Musculoskeletal Pain, Geriatric

With time

Step 1: View clinicals

An 88-year-old woman presents with severe pain in her shoulders, lower back, and both knees which is exacerbated by physical activity, unresolved by acetaminophen, and associated with morning stiffness lasting for around 10 minutes. Her medical history is significant for an inferior ST-elevation myocardial infarction three years ago, which was managed medically, with atrial fibrillation as a lasting sequel. She also underwent bilateral hip replacement five years ago for severe osteoarthritis. She is currently on warfarin, metoprolol, enalapril, and rosuvastatin, and has adhered well to her medications. She lives with her eldest daughter and is well-cared for. A complete blood count is within normal parameters, as is a renal profile, fasting plasma glucose, and ESR.

Step 2: Order all relevant investigations

X-Ray B/L shoulders and knees + lumbar spine

There are severe osteoarthritic changes in both shoulder joints, the lumbar spine, and both knee joints.

MRI B/L shoulders and knees + lumbar spine

The findings of the MRI are comparable with those of the X-rays and suggest severe osteoarthritic changes.

DEXA scan

You realize that a DEXA scan is not indicated at present.

Arthroscopy B/L knee joints

You realize that arthroscopy is not indicated here.

Step 3: Select appropriate management

B/L knee arthroplasty
Intra-articular steroid injections

Score: ★★☆