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46: GOUT

Debra F. Stern, DPT, DBA, MSM, PT; Eric Shamus, PhD, DPT, PT, CSCS; Greg W. Hartley, DPT, PT, GCS, CEEAA

CONDITION/DISORDER SYNONYMS

  • Hyperuricemia

  • Tophaceous gout

  • Gouty arthritis

ICD-9-CM CODES

  • 274.9 Gout, unspecified

  • 315.4 Coordination disorder (clumsiness, dyspraxia and/or specific motor development disorder)

  • 718.03 Articular cartilage disorder, forearm

  • 718.04 Articular cartilage disorder, hand

  • 718.07 Articular cartilage disorder, ankle and foot

  • 719.39 Palindromic rheumatism involving multiple sites

  • 719.4 Pain in joint

  • 729.1 Myalgia and myositis, unspecified

  • 736.9 Acquired deformity of limb

  • Physical therapy diagnoses/treatment diagnoses that may be associated with Rheumatologic disorders affecting movement

    • 718.45 Contracture of joint; pelvic region and thigh

    • 719.70 Difficulty in Walking

    • 728.89 Other disorders of muscle, ligament, and fascia

    • 728.2 Muscular wasting and disuse atrophy

    • 729.9 Other disorders of soft tissue

    • 781.2 Abnormality of gait: Ataxic, paralytic, spastic, staggering

    • 782.3 Edema

ICD-10-CM CODE

  • M10.9 Gout, unspecified

PREFERRED PRACTICE PATTERNS

  • 4D: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Connective Tissue Dysfunction1

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation

  • 7B: Impaired Integumentary Integrity Associated with Superficial Skin Involvement

FIGURE 46-1

Diagnostic algorithm for the nontraumatic, acute monoarticular arthritis patient. Common, acute diagnoses and disease presentations are included in this algorithm. Patients may have uncommon disease presentation, overlapping diagnoses (e.g., gout and septic joint), or illnesses not included in the algorithm. (From Tintinalli JE, Stapczynski JS, Ma OJ, et al. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 7th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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PATIENT PRESENTATION

A 69-year-old male presents to the outpatient physical therapy clinic with complaints of pain (8/10) in the right great toe. The pain appeared suddenly over the past 2 days. Upon examination, you find redness and erythema of the right great toe, pain localized to the great toe, especially in the metatarsal–phalangeal joint, which is worse at night. He has a clear difficulty in walking due to the pain. The patient is moderately obese, diabetic, has sleep apnea, and reports he consumes two alcoholic beverages per day. No lab values are available and other historical information is noncontributory.

KEY FEATURES

Description

  • Gout is a form of arthritis that is caused by uric acid (sodium urate) buildup in the blood, resulting in crystal formation that can inflame the joints.

  • Considered a rheumatic condition because it involves the joints

  • Joint pain: Often in great toe, knee or ankle; episodic but may last for long periods of time

  • Sudden onset: May be over a course of a day, and frequently with severe pain at night

  • Edema

  • Soft tissue pain surrounding affected joints

  • Kidney dysfunction

Essentials of Diagnosis

  • Must be made by a physician and confirmed by ...

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