Acute Joint Pain Flashcards
Categories for joint pain
Articular
Periarticular
Non-articular
Articular causes of joint pain
Trauma (fracture, meniscal tear) Gout Pseudo gout Septic arthritis Seronegative spondyloarthropathy Transient synovitis
Periarticular causes of joint pain
Ligament damage
Tendinitis
Bursitis
Non articular causes of joint pain
Nerve entrapment
Radiculopathy
Bone issues (malignancy, osteomyelitis)
Risk factors for septic arthritis
Immunosupression (diabetes, steroids, HIV)
Prosthetic joints
Trauma
Risk factors for haemoarthrosis
Coagulopathy (e,g. Haemophilia)
Anticoagulant (warfarin)
Trauma (e.g. ACL injury)
Recent infection followed by joint pain implies…
Transient synovitis (reactive arthritis)
Can’t see, can’t pee, can’t climb a tree
Often triggered by GI infection or STI
Which drugs predispose to gout?
Thiazides, aspirin, cyclosporin
If knee is painful, which other joints should you assess?
1 above and 1 below
Bowel disease that can cause joint pains and mouth ulcers
Crohn’s disease
How might you assess neurovascular competency in acute joint pain?
Distal pulses
Sensation and movement of joint
How can you discriminate between septic arthritis and other causes of monoarticular pain
ARTHROCENTESIS
Crystals in gout
Needle shaped and negatively bifringent
Crystals in pseudogout
Positively bifringent and rhomboid shaped
Signs of septic arthritis in the aspirated fluid
Elevated WCC
Cloudy
Bacteria visible on microscopy
Haemarthrosis with fat globules present implies…
Fracture
The fat comes from the bone marrow
If haemarthrosis despite no trauma or infection what do you need to check?
Clotting factors
Look at FVIII and FIX (A and B haemophilia)
Antibody testing for rheumatoid arthritis
Anti-CCP
A radiograph may be useful in an acutely painful joint because…
Can pick up fractures
Can pick up Perthe’s disease
Erosion of joint surfaces
Which type of scan is good if you suspect soft tissue injury (e.g. meniscal tear)?
MRI
Arthrocentesis sample contains PMNs and negatively birefringent crystals, how do you rule out septic arthritis?
Gram staining for the presence of microbes
Management of acute gout
- ACUTE = colchicine, NSAIDs
If they cant take these (hepatic failure or gastric ulcer/asthma), can consider steroid injections
Management of gout chronically
Allopurinol (decrease urate production), inhibitor of xanthine oxidase. Must give it with colchicine for 6 weeks because initial therapy can induce a gout attack!
Also drugs in chemo and if allopurinol isn’t tolerated. But rarer and expensive.
Initial management of suspected septic arthritis
Arthrocentesis
Analgesia
Blood cultures
Broad spectrum antibiotics
Definitive management of septic arthritis
Joint aspiration and lavage by the surgeons
Referred to orthopaedic surgeons
What can a repetitive job like stacking shelves put you at risk of?
Bicipital tendonitis
Management of bicipital tendonitis
Analgesia
REST
Corticosteroid injection into the space but NEVER into the tendon
Management of suspected gonoccocal transient synovitis
Analgesia (regular)
Rest of the affected joint
IV antibiotics until septic arthritis is excluded
Opthalmology review (for the conjunctivitis)
Secondary causes of increased urate
Starvation
Cytotoxic drugs
Chronic renal disease
Most likely infective organism in prosthetic joint septic arthritis
Staph epidermis
