Evaluation of arthritic pain includes a comprehensive history, physical examination, laboratory testing, and diagnostic x-ray films. Patients have pain as the predominant symptom for seeking medical attention.
5 Patients can have pain at one or multiple joints. It is a nociceptive pain that is characterized by an intermittent pain that is worse with mechanical movement of the joint. The pain is usually described as a “dull ache” or “throbbing pain” associated with stiffness and restricted ROM. Patients may express signs and symptoms of depression or anxiety secondary to the chronic debilitating state of arthritis.
Physical examination may reveal reproducible tenderness along the joint line and surrounding tissues. Decreased ROM can occur as the result of pain or pathologic changes. Signs of inflammation of the synovium, called synovitis, characterized by warmth, swelling, effusions, and stress pain, may be present. Instability or deformity of the joint is a late sign that suggests anatomic and physiologic changes of the joint periarticular structures. A patient who has a long-term history of arthritis may have additional muscle wasting and weakness. Last, functional analysis should be done by having the patient ambulate and imitate ADL.
Clinical examination documentation should include physical function, ROM of the affected joint(s), gait assesment, assistive devices needed (eg, cane, walker, or wheelchair), abilities to accomplish ADL, and social and psychosocial factors that have an impact on the patient's perception of pain.