Diagnosis: A Users Guide Dx

The first section of this textbook is dedicated to the the evaluation and diagnosis of rheumatic complaints. An accurate diagnosis is obtained with the aid of a skillful clinical history and physical examination, with or without the aid of synovial fluid analysis, diagnostic tests or musculoskeletal imaging.  While all topics are alphabetically arranged, the diagnosis section begins with chapters  on the evaluation of musculoskeletal complaints, synovial fluid analysis and arthrocentesis of specific joints.

Evaluation of Musculoskeletal Complaints
This chapter begins by presenting the essential elements of the clinical history and musculoskeletal examination. Proper categorization of the patient’s complaints will aid in formulating a differential diagnosis. A detailed rheumatic review of symptoms is listed along with their associated rheumatic diagnoses. The musculoskeletal examination, demonstrated with specific maneuvers and signs, will refine the diagnosis and identify the patient’s functional capacities.

Synovial Fluid Analysis, Arthrocentesis and Injection of Specific Joints
Joint aspiration and injection is purposefully placed at other alphabetically listed test, as it is commonly performed as part of the initial evaluation and its frequency commands that it be easily found.  Synovial fluid analysis and interpretation of synovial fluid findings is discussed first.  Synovial fluid aspiration (arthrocentesis) of selected joints (knee, shoulder, wrist, ankle) is described next, along with the indications, contraindications, precautions, procedures, complications, and use of intraarticular corticosteroids. Lastly, injection of the trochanteric bursa is described as this requires careful attention to topographic anatomy and patient positioning to be successful.

Diagnostic Tests
The majority of the diagnosis section is an alphabetical catalog of laboratory tests, diagnostic procedures, imaging methods, and disease assessment tools commonly used to evaluate rheumatology patients or those with musculoskeletal conditions. Each topic describes the  diagnostic test or procedure, methodology, background information, interpretation of results, guidelines for appropriate use, and information on confounding factors. Information is organized by templated headings that may include: Synonyms, Description, Method, Normal Values, Abnormal Values, Increased In, Decreased In,  Interpretation, Confounding Factors, Complications, Indications, Contraindications, Alternative Procedures, Cost, and Comment.  The range of cost for select tests or procedures is based on commercial clinical laboratory and Medicare reimbursement costs gathered from several sources in the United States. The actual cost may vary according to method, availability, geographic site and patient insurance plan.