Joint pain Flashcards
What are the features of mechanical pain?
pain worse on movement and eases with rest
What are the features of inflammatory pain?
pain may occur at rest and is often aggravated by movements, particularly those which narrow the joint space
What are the features of crystal arthritis?
acute, extreme pain associated with erythema over the joint (normally a single joint)
What are the features of septic arthritis?
pain developing over 1-2days in a single joint
What are the features of rheumatic fever or gonococcal arthritis?
joint pain which flits between joints
What are the features of bone pain?
pain is penetrating, deep or boring and is worse at night
localised pain suggests a malignancy, infection (osteomyelitis), avascular necrosis, osteoid osteoma (benign bone tumour)
What are the features of muscular pain?
pain associated with stiffness and is poorly localised, deep and aggravated by the use of muscle
What is the difference in the presentation of partial and complete tears?
partial tears are painful
complete rupture may be relatively painless
What are the features of fracture pain?
sharp and stabbing, aggravated by movement or use and relived by res/splintage, normally after trauma
What sort of pain is described when there is trapping of a peripheral nerve?
shooting pain
What sort of pain is seen in osteoarthritis?
chronic joint pain in patients >40years, patients have ‘good days’ and ‘bad days’. Normally affects many joints
What sort of pain is described in chronic pain syndrome?
pain is all over, which is unremitting with little diurnal variation
How does inflammatory arthritis present?
presents with early morning stiffness and usually takes at least 1 hours to wear off with activity
How does non-inflammatory arthritis present?
stiffness occurs after rest and last only a few minutes on movement
there may be pain on movement
typically eases with rest
What are the soft tissue causes of stiffness?
contracture, spasticity or tetany due to upper motor lesion
polymyalgia rheumatica
enthesopathy
bursitis
When is erythema seen in the joints?
common in acute inflammatory arthritis
and in infective, traumatic and crystal induced conditions
unusual in rheumatoid arthritis or SLE
What does joint weakness suggest?
joint disorder, peripheral nerve lesion or muscle disease
may be secondary to pain and be focal or generalized
What does proximal weakness suggest?
primary muscle disease
What does distal weakness suggest?
more likely to be neurological
What is ‘locking’ ?
incomplete range of movement of a joint because of anatomical block
may be associated with pain
patient can unlock the join using manoeuvres
What is ‘pseudolocking’?
loss of the range of movement due to pain
What is triggering?
result of a nodular tendon thickening or a fibrous thickening of the flexor sheath
What are the key things to establish in a joint deformity?
malposition may be partial (subluxation) or total (dislocation)
establish if the joint deformity is fixed or mobile and whether it is passively correctable
What are differentials for acute monoarthritis?
septic arthritis crystal arthritis (gout, pseudogout) trauma (haemarthrosis) bleeding diatheses palindromic rheumatism arthritis due to juxta-articular bone tumours leukaemic joint deposits
What are the differentials for oligoarthritis (5 joints) ?
crystal arthritis psoriatic arthritis reactive arthritis (salmonella, campylobacter) ankylosing arthritis osteoarthritis sarcoidosis
What are the differentials for symmetrical polyarthritis?
rheumatoid arthritis
osteoarthritis
viruses (hep A, B and C, mumps)
What are the differentials for asymmetrical polyarthritis?
reactive arthritis
psoriatic arthritis
What are the differentials for chronic monoarthritis?
osteoarthritis
occasionally psoriatic, reactive and RA may present as monoarthritis
What investigations should be carried out for an acute monoarthritis?
aspirate full infections screen FBC, ESR, CRP, U&E, LFT serum uric acid x-ray
What are the investigations needed in chronic monoarthritis?
FBC, ESR, CRP, U&E, LFT
ANA, RF
X-ray
What investigations should be carried out in acute or chronic oligoarthritis?
Aspirate and full infectious screen
FBC, ESR, CRP, U&E, LFT
ANA, RF
X-ray
