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- Ankylosing spondylitis may lead to signicant limitation of spinal motion. The initial inammatory phase
may cause severe pain and stiffness over many years. While symptoms wax and wane, the disease
seldom goes into spontaneous remission with return to unrestricted function. - Reiter’s disease ares often lasts 6 – 24 months. 25% of the time it is a chronic disease never completely
remitting. Avoiding chlamydial STDs may reduce the risk of recurrences.
Activity: Rest the inamed joints but include range of motion, strengthening, and aerobic exercise as
tolerated. The extent to which a patient can continue their job depends on the physical requirements of the
job, the affected joint/s and the severity of the inammation in the joints involved.
Diet: Chronic gout can be controlled through a diet low in purines (animal proteins) and alcohol. Follow
a Heart Smart diet.
Medications: NSAIDs: gastritis, ulcer, GI bleed if not taken with food; indomethacin may cause CNS side
effects (HA, drowsiness, confusion)
Flexeril: daytime drowsiness if used tid; side effects tend to lessen after 2 weeks on the drug.
Prednisone: The goal of steroid treatment is to use the lowest dose that is necessary for as short a time
possible. Steroid side effects are multiple and potentially severe: weight gain, increased appetite, peripheral
edema from salt and water retention, hypertension, hyperglycemia, osteoporosis, avascular necrosis of bone,
nervousness, emotional lability, psychosis, yeast infections.
Prevention and Hygiene: Practice safe sex and use a condom use to decrease the risk of chlamydial STD
and/or Reiter’s are.
No Improvement/Deterioration: Return for prompt reevaluation.
Follow-up actions
Follow any acutely inamed joint until resolution or referral.
Evacuation/Consultation criteria: Promptly evacuate patients with septic joints, pain undiagnosed after 6
weeks or not adequately controlled with conservative therapy, steroid treatment required, acute tendon/muscle
rupture, or severe internal derangement.
Joint Pain: Joint Dislocations
COL Roland J. Weisser, MC, USA and LTC Winston Warme, MC, USAIntroduction: Joint dislocations occur when joints are stressed beyond the normal range of motion. Although
dislocations occasionally occur spontaneously (e.g., patella), they are usually associated with some degree of
trauma. A dislocation is a complete joint disruption such that the articular surfaces are no longer in contact.
Dislocations may be associated with marked swelling/edema and may cause injury to adjacent blood vessels
and nerves. For this reason, most dislocations should be reduced as soon as possible. This minimizes the
morbidity to the patient, but caution is required because there may be associated fractures. Gentle examina-
tion of the distal limb for crepitus or abnormal motion due to fracture is prudent prior to attempting a reduction
maneuver. In this instance, you can cause more harm and you probably need X-rays and an orthopedic con-
sultation. The following table presents an overview of common dislocations and their management.
Body Part History and Usual Objective Findings Treatment
Mechanism of Injury (Details below)
Shoulder: Anterior Common; may be recurrent; Pain and splinting of the Reduce ASAP (technique
requently associated with extremity. Arm slightly below), providing no crepi-
athletics, hyperabduction/ abducted; unable to move tus is noted with gentle
hyperextension most rm across chest; inability IR/ER of the arm
common or from direct a to rotate arm; anterior
impact on posterior shoulder “fullness” from anterior,
medial, inferior displace-
ment of humeral head to
subcoracoid position