Musculoskeletal pain in the elderly is frequently encountered in clinical practice. The list of conditions that cause pain is extensive and includes many self-limited conditions and those that are urgent and potentially disabling. A careful history-taking with attention to chronicity, preceding trauma, pattern of joint involvement, nature of the pain, factors that alleviate or exacerbate the pain, and any associated systemic symptoms can provide very useful diagnostic information. Joint pain may be from derangements in the joints themselves or in any of the supporting periarticular structures. In the elderly, these may coexist. Physical examination will allow further narrowing of the differential diagnosis. Attention should be paid to the presence of joint swelling and tenderness, bony deformities, joint range of motion (both passive and active), soft tissue tenderness, rashes, and subcutaneous nodules. The general medical examination is equally important to assess the presence of extraarticular disease in primary rheumatic conditions. In addition, numerous general medical problems may present with early musculoskeletal complaints, including thyroid disease, viral infections, and hematological malignancies. Laboratory studies and imaging studies can serve as an adjunct to the history and physical examination. Synovial fluid analysis, particularly in the case of a monoarthritis can be invaluable to rule out infection or confirm the diagnosis of a crystal-induced arthritis.

Evaluation and management of the elderly presents some unique challenges to the practitioner. Clinical presentation of disease may differ in older and younger adults and multiple comorbidities may make the workup challenging.