musculoskeletal and connective tissue disorders
Evaluation of the Patient With Joint Symptoms
History
The clinician should focus on systemic and extra-articular symptoms as well as joint symptoms. Many symptoms and clinical findings, including the following, can be associated with various joint disorders and provide clues to the diagnosis of a specific systemic disorder: Fever Chills Malaise Weight loss Raynaud Syndrome None Rash Mucosal ulcers Eye redness or pain Photosensitivity Dysesthesias Gastrointestinal symptoms Cardiopulmonary symptoms is the most common symptom of joint disorders (see Pain in and Around a Single Joint and Stiffnessrefers to difficulty in moving a joint, but to patients, stiffness also may mean weakness, fatigue, or fixed limitation of motion. 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 Introduction to Autoimmune Rheumatic Disorders . Stiffness is more severe and prolonged with increasing severity of joint inflammation. The theater sign (short-lived knee or hip stiffness upon standing that necessitates walking slowly after sitting for several hours) is common in Osteoarthritis (OA) . 1 hour can be an important early symptom of joint inflammation, such as in Rheumatoid Arthritis (RA) , 1 hour and lessens with movement may reflect Ankylosing Spondylitis . is a desire to rest that reflects exhaustion. It differs from weakness, inability to move, and reluctance to move because of pain with movement. Fatigue may reflect activity of a systemic inflammatory disorder as well as other disorders. Clinicians should try to distinguish fatigue from sleepiness. Instability(buckling of a joint) suggests an internal joint derangement or weakness of the ligaments or other periarticular structures that stabilize the joint, which are assessed by stress testing on physical examination. Buckling occurs most often in the knee. 