A 65-year-old female established patient with RA returns to the office for a follow-up visit. She still has pain, stiffness, and swelling in her left hand, elbow, and neck. The pain is considerably worse in the morning. She denies any fevers, cough, or dyspnea. The physician performs an expanded problem-focused exam.
A two-view X-ray of the left hand is performed and results are read during the visit. The hand X-ray is negative. Because of the severity of the neck and upper back pain, five trigger-point injections are given, including the right and left trapezius, right and left rhomboid, and right paraspinal muscles. No medication is changed.