OWL: OCOSH Classification/Joint Diseases/Arthralgia

2007 Arthritis and pain

Dray A, Read SJ. — 2009-10-02 21:00:37 GMT

Clinical presentation of osteoarthritis (OA) is dominated by pain during joint use and at rest. OA pain is caused by aberrant functioning of a pathologically altered nervous system with key mechanistic drivers from peripheral nerves and central pain pathways. This review focuses on symptomatic pain therapy exemplified by molecular targets that alter sensitization and hyperexcitability of the nervous system, for example, opioids and cannabinoids. We highlight opportunities for targeting inflammatory mediators and their key receptors (for example, prostanoids, kinins, cytokines and chemokines), ion channels (for example, NaV1.8, NaV1.7 and CaV2.2) and neurotrophins (for example, nerve growth factor), noting evidence that relates to their participation in OA etiology and treatment. Future neurological treatments of pain appear optimistic but will require the systematic evaluation of emerging opportunities.
Arthritis and pain. Future targets to control osteoarthritis pain. Dray A, Read SJ. Arthritis Res Ther. 2007;9(3):212. Full Text

2008 Aching Joints Assessment Investigations and Management in Primary Care PatientPlus

Not Available — 2009-05-25 21:00:37 GMT

The complex challenge to the physician is to safely diagnose simple arthralgia from degenerative joint disease, inflammatory arthropathies or pain secondary to other diseases.
Updated 2010

2008 Chronic shoulder pain part I Evaluation and diagnosis

Burbank KM, Stevenson JH, Czarnecki GR, Dorfman J. — 2009-10-02 21:00:37 GMT

Shoulder pain is defined as chronic when it has been present for longer than six months. Common conditions that can result in chronic shoulder pain include rotator cuff disorders, adhesive capsulitis, shoulder instability, and shoulder arthritis. Rotator cuff disorders include tendinopathy, partial tears, and complete tears. A clinical decision rule that is helpful in the diagnosis of rotator cuff tears includes pain with overhead activity, weakness on empty can and external rotation tests, and a positive impingement sign. Adhesive capsulitis can be associated with diabetes and thyroid disorders. Clinical presentation includes diffuse shoulder pain with restricted passive range of motion on examination. Acromioclavicular osteoarthritis presents with superior shoulder pain, acromioclavicular joint tenderness, and a painful cross-body adduction test. In patients who are older than 50 years, glenohumeral osteoarthritis usually presents as gradual pain and loss of motion. In patients younger than 40 years, glenohumeral instability generally presents with a history of dislocation or subluxation events. Positive apprehension and relocation are consistent with the diagnosis. Imaging studies, indicated when diagnosis remains unclear or management would be altered, include plain radiographs, magnetic resonance imaging, ultrasonography, and computed tomography scans. Plain radiographs may help diagnose massive rotator cuff tears, shoulder instability, and shoulder arthritis. Magnetic resonance imaging and ultrasonography are preferred for rotator cuff disorders. For shoulder instability, magnetic resonance imaging arthrogram is preferred over magnetic resonance imaging.
Burbank KM, Stevenson JH, Czarnecki GR, Dorfman J. Am Fam Physician. 2008 Feb 15;77(4):453-60. Full Text

Acupuncture in musculoskeletal disorders

Pirotta M. — 2009-10-02 21:00:37 GMT

Several surveys have identified that Australian general practitioners have largely accepted acupuncture as part of their armamentarium. About a quarter of GPs have been trained in acupuncture and the majority of those surveyed agreed that acupuncture was effective and that they had referred patients for the therapy. Acupuncture is an integral part of traditional Chinese medicine and has thousands of years of history of use. While acupuncture presents some challenges to test in randomised controlled trials, such as inadequate placebos and difficulty achieving blinding of both researchers and participants, many trials of increasingly high standard have been published; for example, the Cochrane Collaboration has over 120 reviews and protocols relating to acupuncture. This article presents some recent evidence about the use of acupuncture to treat musculoskeletal conditions.
Acupuncture in musculoskeletal disorders - is there a point? Pirotta M. Aust Fam Physician. 2007 Jun;36(6):447-8. Review. Full text available

Aromatase Inhibitors and Joint Pain Medscape CME

Not Available — 2009-10-05 21:00:37 GMT

Upon completion of this activity, participants will be able to:
Describe the prevalence and location of arthralgias among women taking aromatase inhibitors.
Describe synovial, electromyographic, and inflammatory marker changes associated with use of aromatase inhibitors.
One third of postmenopausal women with breast cancer taking aromatase inhibitors (AIs) reported arthralgia � either new onset or worsening, according to investigators of a new study published online September 14 in the Journal of Clinical Oncology

Aromatase Inhibitor�Associated Arthralgias

Rowan T. Chlebowski — 2009-10-05 21:00:37 GMT

The aromatase inhibitors (AIs) have become an established component of adjuvant therapy for postmenopausal women with hormone receptor�positive breast cancer.1-3 Although adherence to AI regimens in clinical trials has been favorable,4 in clinical practice the arthralgias associated with AI use adversely influence adherence.5-7 In this issue of Journal of Clinical Oncology, Sestak et al8 and Dizdar et al9 provide prospective information on a related adverse effect, AIassociated carpal tunnel syndrome (CTS).
Rowan T. Chlebowski Editorial Journal of Clinical Oncology, Vol 27, 2009 Full text

Chronic shoulder pain part II Treatment

Burbank et al — 2009-10-02 21:00:37 GMT

Chronic shoulder pain is a common problem in the primary care physician's office. Effective treatment depends on an accurate diagnosis of the more common etiologies: rotator cuff disorders, adhesive capsulitis, acromioclavicular osteoarthritis, glenohumeral osteoarthritis, and instability. Activity modification and analgesic medications comprise the initial treatment in most cases. If this does not lead to improvement, or if the initial presentation is of sufficient severity, a trial of physical therapy that focuses on the specific diagnosis is indicated. Combined steroid and local anesthetic injections can be used alone or as an adjuvant to the physical therapy. The site of the injection (subacromial, acromioclavicular joint, or intra-articular) depends on the diagnosis. Injections into the glenohumeral joint should be done under fluoroscopic guidance. Symptoms that persist or worsen after six to 12 weeks of directed treatment should be referred to an orthopedic specialist.
Chronic shoulder pain: part II. Treatment. Burbank KM, Stevenson JH, Czarnecki GR, Dorfman J. Am Fam Physician. 2008 Feb 15;77(4):493-7.

Pyrophosphate arthropathy

Doherty M. — 2009-10-04 21:00:37 GMT

Review of the features and management of chondrocalcinosis
Pyrophosphate arthropathy--recent clinical advances. Doherty M. Ann Rheum Dis. 1983 Aug;42 Suppl 1:38-44. full text

Shoulder Pain

Masters S, Burley S. — 2009-10-02 21:00:37 GMT

This article presents a systematic approach to diagnosing and managing disorders of the shoulder joint and surrounding structures.
Shoulder pain. Masters S, Burley S. Aust Fam Physician. 2007 Jun;36(6):414-6, 418-20. Full text

The discordance between clinical and radiographic knee osteoarthritis: a systematic search and summary of the literature.

Bedson J, Croft PR. — 2009-10-02 21:00:37 GMT

Our objectives were to identify estimates of the prevalence of radiographic knee OA in adults with knee pain and of knee pain in adults with radiographic knee OA, and determine if the definitions of x ray osteoarthritis and symptoms, and variation in demographic factors influence these estimates.
CONCLUSION: Knee pain is an imprecise marker of radiographic knee osteoarthritis but this depends on the extent of radiographic views used. Radiographic knee osteoarthritis is likewise an imprecise guide to the likelihood that knee pain or disability will be present. Both associations are affected by the definition of pain used and the nature of the study group. The results of knee x rays should not be used in isolation when assessing individual patients with knee pain.
Bedson J, Croft PR. BMC Musculoskelet Disord. 2008 Sep 2;9:116. Full text

The painful shoulder

Codsi MJ. — 2009-10-02 21:00:37 GMT

Physicians can usually diagnose the cause of shoulder pain by performing a focused history and physical examination and ordering anteroposterior and lateral radiographs. Treatment depends on the cause and can include physical therapy, injections of corticosteroids into the joint space or bursa, and surgery. This paper reviews the diagnosis and treatment of impingement syndrome, adhesive capsulitis, rotator cuff tears, and arthritis of the glenohumeral joint and acromioclavicular (AC) joint.
The painful shoulder: when to inject and when to refer. Codsi MJ. Cleve Clin J Med. 2007 Jul;74(7):473-4, 477-8, 480-2 passim. Full text