How is the assessment carried out in muscle and joint pain?
In muscle and joint pain, the first distinction is whether the pain arises from the muscle or from the joint and whether there is any sign of inflammation in the joint. Swelling, redness, increased warmth and the duration of morning stiffness are decisive in making this distinction. The assessment is made by examination; laboratory tests and imaging are requested where necessary.
Musculoskeletal complaints are common. The World Health Organization (opens in a new tab) reports that approximately 1.71 billion people worldwide have a musculoskeletal condition, and that osteoarthritis affects 528 million people, rheumatoid arthritis 18 million, neck pain 222 million and gout 54 million.
This page addresses regional muscle and joint pain. For the low back and neck region see Low Back and Neck Pain, and for pain felt in many areas of the body see Widespread Muscle Pain (Fibromyalgia).
Distinguishing questions
| Question | Why it is asked |
|---|---|
| Is there swelling, redness or increased warmth in the joint? | To distinguish inflammatory joint diseases |
| How long does the morning stiffness last? | Because prolonged stiffness suggests an inflammatory cause |
| Does the pain increase with movement or at rest? | To distinguish mechanical from inflammatory pain |
| How many joints are involved and is the pattern symmetrical? | Because the pattern of involvement guides the diagnosis |
| Is there fever, weight loss or a rash? | Because these may point to a systemic disease |
| Is there a history of strain or trauma? | To distinguish injury-related pain |
| What medicines are being taken? | Because some medicines may cause muscle pain |
How does the assessment proceed?
- Medical history and family history. The site, duration and course of the pain, the factors that aggravate and relieve it; accompanying symptoms and current medication.
- Joint and muscle examination. Range of movement, tenderness, swelling and deformity are assessed.
- Laboratory tests. Where necessary, inflammatory markers, a full blood count, vitamin D level, thyroid function tests, uric acid and kidney and liver function tests are requested.
- Imaging. This is requested according to the examination findings; it is not needed in every case of pain.
- Referral. Where the findings suggest inflammatory joint disease, a rheumatology assessment may be requested; where they point to a structural problem, an orthopaedic or physical therapy assessment may be sought.
- Drawing up the plan. Adjustments to movement, medication where necessary and, where considered suitable, procedures performed at the practice are planned.
In which patients is it assessed differently?
- In patients with swelling, redness and increased warmth in a joint (priority assessment is needed for inflammatory joint diseases and joint infection)
- In patients whose pain is accompanied by fever (joint infection requires urgent assessment)
- In patients whose pain began after trauma (priority assessment for fracture is needed)
- In patients with a history of cancer (the pain is assessed as a priority)
- In patients with a diagnosis of osteoporosis and in patients over 65 years of age (a fracture may develop with minor strains)
- In patients who are pregnant or breastfeeding (the medicines that may be used are limited)
- In patients taking blood thinners (needle-based procedures are assessed separately)
- In patients taking cholesterol medicine (muscle pain related to the medicine is assessed separately; do not stop the medicine on your own initiative)
- In patients under 18 years of age (assessment lies within the field of paediatrics; this page has been prepared for adults)
How long does it take, and how many appointments are needed?
The number of appointments and the time required vary according to the cause and duration of the pain. A definite number cannot be given in advance. In short-lived pain from strain, a single assessment may be enough; long-standing pain may require follow-up at certain intervals. If a procedure that is considered suitable is planned, the number of sessions and the interval between them are set at the end of the examination.
What should you do before and after the consultation?
When you come to your appointment, bring:
- A list of all the medicines and supplements you use
- Any previous imaging reports and test results you have
- Your notes on which movements increase the pain
After the appointment, you are given a written plan. Apply the movement advice gradually; do not continue movements that increase the pain. The time it takes for an effect to appear varies from person to person.
Risks and points to be aware of
If swelling in a joint and fever are present together, do not wait. Joint infection requires urgent assessment.
Heat and cold application is not the same for every kind of pain. The type and duration of the application are determined after the examination. It is not applied to areas where the skin is broken or where there is loss of sensation.
Frequent use of painkillers calls for caution over the stomach, the kidneys and blood pressure. Report how often you use them; do not increase the dose on your own initiative.
Needle-based procedures carry risks of their own. Pain at the site of the procedure, bruising, bleeding and, rarely, infection may occur. The suitability criteria for each procedure are set out on its own page.
If muscle pain develops while you are taking cholesterol medicine, report it. Do not stop the medicine on your own initiative.
Inactivity may increase joint stiffness. The World Health Organization (opens in a new tab) highlights physical approaches that build muscle strength and the ability to move.
Results vary from person to person.
When should you see a physician without delay?
If you notice these symptoms, consult a physician without delay:
- Sudden swelling, redness and increased warmth in a joint
- Fever accompanying joint pain
- Morning stiffness lasting longer than an hour
- Muscle weakness (difficulty climbing stairs or combing your hair)
- Unintentional weight loss and night sweats accompanying the pain
- A rash appearing on the skin
In the case of a swollen joint with fever, severe muscle pain together with darkening of the urine, or being unable to bear weight or a deformity after trauma, go directly to the emergency department.
Frequently asked questions
Could my joint pain be caused by rheumatism?
This distinction is made by examination. Swelling, redness and increased warmth in the joint, and morning stiffness lasting longer than an hour, suggest inflammatory joint diseases and may call for a rheumatology assessment. If these findings are absent, the clinical picture is usually assessed differently.
Which tests are requested for muscle and joint pain?
There is no standard list. According to the examination findings, inflammatory markers, a full blood count, vitamin D level, thyroid function tests, uric acid and kidney and liver function tests may be assessed.
Do I need to have an X-ray?
Imaging is not needed in every case of joint pain. Whether it is needed is decided according to the examination findings and whether warning signs are present.
Should I apply heat or cold for joint pain?
This varies according to the character and cause of the pain; a single rule cannot be given. The approach to newly developed swelling and strains may differ from the approach to long-standing stiffness. The type and duration of the application are determined after the examination.
Does vitamin D deficiency cause joint pain?
Vitamin D status is one of the factors looked at in the assessment of muscle and joint pain. Finding a deficiency, however, does not show that it is the only cause of the pain. The use of a supplement is planned following assessment by a physician.
Which procedures may be planned for muscle and joint pain?
If considered suitable following the assessment, procedures such as hijama and major ozone therapy may be added to the plan. Each has its own suitability criteria, course and possible side effects, described separately on the relevant pages.
Sources
- World Health Organization, Musculoskeletal health fact sheet, 14 July 2022. https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions (opens in a new tab)
- World Health Organization, Low back pain fact sheet, 19 June 2023. https://www.who.int/news-room/fact-sheets/detail/low-back-pain (opens in a new tab)
