Approach to Joint Pain



History:

Is the pain from:

	• Joint

	• Adjacent bursa

	• Tendon

	• Ligament

	• Bone

	• Muscle

	• Referred from a visceral organ or nerve root

Symptoms of Joint Disease:

	• Pain

	• Stiffness

	• Swelling

	• Limitation of motion

	• Weakness

	• Fatigue



Joint - Following 3 broad categories of joint disease must be differentiated:

• Inflammatory arthritis:

	- Pain is present both at rest and with motion

	- Stiffness is present upon waking and typically lasts 30-60 minutes or longer

	- Fatigue is usually noted in the afternoon or early evening

• Noninflammatory arthritis:

	- Pain occurs mainly or only during motion and improves quickly with rest

	- Stiffness is experienced briefly (e.g., for about 15 minutes) upon waking in the morning or after periods of inactivity

• Arthralgia:

	- Joint tenderness

	- No joint deformity



Synovitis:

	• Site of inflammation in persons with rheumatoid arthritis (RA) and many other inflammatory arthritides

Crystal Deposition:

	• Monosodium urate

	• Calcium pyrophosphate dihydrate

	• Basic calcium phosphate (including hydroxyapatite)

	• Calcium oxalate

Infectious Arthritis:

	• Acute or chronic infections related to bacterial, fungal, or viral organisms

Structural or Mechanical Joint Derangement:

	• Previous joint trauma (e.g., meniscal tears)

	• Congenital or developmental joint alterations (e.g., congenital hip dysplasia and slipped capital femoral epiphysis)

	• Alterations of the subchondral bone (e.g., osteopetrosis, avascular necrosis, and Paget disease)

	• Alterations of supporting structures (e.g., hypermobility)

	• Cartilage derangements (e.g., ochronosis and crystal deposition)

Enthesitis:

	• Site of pathology in the seronegative spondyloarthropathies



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