Tlit; complain! of chronic polyarthralgia or myalgia, which is constant day and night and does not conform to any dear pattern, should raise the suspicion that this may be a somatic presentation of an underlying psychological or psychosocial problem, for which an explanation should be sought. Other clues include lack of objective abnormal clinical findings, such as reduced movement or joint swelling, and the prominence of features such as tiredness, lack of energy, change in mood, sleep patterns or appetite although such features may be the consequence of chronic pain.
A sprained ligament is one which has been partially torn in response to trauma. Immediately after a sprain the pain may be severe and constant. Subsequently, pain only occurs with movement that stretches the damaged ligament and is relieved when the ligament is relaxed. A complete ligament tear may produce an unstable joint which becomes increasingly painful as the day progresses when the supporting muscles tire and the related ligaments stretch. At times there is a characteristic pattern of instability, e.g. following lateral ligament rupture of the ankle the hindfoot is subject to recurrent episodes of inversion.
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