Generalized Approach to Joint Pain

Question 1

Mono-articular

Answer 1

One joint

Question 2

Poly-articular

Answer 2

multiple joints

Question 3

Migratory

Answer 3

Moves from one joint to another

Question 4

Extra-articular

Answer 4

bones, muscles, tendons, bursa, skin

Question 5

Myalgia

Answer 5

Muscle pain

Question 6

Arthalgia

Answer 6

Joint pain

Question 7

Tendonitis

Answer 7

Inflammation of the tendon

Question 8

Bursitis

Answer 8

Inflammation of the bursa

Question 9

Tenosynovitis

Answer 9

Inflammation of the tendon sheath

Question 10

Sprain

Answer 10

Ligament injury

Question 11

Strain

Answer 11

Muscular injury

Question 12

Effusion

Answer 12

Fluid in the joint

Question 13

Dislocation

Answer 13

Complete lack of contact between two articular sufraces

Question 14

Sublaxation

Answer 14

Residual contact between two articular surfaces

Question 15

Valgus Deformity

Answer 15

Distal part of the limb directed away from the midline (knock knees)

Question 16

Varus Deformity

Answer 16

Distal part of the limb directed toward the midline (bowlegs)

Question 17

Joint pain causes

Answer 17

Traumatic, infectious, systemic

Question 18

Joint pain systems

Answer 18

pain, stiffness

Question 19

Joint pain signs

Answer 19

Warmth, redness, swelling, pain to touch/motion

Question 20

Examination Approach

Joint v. Extremity

Answer 20

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)

Question 21

Inspection of Extremity – what to look for

Answer 21

Symmetry/asymmetry, color, erythema, scars, abrasions, injuries, swelling, ecchymosis, splinting, deformity

Question 22

Palpation of Extremity

Answer 22

Temperature (warm/cool compared to opposite side), tenderness, edema, effusion, entire affected joint/specific area

Question 23

Active Range of Motion

Answer 23

Performed by patient while physician observes

Question 24

Passive Range of Motion

Answer 24

Performed by physician while patient relaxes

Question 25

Ratings for Deep Tendon Reflexes (DTR) and their descriptions

Answer 25

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

Question 26

Muscle Strength

Answer 26

Compare strength to opposite side. Recorded as 0-5/5

Question 27

Muscle Strength Rating and their descriptions

Answer 27

+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)

Question 28

Sensory/Dermatome Landmarks

Answer 28

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

Question 29

Capillary Refill

Answer 29

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

Question 30

Rating of Pulses

Answer 30

\+4/4: Bounding
\+3/4: Strong, full, increased
\+2/4: Average intensity, expected, normal
\+1/4: Diminished, barely palpable
0/4: Absent, not palpable

Question 31

Rating for Edema

Answer 31

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

Question 32

TART

Answer 32

Tissue Texture Changers
Asymmetry
Restriction of Motion
Tenderness