From the Guidelines
When evaluating symptoms across musculoskeletal (MSK), vascular, and infectious conditions, it is crucial to assess a range of symptoms including pain, swelling, redness or skin changes, mobility issues, systemic symptoms, vascular signs, and neurological symptoms to guide accurate diagnosis and treatment. The assessment should include:
- Pain: Location, intensity, duration, and character (e.g., sharp, dull, throbbing) 1
- Swelling: Presence, location, and extent
- Redness or skin changes: Discoloration, warmth, or rashes
- Mobility issues: Stiffness, limited range of motion, or weakness
- Systemic symptoms: Fever, chills, fatigue, or unexplained weight loss
- Vascular signs: Pulse changes, discoloration of extremities, or coldness
- Neurological symptoms: Numbness, tingling, or altered sensation For a comprehensive evaluation, these symptoms should be assessed systematically, noting their onset, progression, and any exacerbating or alleviating factors. It is also important to consider how symptoms may overlap or indicate multiple conditions, such as joint pain and swelling suggesting arthritis (MSK) or cellulitis (infectious), or leg pain and swelling indicating deep vein thrombosis (vascular) 1.
Given the potential for serious conditions like septic arthritis, compartment syndrome, or arterial occlusion, early recognition and timely intervention are critical. The most recent guidelines, such as those from 2022, emphasize the importance of imaging in diagnosing musculoskeletal infections and differentiating between conditions like osteomyelitis and septic arthritis 1. The use of diagnostic criteria, such as the Kocher criteria for septic arthritis, can aid in distinguishing between conditions that require urgent surgical intervention and those that may be managed expectantly. Correlating symptoms with physical examination findings and appropriate diagnostic tests is essential for reaching an accurate diagnosis and guiding treatment, as highlighted in recent studies 1.
From the Research
Musculoskeletal (MSK) Conditions
- Symptoms of MSK infections include:
- Soft tissue edema and hyperemia
- Soft tissue abscesses
- Joint, bursal and tendon sheath effusions/synovitis
- Subperiosteal abscesses
- Cellulitis, fasciitis, necrotizing deep soft tissue infection, pyomyositis, soft tissue abscess, infectious bursitis, and infectious tenosynovitis 2
- MSK infections can be difficult to diagnose clinically, with nonspecific signs, symptoms, and physical examination findings, and inconclusive laboratory values 2
Vascular Conditions
- Vascular spinal emergencies include:
- Epidural abscess
- Nontraumatic epidural hematoma
- Vascular malformations
- Spinal cord infarction
- These conditions can lead to the sudden onset of neurologic symptoms, such as motor weaknesses, bowel and bladder incontinence, and sensory changes 3