Page 356 - Medicine and Surgery

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Musculoskeletal system 8

Clinical, 352 Seronegative arthritides Genetic musculoskeletal disorders,
Bone and joint infections, 354 (spondyloarthropathies), 362 375
Osteoarthritis, 357 Connective tissue disorders, 365 Bone tumours, 376
Seropositive arthritis, 359 Crystal arthropathies, 371 Vasculitis, 377
Metabolic bone disorders, 373

Clinical Joint swelling
Swelling may be within the joint, the bone or the sur-
Symptoms rounding soft tissue. Joint swelling following an injury
may be acute due to a haemarthrosis or appear more
Joint pain slowly due to an effusion.
Arthritis describes painful swollen joints. Again this
Joint disorders often have pain as their presenting fea- may be a mono, oligo/pauci or polyarthritis. The distri-
ture. Joint pain is described as arthralgia if there is no ac- bution of joint involvement should be elicited including
companying swelling or as arthritis if the joint is swollen. whether it is distal or proximal, symmetrical or asym-
The pattern of joint involvement, its symmetry, onset, metrical. The nature of the onset, duration, timing and
timing and provoking and relieving factors are impor- exacerbating factors should be noted. Any other associ-
tant in establishing the diagnosis. Arthritis may involve a ated features such as joint instability should be enquired
single joint (monoarticular), less than four joints (oligo about. This may be due to ligament damage.
or pauciarticular) or mutiple joints (polyarticular). The
relationship to exercise may be important, as inflamma-
tory disorders are often worse after periods of inactivity Joint stiffness
and relieved by rest, whereas mechanical disorders tend
Joint stiffness is another presentation usually associated
to be worse on exercise and relieved by rest. Joint pain
with the other cardinal features of pain and swelling.
tends to radiate distally and may be associated with lo-
Morning stiffness and stiffness after periods of inactivity
cal tenderness. A full systems enquiry is necessary as
are characteristic of rheumatoid arthritis but may oc-
many disorders have multisystem involvement. Changes
cur with other forms of arthritis. Less than 10 minutes
in sensation including tingling or numbness are often
of stiffness is common in osteoarthritis compared with
due to abnormalities in nerve function. This may be due
more than 30 minutes in inflammatory arthritis. Sacroil-
to pressure, ischaemia or neuropathies. Establishment of
iacstiffnessisaparticularfeatureofankylosingspondyli-
the distribution helps to differentiate peripheral nerve
tis. Locking of a joint is a sudden inability to complete
damage from nerve root damage. Loss of function is im-
amovement, such as extension at the knee caused by a
portant as therapy aims to both relieve pain and establish
mechanical block such as a foreign body in the joint or
necessary function for daily activities.
atorn meniscus.
352