Clinical Presentation & Protocol
Patient Usually Complains Of
Patient is a long-term dialysis recipient (duration: [X] years) presenting with chronic, progressive musculoskeletal pain, specifically involving the shoulders, wrists, and hips. Symptoms include morning stiffness, joint swelling, and decreased range of motion. No history of acute trauma. Patient reports symptoms are refractory to standard analgesics.
Clinical Examination Findings
Physical examination reveals bilateral carpal tunnel syndrome symptoms, palpable nodules over the flexor tendons, and limited joint mobility. Signs of periarticular swelling and tenderness noted in the glenohumeral and hip joints. No evidence of acute inflammatory arthritis or systemic infection.
Treatment Protocol
Plan includes optimization of dialysis modality (high-flux membranes or hemodiafiltration) to enhance beta-2 microglobulin clearance. Referral to orthopedics for surgical decompression of carpal tunnel if indicated. Pain management with non-steroidal anti-inflammatory drugs (NSAIDs) with caution regarding renal status, or alternative analgesics.