I. Bone and Joint Diseases: Clinical Principles

  • There are some key take home points to note of when approaching Bone and Joint diseases.
  • These are mostly clinical in nature, and require one to rely on the principles of thorough history taking and physical examination

How do diseases of the MSK system manifest clinically?

Here are some main clinical manifestations of bone and joint disease (please note that this is not a detailed comprehensive list –  for that you can refer to clinical texts):

1. Bones 

  • Pain (night pain is worrying, eg. for neoplasm, or tuberculosis)
  • Swelling
  • Pathologic fracture – occurs in underlying abnormal bone, which can be due to infectious (eg. chronic osteomyelitis), metabolic (eg. osteoporosis) or neoplastic disease
  • Sinuses (associated with osteomyelitis)
  • Deformity (can be associated with metabolic conditions)

2. Joints

  • Pain, loss of function
  • Swelling
    • Clinically, septic arthritis and crystal arthropathies can sometimes be difficult to distinguish from each other, and require examination of joint fluid aspirate – see point 5 above
  • Loss of function
  • Stiffness
  • Abnormal range of motion / locking (this may occur in traumatic conditions eg. ligamentous or meniscal injury in the knee, which will be covered during the clinical posting)

 3. Symptoms related to soft tissue structures close to bone/joints:

  • Nerve compression – eg. osteophytes in cervical spine arthritis can lead to nerve compression
  • Tendons, insertions – eg. pain from tendinitis
  • Joint capsule / tendon / tendon sheath Eg. Nodule – ganglion

4. Systemic symptoms: Fever, weight loss

  • Other clinical manifestations of underlying systemic disease – eg. in patients with hyperuricaemia, disseminated infection, hyperparathyroidism

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