Joint disorders often have pain as their presenting feature. Joint pain
is described as arthralgia if there is no accompanying swelling or as arthritis
if the joint is swollen. The pattern of joint involvement, its symmetry, onset,
timing and provoking and relieving factors are important in establishing the
diagnosis. Arthritis may involve a single joint (monoarticular), less than four
joints (oligo or pauciarticular) or mutiple joints (polyarticular). The
relationship to exercise may be important, as inflammatory disorders are often
worse after periods of inactivity and relieved by rest, whereas mechanical
disorders tend to be worse on exercise and relieved by rest. Joint pain tends
to radiate distally and may be associated with local tenderness. A full systems
enquiry is necessary as many disorders have multisystem involvement. Changes in
sensation including tingling or numbness are often due to abnormalities in
nerve function. This may be due to pressure, ischaemia or neuropathies.
Establishment of the distribution helps to differentiate peripheral nerve
damage from nerve root damage. Loss of function is important as therapy aims to
both relieve pain and establish necessary function for daily activities.