Oligoarthralgia (pain in one to four joints)

Rationale

Acute joint pain may reflect an urgent process that needs immediate evaluation and treatment to prevent permanent damage and loss of function. Chronic pain in a small number of joints is very common and a very frequent cause of disability.

Causal Conditions

(list not exhaustive)

1. Acute joint pain
   1. Injury (e.g., meniscal tear)
   2. Infection
   3. Crystal deposition
   4. Hemarthrosis (e.g., clotting disorder)
   5. Acute reactive arthritis
   6. Other (e.g., osteoporotic fracture, spontaneous osteonecrosis of the knee)
2. Chronic joint pain
   1. Osteoarthrosis (primary or secondary)
   2. Chronic inflammatory arthritis (e.g., rheumatoid arthritis, psoriatic arthritis)
   3. Periarticular disease (e.g., bursitis, tendinosis)
   4. Pediatric disorders (e.g., slipped epiphysis, Osgood-Schlatter disease)
3. Nonarticular disease (e.g., bone malignancy, leukemia)

Key Objectives

Given a patient with joint pain, the candidate will determine the acuity and severity of the problem. In particular, the candidate will determine if the patient requires immediate, definitive management or if they require referral.

Enabling Objectives

Given a patient with joint pain, the candidate will

1. list and interpret critical clinical findings, including those related to
   1. whether the joint or other tissues are the source of the pain,
   2. whether the underlying cause is traumatic, inflammatory, or mechanical,
   3. whether urgent investigation is required,
   4. the functional impact of the pain, and
   5. an occupational and recreational history;
2. list critical investigations and interpret the results of the investigations, including
   1. appropriate laboratory investigations and other tests,
   2. joint aspiration, if indicated, and appropriate investigations (e.g., culture, cell count, crystal analysis),
   3. determination as to whether appropriate radiologic investigations are required, and
   4. determination as to whether other investigations are indicated (e.g., specialized cultures, computed tomography, magnetic resonance imaging);
3. construct an effective management plan, including
   1. initial management of common inflammatory conditions (e.g., gout, infection),
   2. initial management of common injuries (e.g., sprains),
   3. referral for specialized care if indicated (e.g., orthopedic surgery, rheumatology, hematology), and
   4. counselling regarding appropriate return to activities and recognition of the potential for long-term impact on function.