SUDDEN JOINT AND EXTREMITY PAIN IN PREGNANCY

The diagnosis of sudden joint and extremity pain in pregnancy requires the obstetric practitioner to call upon information that bridges the disciplines of obstetrics, internal medicine, neurology, and orthopedi cs. Pain in the extremities may he caused by a multitude of conditions including vascular, neurologic, or primary rheumatologic abnormalitie s, or the pain may be referred from a more distant site to the affecte d extremity. The initial evaluation of the patient should begin with a generalized assessment and more distant causes of the pain should be ruled out as the possible etiologies are considered, evaluated, and re jected. Limiting the diagnostic possibilities early in the process may focus the evaluation on one or several local etiologies and exclude o ther potential causes. Failure to evaluate all potential etiologies ma y result in false diagnoses, needless expenses to evaluate these false diagnoses, and prolonged pain secondary to delay in making the correc t diagnosis. A detailed history and physical examination with special attention to joints continues to be the least invasive and most cost-e ffective first step in the evaluation of the origin of joint pain. Ln general, the diagnostic approach should be aimed at first determining whether the origin of pain is located in the extremity or referred to that location from a more distant site. Also, as part of the initial e valuation, an attempt should be made to determine whether the pain is a local process involving a single joint or extremity or is part of a larger systemic process in which multiple sites may be involved. The h istory and physical examination is usually all that is required to mak e these determinations.