JOINT/ LIMB PAIN

Key History:
 Location, quality, intensity, duration, pattern (small vs. large joints; number involved;
swelling, redness, warmth),
 associated symptoms (constitutional, red eye, oral or genital ulceration, diarrhea,
dysuria, rash,focal numbness/weakness),
 exacerbating and alleviating factors;
 trauma (including vigorous exercise);
 medications;
 DVT risk factors;
 alcohol and drug use;
 family history of rheumatic disease.

Key Physical Exam

 Vital signs;
 HEENT(head, ears, eyes, nose, and throat) and musculoskeletal exams;
 relevant neurovascular exam

Case 1 : Osteoarthritis

Presentation
56 yo obese F presents with right knee stiffness and pain that increases with movement.
Her symptoms have gradually worsened over the past 10 years. She noticed swelling and
deformity of the joint and is having difficulty walking.

Differential
1. Osteoarthritis
2. Pseudogout
3. Gout
4. Meniscal or ligament damage

Workup
1. XR—knee
2. CBC
3. ESR
 JOINT/ LIMB PAIN

4. Knee arthrocentesis and

5. synovial fluid analysis (cell count, Gram stain, culture, crystals)
6. MRI—knee

Case 2 : Rheumatoid arthritis

Presentation
28 yo F presents with pain in the metacarpophalangeal joints of both hands. Her left knee is
also painful and red. She has morning joint stiffness that lasts for an hour. Her mother had
rheumatoid arthritis

Differential
1. Rheumatoid arthritis
2. SLE
3. Disseminated gonorrhea
4. Arthritis associated with inflammatory bowel disease
5. Osteoarthritis

Workup
1. ANA, anti-dsDNA, ESR, RF,
2. CBC
3. XR—hands, left knee
4. Cervical culture
5. Arthrocentesis and synovial
6. fluid analysis

Case 3: DVT

Presentation
45 yo F presents with right calf pain. Her calf is tender, warm, red, and swollen compared to
the left side. She was started on OCPs two months ago for dysfunctional uterine bleeding.
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Differential
1. DVT
2. Baker’s cyst rupture
3. Myositis
4. Cellulitis
5. Superficial venous thrombosis

Workup
1. Doppler U/S—right leg
2. CBC
3. CPK
4. D-dimer
5. PT, aPTT, fibrinogen
6. XR—right leg