Approach to Patient with Joint Pain

Question 1

History of Pain

Answer 1

• OLDCAARTS
• Point to the pain
• Do you recall anything that might have occurred to cause the pain?
– Activity out of the ordinary: painting, cleaning or rearranging, traveling, playing with
grand children, climbing ladders
– Injury during usual activities: Falls (down stairs, parking lot), exercise/sports, MVA

Question 2

Sprain

Answer 2

ligaments stretch causing tearing; with tearing there is bleeding outside of the ligament resulting in bruising. The greater the tearing of the ligament, the greater the blood loss and subsequent bruising.

Question 3

Strain

Answer 3

often occurs when the muscle is stretching and contracting simultaneously, i.e. sprinters have frequent hamstring injured during the late swing phase as the hamstring muscle contract while lengthening in an attempt to decelerate the lower leg in preparation for the foot strike.*

Question 4

Sprain vs. Strain

Answer 4

Both cause immediate pain, but the mechanism is different

-Sprains may hear a pop and strains have a grabbing sensation

Question 5

Sequence of Assessing of Joint Pain

Answer 5

• OLDCARTS
• Point to the pain
• Mechanism of injury
• Physical exam (bilateral–>observation, palpation, ROM, extremity examination (neuromuscular exam), orthopedic tests/diagnostic maneuvers)

Question 6

Observe

Answer 6

• Look at the joint –can be extremity or spine.
• Assess from side to side
• Are they symmetric?
• Is there swelling?
• Is there discoloration?
• Are there abrasions?
• What about muscle mass surrounding the joint?

Question 7

Inflammation

Answer 7

Symptoms
-Pain
-Stiffness
Signs
-warmth
-redness
-swelling
-pain (to touch, pain with motion)

Question 8

Injury

Answer 8

• Definitive on set
• Generally mono-articular
• Generally unilateral

Question 9

Non-Injury

Answer 9

• Insidious or gradual
• May be associated with constitutional symptoms
• May be mono-articular or polyarticular
• May be unilateral or bilateral
• May be a single joint or multiple joints
• May be migratory
• May change with activity
• May have extra-articular signs

Question 10

Neurologic Assessment

Answer 10

• Muscle strength
– Name the direction
– Use the correct grading scale
 – 5/5 is normal
• DTR
– Name the muscle/tendon OR spinal
level
– Use the correct grading scale
– 2/4 is normal
•Dermatomes

Question 11

Vascular Assessment

Answer 11

• Pulse (distal)
– Name the location
– Use the correct grading scale 
– 2/4 is normal
• CapillaryRefill
– Name the location
– Identify the filling time
• Edema
– Name the location
– Use the correct description (pitting or nonpitting)
– Use the correct grading scale (0-4)

Question 12

Monoarticular

Answer 12

one joint

Question 13

Polyarticular

Answer 13

multiple joints

Question 14

Migratory

Answer 14

moves from one joint to another

Question 15

Extra-articular

Answer 15

bones, muscles, tendons, bursa, skin

Question 16

Myalgia

Answer 16

muscle pain

Question 17

Arthralgia

Answer 17

joint pain

Question 18

Effusion

Answer 18

fluid escaped from blood vessels or lymphatics into the tissues or a cavity aka joint effusion

Question 19

Tendonitis

Answer 19

inflammation of the tendon

Question 20

Bursitis

Answer 20

inflammation of the bursa

Question 21

Tenosynovitis

Answer 21

inflammation of the tendon sheath

Question 22

Subluxation

Answer 22

residual contact between two articular surface

Question 23

Dislocation

Answer 23

complete lack of contact between two articular surfaces

Question 24

Sensitivity

Answer 24

the proportion of patient with the diagnosis that also have the physical sign (true positive)

Question 25

Specificity

Answer 25

the portion of patient without the diagnosis who lack the physical sign (true negative)

Question 26

SnNOUT vs. SpPIN

Answer 26

1. a sensitive test with a negative rules a disease OUT.

2. a specific test with a positive result rules IN a disease.

Question 27

VINDICATE

Answer 27

– Vascular
– Inflammatory
– Neoplastic
– Degenerative/deficiency – Idiopathic/intoxication – Congenital
– Autoimmune/allergic
– Traumatic
– Endocrine