Ambulatory Report – 11.30.16 – Joint Pain!

Thanks to LT & Jeff Kohlwes for presenting the case of a 40 yo M without significant PMH presenting with worsening knee pain and effusion, ultimately found to have pigmented villonodular synovitis.
  • Joint pain is common, and there are many approaches.  
    • I typically ask 3 questions to narrow my differential:
      • Monoarticular or Polyarticular?
      • Inflammatory or Non-Inflammatory?
      • Acute or Chronic?
    • Based on these three I can often narrow my differential significantly (below is a basic approach, this is by no means exhaustive)
  • So how do know if the joint pain is inflammatory or non-inflammatory?
    • Inflammatory
      • Warm, Red, Painful, Swollen, Effusion w/ WBCs
      • Morning stiffness for > 30min
      • Very hard to get out of bed, better after take a shower and move around in the morning
      • Better with activity
      • Better with NSAIDs
      • Waking up with pain at night
    • Non-Inflammatory
      • Painful, Stiff (Gelling Phenomenon = stiffness after non-activity), May have effusion w/ few WBCs
  • And what about that synovial fluid?
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