reflexes with a rubber reflex hammer. These assessments help determine where the pain comes from, how much you can move before pain forces you to stop and whether you have muscle spasms. They will also help rule out more serious causes of back pain.

If there is reason to suspect that you have a tumor, fracture, infection or other specific condition that may be causing your back pain, your doctor may order one or more tests:

* X-ray. These images show the alignment of your bones and whether you have arthritis or broken bones. X-ray images won’t directly show problems with your spinal cord, muscles, nerves or disks.
* Magnetic resonance imaging (MRI) or computerized tomography (CT) scans. These scans can generate images that may reveal herniated disks or problems with bones, muscles, tissue, tendons, nerves, ligaments and blood vessels.
* Bone scan. In rare cases, your doctor may use a bone scan to look for bone tumors or compression fractures caused by osteoporosis. In this procedure, you’ll receive an injection of a small amount of a radioactive substance (tracer) into one of your veins. The substance collects in your bones and allows your doctor to detect bone problems using a special camera.
* Nerve studies (electromyography, or EMG). This test measures the electrical impulses produced by the nerves and the responses of your muscles. Studies of your nerve-conduction pathways can confirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinal stenosis).

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