Page 104 Guide to Pain Management in Low-Resource Settings

92 Richard Fisher

• Pain is often the presenting symptom in patients and a physical examination is the key to their
with a musculoskeletal abnormality. Take a care- diagnosis.
ful history of the onset and quality of the dis- • If deformity or signifi cant abnormality is present
comfort. on the physical exam with little associated pain,
• Th e physical examination is easily performed, but consider an underlying neuropathy.
be sure to include the evaluation of all important
structures: nerve, vessel, skin, muscles, tendons,
References
joints, ligaments, and bone.
• Systemic signs (fever, weight loss, fatigue) provide [1] Alpert SW, Koval KJ, Zuckerman JD. Neuropathic arthropathy: review
of current knowledge. J Am Acad Orthop Surg 1996;4:100–8.
a clue to possible infection or tumor. [2] American Society for Surgery of the Hand. Th e hand: examination and
• Special radiographic and imaging studies are diagnosis, 3rd edition. New York: Churchill Livingstone; 1990. [2]
Bernstein J. Musculoskeletal medicine. Rosemont, IL: American Acad-
helpful, but try to the make the diagnosis without emy of Orthopaedic Surgeons; 2003.
them if they are not available. [3] Olson SA, Glasgow RR. Acute compartment syndrome in lower ex-
tremity musculoskeletal trauma. J Am Acad Orthop Surg 2005;13:436–
• Th ere are only a few common chronic pain syn- 44.
dromes involving the musculoskeletal system,