Approach to Joint Pain

DR SURYA DARMA , SPPD

BAGIAN PENYAKIT DALAM

FK UNSRI/RSMH
PALEMBANG

Area Keterampilan Klinis

15. Melakukan prosedur diagnosis

anamnesis
pemeriksaan fisik umum dan khusus sesuai dengan
masalah pasien
pemeriksaan penunjang dasar dan rasional

Diagnostic approach
Physical diagnostic

Anamnesis
Chief complaint
Present history
Past history
Family history
Social history
Drug history

Anamnesis
Major complaints in chronological order
Pain e.g. onset, site, duration, severity,

radiation, character, diurnal variation,

aggravating or relieving factors
Pattern of joint involvement e.g. inflammatory
or non inflammatory, single or multiple joints,
symmetric or asymmetric involvement, small
joints or large joints and axial or peripheral

Musculoskeletal Presenting
Complaints
Pain
Stiffness

(subjective feeling or inability to move freely,

stiffness that can be worn off suggest
inflammation)
Swelling
Deformity
Weakness
Non specific symptoms reflecting acute phase
response (fatigue, fever, disability)

Anatomy

Complaints

Pathophysiology
inflammation

degenerative

Joint

infection

trauma

locking

Key points
Articular vs periarticular
Acute vs chronic
Inflammatory vs non inflammatory
Monoarthritis vs poliarthritis
Small joints vs large joints
Peripheral joints vs axial joints
Symmetric vs asymmetric

Articular Vs. Periarticular

Clinical feature Articular

Periarticular

Anatomic
structure

Tendon, bursa,
ligament, muscle,
bone
Focal point
Active, in few
planes

Painful site
Pain on
movement
Swelling

Synovium,
cartilage,
capsule
Diffuse, deep
Active/passive,
all planes
Common

Uncommon

Inflammatory Vs. Non inflammatory

Feature

Inflammatory

Non inflammatory

Pain (when?)
Swelling
Erithema
Warmth
AM stiffness
Systemic features
IncreaseESR, CRP
Synovial fluid WBC
Examples

Yes (AM)
Soft tissue
Sometimes
Sometimes
Prominent
Sometimes
Frequent
WBC >2000
Septic, RA, SLE,
Gout

Yes (PM)
Bony
Absent
Absent
Minor (< 30 )
Absent
Uncommon
WBC < 2000
OA, AVN

Monoarthritis vs poliarthritis
Monoarthritis

Osteoarthritis
Gout arthritis
Septic arthritis
Pseudogout
Oligoarthritis
Spondyloarthritis (PsA,
ReA)

Poliarthritis

RA
Chronic gout

Small joints vs large joints

Large joints

Small joints
Wrist joint
Manus joint

MCP
PIP
DIP

Pedis joint

MTP
PIP
DIP

Vertebrae
Hip joint
Genu joint
Ankle joint
Shoulder joint
Elbow joint

Axial vs peripheral
Axial
Skull
Vertebrae
Thorax cavity
Pelvis

Peripheral

Upper extremity
Lower extremity
Supporting bone

Scapula
Clvicula
Acetabulum

UESTIONS

Terima Kasih