bone, joint, and muscle disorders
Musculoskeletal Pain
Evaluation of Musculoskeletal Pain
In trying to establish the cause of joint pain, doctors first determine How many and which joints are involved Whether the central part of the skeleton (such as the spine and pelvis) is involved Whether the joint pain is acute or chronic What factors relieve or worsen the pain Whether there are other symptoms affecting other organs (for example, rash, fever, or dry eyes) Determining these factors gives important clues to what disorder is likely causing the pain. Doctors do a physical examination to help determine these factors and detect other important findings that could help determine the cause of the pain. Sometimes, the type of pain suggests where the pain has originated. For example, pain that worsens with movement suggests a musculoskeletal disorder. Pain with muscle spasm suggests that pain is caused by a muscle disorder (sometimes a chronic spinal cord injury). The site of swelling or the location of tenderness when the doctor feels (palpates) the area (for example, a joint, ligament, or bursa) or passively moves a joint often indicates the source of pain. However, often these characteristics of pain do not indicate its origin or cause. Thus, doctors usually base a specific diagnosis on the presence of other symptoms, physical examination findings, and often the results of laboratory tests and x-rays. For example, Lyme disease often causes joint pain with swelling and a bull's eye-like rash, and blood tests show antibodies to the bacteria that cause Lyme disease. Gout is characterized by a sudden attack of pain, swelling, and redness in the joint at the base of the big toe or other joints. Tests of the joint fluid generally show the presence of uric acid crystals. Laboratory Tests None X-rays None Computed tomography (CT) and magnetic resonance imaging (MRI) , Computed tomography (CT) and magnetic resonance imaging (MRI) None include Ultrasonography , arthrography (an x-ray procedure in which a radiopaque dye is injected into a joint space to outline the structures, such as ligaments inside the joint), and is often done if the joint is swollen. Doctors extract the fluid from the joint by first sterilizing the area with an antiseptic solution and then numbing the skin with an anesthetic. Then a needle is inserted into the joint and joint fluid is withdrawn (a procedure called Joint aspiration (arthrocentesis) or arthrocentesis). This procedure causes little or no pain. The fluid is usually tested for, among other things, bacteria that can cause infection and is examined under a microscope for crystals that cause gout and related disorders. 