What is the diagnosis and recommended management for a patient presenting with bilateral shoulder pain and bilateral knee pain, characterized as sharp and throbbing, with exacerbation upon movement, and a history of canceled orthopedic and cardiology follow-ups?

From the Guidelines

The patient should be started on conservative management for bilateral shoulder and knee pain, including weight loss if applicable, and participation in self-efficacy and self-management programs, as these have been shown to provide clinically important benefits for osteoarthritis symptom management 1. For the management of these musculoskeletal complaints, I recommend starting with conservative measures including acetaminophen 650-1000mg every 6 hours or ibuprofen 400-600mg every 6-8 hours as needed for pain relief, not exceeding maximum daily doses (4000mg for acetaminophen, 3200mg for ibuprofen) as per the american college of rheumatology 2012 recommendations 1.

• Physical therapy should be initiated for both shoulder and knee pain, focusing on gentle range of motion exercises, strengthening, and proper body mechanics.
• Application of ice for 15-20 minutes several times daily can help reduce inflammation.
• The patient should prioritize attending the rescheduled orthopedic consultation for proper evaluation, especially given the severity of knee pain (10/10).
• It's also critical that the patient complete the cardiology follow-up on 4/14/25 and continue wearing the heart monitor as directed, as cardiac clearance is necessary before any potential surgical intervention.
• The patient's bilateral joint pain without injury suggests possible degenerative joint disease or inflammatory condition that requires proper diagnosis through the orthopedic evaluation and imaging studies.
• Weight management and activity modification to avoid movements that worsen symptoms should also be implemented while awaiting specialty care, as weight loss of 5-10% of body weight has been shown to have clinically important benefits for osteoarthritis symptom management 1.
• Additionally, tai chi is strongly recommended for patients with knee and/or hip OA, as it has been shown to have a holistic impact on strength, balance, and fall prevention, as well as on depression and self-efficacy 1.
• Cognitive behavioral therapy (CBT) is also conditionally recommended for patients with knee, hip, and/or hand OA, as it may reduce pain and improve health-related quality of life 1.

From the Research

Patient History and Presentation

• The patient presents with bilateral shoulder pain and bilateral knee pain, both of which are sharp and throbbing in character.
• The shoulder pain has been present for 2 months with a severity of 4/10, while the knee pain is a longstanding issue that has worsened over the past couple of months with a severity of 10/10.
• Both pains are exacerbated by movement, with no specific timing pattern or reported radiation or associated symptoms.
• The patient has a history of canceling appointments with orthopedics for surgical evaluation and not following up with cardiology for preoperative clearance, although they are currently wearing a heart monitor and have a follow-up appointment scheduled.

Management and Treatment Options

• Considering the patient's symptoms and history, management of their pain is crucial. According to 2, ibuprofen is widely used for the relief of symptoms of pain, inflammation, and fever, and has a good safety profile at low doses.
• However, the patient's cardiovascular history and current use of a heart monitor must be taken into account when considering treatment options. As noted in 3, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can increase the risk of cardiovascular disease.
• A comprehensive patient history, as outlined in 4 and 5, is essential in guiding diagnosis and treatment. This includes active listening, empathetic communication, and cultural sensitivity.

Reassurance and Patient Education

• Given the patient's symptoms and history of not following up with appointments, reassurance therapy may be beneficial. As suggested in 6, effective reassurance involves questioning and examining the patient, assuring them that serious illness is not present, and suggesting that symptoms will resolve.
• Patient education on the importance of follow-up appointments and adherence to treatment plans is also crucial. By engaging the patient in their care and providing clear explanations of their condition and treatment options, healthcare providers can promote patient autonomy and improve outcomes.