metacarpophalangeal pain

[DON ROOFA]

Hi all..
i'm a physiotherapy student and i have a patient with metacarophalangeal pain but still don't know the cause of pain
is it from ligaments, RA or something else ?
so plzzz help me
Pt info:
age : 35 y
occupation : teacher
pain : only in the right index , with flexion and extension ( more in flexion ), at the end of R.O.M. since 2 months ago.
no swelling, trauma or history of #
no history of RA in the family
no crepitation or deformity
R.O.M : WNR . in all direction.
no x-ray or MRI
thats all . if you need more info. plz tell me
need ur help guys

[gcoe]

Hi don roofer

Nothing immediately springs to mind. As a discipline for your own professional development, and also to make matters easier for your colleagues to help you why not write your assessment out in full and in an orderly fashion. What you have described so far includes important points and ideas but there are huge gaps which makes it hard work to interpret eg: detailed HPC? Nature and behaviour of pain, 24 HR symptom change and morning stiffness, hand dominance, does he use a computer ie mouse use could be anissue. When stating ROM did you mean active or passive? Did you carry out accessory movements? Don't be lazy and leave your reader trying to guess. More than happy to respond then.

BTW what does WNR mean?

[DON ROOFA]

hi gcoe

no history of disease or medication.
the pain localized and inside the joint . the pain increase when the patient attempt to crackle his finger, at the end of range only. same symptom over the day.
no stiffness . right handed . use computer but not a lot . he's teacher so i'm sure he use the pen a lot. no pain with A.R.O.M only with P.R.O.M. normal muscle power.
slight pain with joint gliding .

WNR : within normal range (full range of motion)
and what do u mean by HPC ? (patient history)?

thanks a lot

[gcoe]

HPC = history of presenting complaint - best to learn and stick to international standard abbreviations.

Doesn't sound typical. Did the pain come on slowly; no sudden onset? Is it getting worse, staying the same/getting better?

What about over the 24 hours?

I would try to establish if ther is an inflammatory component night pain and any morning stiffness.

If there is it could be one of the rheumatological diseases:
RA, gout, pseudo gout, psoriatic arthritis, reactive arthritis (reiters syndrome) could be the start of a systemic arthritis
Probably unlikely to be an infective arthritis
some systemic diseases can cause low grade joint aches and pains - how toes the patient feel in himself?
Could be an arthralgia if no inflammatory component - this can happen after a viral infection - not very well understood but generally benign and goes away.
Have you cleared the other joints that can refer to the 2nd mcp? Might be worth checking the inter carpal and wrist joints and clear the neck.
Muscle pain referring to the joint - see if there are any trigger point in the wrist and hand muscles. Most likely culprit would be the interosseii on either side - in fact this could mimicmcp joint pain and as tiis is something you can help with maybe check that out first.