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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.
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