Generalized Approach to Joint Pain Flashcards
Mono-articular
One joint
Poly-articular
multiple joints
Migratory
Moves from one joint to another
Extra-articular
bones, muscles, tendons, bursa, skin
Myalgia
Muscle pain
Arthalgia
Joint pain
Tendonitis
Inflammation of the tendon
Bursitis
Inflammation of the bursa
Tenosynovitis
Inflammation of the tendon sheath
Sprain
Ligament injury
Strain
Muscular injury
Effusion
Fluid in the joint
Dislocation
Complete lack of contact between two articular sufraces
Sublaxation
Residual contact between two articular surfaces
Valgus Deformity
Distal part of the limb directed away from the midline (knock knees)
Varus Deformity
Distal part of the limb directed toward the midline (bowlegs)
Joint pain causes
Traumatic, infectious, systemic
Joint pain systems
pain, stiffness
Joint pain signs
Warmth, redness, swelling, pain to touch/motion
Examination Approach
Joint v. Extremity
Joint: Inspection, palpation, ROM (active and passive), specialty testing
Extremity: Inspection, palpation, ROM (active and passive), specialty testing, reflexes, neurovascular status (including motor/sensory and pulses/capillary refill)
Inspection of Extremity – what to look for
Symmetry/asymmetry, color, erythema, scars, abrasions, injuries, swelling, ecchymosis, splinting, deformity
Palpation of Extremity
Temperature (warm/cool compared to opposite side), tenderness, edema, effusion, entire affected joint/specific area
Active Range of Motion
Performed by patient while physician observes
Passive Range of Motion
Performed by physician while patient relaxes
Ratings for Deep Tendon Reflexes (DTR) and their descriptions
4+/4: Very brisk. hyperactive, with clonus (rhythmic oscillation between flexion and extension
3+/4: brisker than average, possibly but not necessarily indicative of disease
2+/4: Average, normal
1+/4: somewhat diminished, low normal
0/4: no response
Muscle Strength
Compare strength to opposite side. Recorded as 0-5/5
Muscle Strength Rating and their descriptions
+0/5: No muscular contraction detected
+1/5: Barely detectable flicker/trace of contraction
+2/5: Active movement with gravity eliminated
+3/5: Active movement against gravity
+4/5: Active movement against gravity and some resistance
+5/5: Active movement against full resistance without evidence of fatigue (normal muscle strength)
Sensory/Dermatome Landmarks
C4 - top of shoulder C6 - radial aspect of forearm C8 - 5th digit T4 - nipple line T10 - umbilicus L5 - great toe S1 - posterolateral calf/little toe
Capillary Refill
Compress the nail to cause blanching. Release pressure and note the time it takes for color to return. Normal is 2 seconds or less.
Tests digital perfusion
Rating of Pulses
\+4/4: Bounding \+3/4: Strong, full, increased \+2/4: Average intensity, expected, normal \+1/4: Diminished, barely palpable 0/4: Absent, not palpable
Rating for Edema
0: Absent
1+: Barely detectable, slight pitting (2mm), disappears rapidly
2+: Slight indentation (4mm), 10-15 sec to return to normal
3+: Deeper indentation (6mm), >1 minute to return to normal
4+: Very marked indentation (8mm), 2-5 minutes to return to normal
TART
Tissue Texture Changers
Asymmetry
Restriction of Motion
Tenderness
