Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ There are textbooks written about the numerous periarticular syndromes that commonly present to primary care physicians, orthopedists, and rheumatologists. Table 27-16 briefly outlines some of the most common. ++Table Graphic Jump LocationTable 27-16.Some common periarticular pain syndromes.View Table||Download (.pdf)Table 27-16. Some common periarticular pain syndromes. Area of Pain Diagnosis History Physical and Diagnostic Evaluation Neck and shoulder Cervical strain Common cause of “stiff neck” in patient who is otherwise well Often noticed upon wakening Spasm of the cervical and upper back muscles Neck pain often worst with lateral flexion Head tilt often present Cervical radiculopathy Pain and stiffness of cervical spine, usually with radiation to upper back and arm Occasionally manifests solely as pain between spine and scapula Spurling test: sensitivity, 30%; specificity, 93% MRI diagnostic Subacromial or rotator cuff disorder Shoulder pain, often subacute onset, often worse at night Positive painful arc test Rotator cuff tear Pain similar to above Occurs after injury in younger patients Often spontaneous in older patients Positive internal or external rotation lag test MRI diagnostic Elbow Lateral and medial epicondylitis Pain over tendon insertion on medial and lateral epicondyle Tenderness at site of pain Exacerbated with wrist flexion (medial) or extension (lateral) Olecranon bursitis Pain over olecranon bursa Tenderness and swelling over the olecranon bursa Hand DeQuervain tenosynovitis Pain at the lateral base of the thumb Worse with pincer grasp Positive Finkelstein maneuver (ulnar deviation of wrist with fingers curled over thumb) Hip Trochanteric bursitis Pain over bursa Patient often notes pain when lying on area at night Tenderness over bursa Sometimes visualized on radiograph Meralgia paresthetica Pain or numbness over lateral thigh Often after weight gain or loss Neuropathic-type pain Abnormal sensation over lateral femoral cutaneous nerve distribution Knee Patellofemoral syndrome Anterior knee pain, often worse climbing or descending stairs Crepitus beneath patella Meniscal and ligamentous injuries Ligament injuries tend to be traumatic Classically associated with the knee giving way Meniscal injuries may be traumatic or degenerative Knee locking is classic Ligament injuries will manifest as laxity on exam Meniscal injuries as a click MRI is diagnostic Foot and ankle Achilles tendinitis Pain over distal tendon Pain and stiffness worse after inactivity Tenderness over insertion of tendon Plantar fasciitis Pain anterior to heel Worse with first standing History usually diagnostic Radiograph may show heel spur Morton neuroma Pain between the second and third or third and fourth metatarsal heads Tenderness between the second and third or third and fourth metatarsal heads Polyperiarticular Fibromyalgia Diffuse pain syndrome Often nonrestorative sleep Diagnosis depends on tenderness at 11 or more specific locations Polymyalgia rheumatica Pain and disability of large muscles of shoulder and hips Disease is often associated with findings consistent with inflammatory disease (anemia, elevated CRP and ESR) CRP, C-reactive protein; ESR, erythrocyte sedimentation rate. Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth