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Harrison's Principles of Internal Medicine, 18e
| Part 15. Disorders of the Joints and Adjacent Tissues > Section 3. Disorders of the Joints and Adjacent Tissues > |
Chapter 331. Approach to Articular and Musculoskeletal Disorders
Sections: Approach to Articular and Musculoskeletal Disorders: Introduction, Articular versus Nonarticular, Inflammatory versus Noninflammatory Disorders, Rheumatologic Evaluation of the Elderly, Rheumatologic Evaluation of the Hospitalized Patient, Physical Examination, Approach to Regional Rheumatic Complaints, Laboratory Investigations, Diagnostic Imaging in Joint Diseases, Further Readings.
Topics Discussed: joint disorders; musculoskeletal diseases.
Excerpt:"Musculoskeletal complaints account for >315 million outpatient visits per year and nearly 20% of all outpatient visits in the United States. The Centers for Disease Control and Prevention estimate that 22% (46 million) of the U.S. population has physician-diagnosed arthritis and 19 million have significant functional limitation. While many patients will have self-limited conditions requiring minimal evaluation and only symptomatic therapy and reassurance, specific musculoskeletal presentations or their persistence may herald a more serious condition that requires further evaluation or laboratory testing to establish a diagnosis. The goal of the musculoskeletal evaluation is to formulate a differential diagnosis that leads to an accurate diagnosis and timely therapy, while avoiding excessive diagnostic testing and unnecessary treatment (Table 331-1). There are several urgent conditions that must be diagnosed promptly to avoid significant morbid or mortal sequelae. These "red flag" diagnoses include septic arthritis, acute crystal-induced arthritis (e.g., gout), and fracture. Each may be suspected by its acute onset and monarticular or focal musculoskeletal pain (see below)...."
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