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Disease Joints
Some musculoskeletal disorders affect primarily the joints, causing arthritis. Others affect primarily the bones (eg, fractures, Paget's disease, tumors), muscles or other extra-articular soft tissues (eg, fibromyalgia), or periarticular soft tissues (eg, polymyalgia rheumatica, bursitis, tendinitis, sprain). Arthritis has myriad possible causes, including infection, autoimmune disorders, crystal-induced inflammation, and noninflammatory tissue degeneration (eg, osteoarthritis). Arthritis may affect single joints (monarthritis) or multiple joints (polyarthritis) in a symmetric or asymmetric manner. Joints may suffer fractures or sprains.

The clinician should also focus on systemic and extra-articular symptoms as well as joint symptoms. Many symptoms, including fever, chills, malaise, weight loss, Raynaud's syndrome, mucocutaneous symptoms (eg, rash, eye irritation or pain, photosensitivity), and GI or cardiopulmonary symptoms, can be associated with various joint disorders.

Pain is the most common symptom of joint disorders. The history should address the character, location, severity, factors that aggravate or relieve pain, and time frame (new-onset or recurrent). The clinician must determine whether pain is worse when first moving a joint or after prolonged use and whether it is present upon waking or develops during the day. Usually, pain originating from superficial structures is better localized than pain originating from deeper structures. Pain originating in small distal joints tends to be better localized than pain originating in large proximal joints. Joint pain can be referred from extra-articular structures or from other joints. Arthritis often causes aching pain, whereas neuropathies often cause burning pain.

Stiffness may mean weakness, fatigue, or fixed limitation of motion to patients. The clinician must separate the inability to move a joint from reluctance to move a joint because of pain. Characteristics of stiffness may suggest a cause, as in the following:

  • Discomfort that occurs with motion when attempting to move a joint after a period of rest occurs in rheumatic disease. Duration of stiffness after beginning joint motion reflects its severity.
  • The theater sign (stiffness upon standing that necessitates walking slowly after sitting for several hours) is common in osteoarthritis.
  • Stiffness is more severe and prolonged in inflammatory joint disorders.
  • Morning stiffness in peripheral joints that lasts > 1 h can be an important early symptom of RA
  • In the low back, morning stiffness that lasts > 1 h may reflect spondylitis.
Fatigue is a desire to rest that reflects exhaustion. It differs from weakness, inability to move, and reluctance to move due to pain with movement.
Instability (buckling of a joint) may suggest weakness of the ligaments or other structures that stabilize the joint, which are assessed by stress testing. Buckling occurs most often in the knee and most often results from an internal joint derangement.
  • Arthralgia
  • Arthritis  
  • Arthrodesis  
  • Arthrogryposis Multiplex Congenita  
  • Bursitis  
  • Chondrocalcinosis  
  • Congenital Dislocation  
  • Congenital Hip Dislocation  
  • Connective Tissue Disease
  • Dislocation  
  • Ehlers-Danlos Syndrome  
  • Elbow Injuries
  • Fracture–Dislocation  
  • Ganglion Cyst  
  • Gout  
  • Hemarthrosis  
  • Herniated Disk
  • Hypertrophic Spondylitis  
  • Neurogenic Arthropathy  
  • Ochronosis  
  • Ochronotic Arthropathy  
  • Osteoarthritis  
  • Osteochondritis Dissecans  
  • Pigmented Villonodular Synovitis  
  • Polyarthralgia  
  • Psoriatic Arthritis  
  • Reflex Sympathetic Dystrophy  
  • Rheumatoid Arthritis  
  • Septic Arthritis  
  • Simple Dislocation  
  • Still’s Disease  
  • Synovioma  
  • Synovitis
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