Algorithm for the Diagnosis of Musculoskeletal Complaints - Flowchart
Algorithm for the Diagnosis of Musculoskeletal Complaints - Flowchart
«Flowchart»

Musculoskeletal Complaint

Musculoskeletal Complaint

Musculoskeletal Complaint

Initial rheumatic history and physical exam to determine


    Is it articular?
    Is it acute or chronic?
    Is inflammation present?
    How many/which joints are involved?

Initial rheumatic history and physical exam to determine


    Is it articular?
    Is it acute or chronic?
    Is inflammation present?
    How many/which joints are involved?

Initial rheumatic history and physical exam to determine


    Is it articular?
    Is it acute or chronic?
    Is inflammation present?
    How many/which joints are involved?

Is it articular?
Is it acute or chronic?
Is inflammation present?
How many/which joints are involved?

Nonarticular condition
Consider


Trauma/fracture
Fibromyalgia
Polymyalgia rheumatica
Bursitis
Tendinitis

Nonarticular condition
Consider


Trauma/fracture
Fibromyalgia
Polymyalgia rheumatica
Bursitis
Tendinitis

Nonarticular condition
Consider



Trauma/fracture
Fibromyalgia
Polymyalgia rheumatica
Bursitis
Tendinitis


Trauma/fracture Trauma/fracture Trauma/fracture
Fibromyalgia Fibromyalgia Fibromyalgia
Polymyalgia rheumatica Polymyalgia rheumatica Polymyalgia rheumatica
Bursitis Bursitis Bursitis
Tendinitis Tendinitis Tendinitis

Acute

Acute

Acute

Consider


Acute arthritis


Infectious arthritis
Gout
Pseudogout
Reactive arthritis


Initial presentation of chronic arthritis

Consider


Acute arthritis


Infectious arthritis
Gout
Pseudogout
Reactive arthritis


Initial presentation of chronic arthritis

Consider


Acute arthritis


Infectious arthritis
Gout
Pseudogout
Reactive arthritis


Initial presentation of chronic arthritis


Acute arthritis


Infectious arthritis
Gout
Pseudogout
Reactive arthritis


Infectious arthritis
Gout
Pseudogout
Reactive arthritis


Infectious arthritis Infectious arthritis Infectious arthritis
Gout Gout Gout
Pseudogout Pseudogout Pseudogout
Reactive arthritis Reactive arthritis Reactive arthritis
Initial presentation of chronic arthritis

Chronic

Chronic

Chronic

Is inflammation present?


    Is there prolonged morning stiffness?
    Is there soft tissue swelling?
    Are there systemic symptoms?
    Is there ESR or CRP elevated?

Is inflammation present?


    Is there prolonged morning stiffness?
    Is there soft tissue swelling?
    Are there systemic symptoms?
    Is there ESR or CRP elevated?

Is inflammation present?


    Is there prolonged morning stiffness?
    Is there soft tissue swelling?
    Are there systemic symptoms?
    Is there ESR or CRP elevated?

Is there prolonged morning stiffness?
Is there soft tissue swelling?
Are there systemic symptoms?
Is there ESR or CRP elevated?

Chronic noninflammatory arthritis

Chronic noninflammatory arthritis

Chronic noninflammatory arthritis

Osteoarthritis

Osteoarthritis

Osteoarthritis

Osteoarthritis Osteoarthritis

Unlikely to be rheumatoid arthritis
Consider


Osteonecrosis
Charcot arthritis

Unlikely to be rheumatoid arthritis
Consider


Osteonecrosis
Charcot arthritis

Unlikely to be rheumatoid arthritis
Consider



Osteonecrosis
Charcot arthritis


Osteonecrosis Osteonecrosis Osteonecrosis
Charcot arthritis Charcot arthritis Charcot arthritis

Chronic inflammatory arthritis

Chronic inflammatory arthritis

Chronic inflammatory arthritis

Chronic inflammatory mono/oligoarthritis
Consider


Indolent infection
Psoriatic arthritis
Reactive arthritis
Pauciarticular JA

Chronic inflammatory mono/oligoarthritis
Consider


Indolent infection
Psoriatic arthritis
Reactive arthritis
Pauciarticular JA

Chronic inflammatory mono/oligoarthritis
Consider



Indolent infection
Psoriatic arthritis
Reactive arthritis
Pauciarticular JA


Indolent infection Indolent infection Indolent infection
Psoriatic arthritis Psoriatic arthritis Psoriatic arthritis
Reactive arthritis Reactive arthritis Reactive arthritis
Pauciarticular JA Pauciarticular JA Pauciarticular JA

Chronic inflammatory polyarthritis

Chronic inflammatory polyarthritis

Chronic inflammatory polyarthritis

Consider


Psoriatic arthritis
Reactive arthritis

Consider


Psoriatic arthritis
Reactive arthritis

Consider


Psoriatic arthritis
Reactive arthritis


Psoriatic arthritis Psoriatic arthritis Psoriatic arthritis
Reactive arthritis Reactive arthritis Reactive arthritis

Rheumatoid arthritis

Rheumatoid arthritis

Rheumatoid arthritis

Unlikely to be osteoarthritis
Consider


SLE
Scleroderma
Polymyositis

Unlikely to be osteoarthritis
Consider


SLE
Scleroderma
Polymyositis

Unlikely to be osteoarthritis
Consider



SLE
Scleroderma
Polymyositis


SLE SLE SLE
Scleroderma Scleroderma Scleroderma
Polymyositis Polymyositis Polymyositis

End

End

End

Is it articular?

Is it articular?

Is it articular?

Yes

Yes

Yes

No

No

No

Is complaint >6 wk?

Is complaint >6 wk?

Is complaint >6 wk?

Yes

Yes

Yes

No

No

No

Yes

Yes

Yes

No

No

No

Are DIP, CMC1, hip or knee joints involved?

Are DIP, CMC1, hip or knee joints involved?

Are DIP, CMC1, hip or knee joints involved?

Yes

Yes

Yes

No

No

No

How many joints involved?

How many joints involved?

How many joints involved?

1-3

1-3

1-3

>3

>3

>3

Is involvement symmetric?

Is involvement symmetric?

Is involvement symmetric?

Yes

Yes

Yes

No

No

No

Are PIP, MCP, or MTP joints involved?

Are PIP, MCP, or MTP joints involved?

Are PIP, MCP, or MTP joints involved?

Yes

Yes

Yes

No

No

No