Rheumatologic Examination

Rheumatologic Examination
Presentation by:Walter Eisenhauer MMS PA-C

Approach to Disorders of the Joints
* Etiologies of Joint Pain
+ Traumatic
+ Infectious
+ Degenerative
+ Metabolic
+ Immunologic
+ Neoplastic

Diagnosis

* Based on
+ History
+ Physical
+ Lab
+ X-ray
* Origination of Joint Symptoms
+ Synovium Cartilage Periarticular structures
+ Inflammatory Non-inflammatory

History

* Duration of Joint Symptoms
* Rapidity of Development
* Self Limited Symptoms Vs Persistent
* Number and Location of Affected Joints
* Pattern of Affected Joints
+ Symmetric
+ Asymmetric
* Sequence of Joint Involvement
+ Additive
+ Migratory
* Pain at Rest/Following Exercise
* Gelling
* Precipitating Events-Illness
* Morning Stiffness
* Symmetric Distribution of inflammatory changes-RA
* Weight Bearing Joints After Exercise-DJD
* Migratory-Rheumatic Fever
* Additive-RA
* Persistent Low Back Pain in Young Man-Ankylosing Spondylitis
* Acute Inflammation-Infection/Crystal Deposition Disease
* Chills/High Fever
* Constitutional Sx-RA/Neoplasm/infections
* Medications-Pronestyl Induced Lupus


Past Medical History

* Hepatitis
* Rubella, Mumps, Parvovirus
* Reynauds
* Iritis-Ankylosing Spondylitis
* Inflammatory Bowel Disease

Social History

* Sexual Practices
* Work
* S/S Depression-Anxiety
* Stress
* Diet-CA++/Purines

Physical Examination

* Skin
+ Nodules on extensor surfaces
+ Psoriatic Rashes
+ Nails
+ Signs of Vasculitis
+ Mucocutaneous lesions of Reiters Syndrome
+ Eye Dryness

Examination of the Joints

* Examine even Unaffected Joints
* Examine Peri-Articular Surfaces
+ Atrophy Effusions Erythema
+ Palpation
* Establish Range of Motion
* Palpate Exact Location of Tenderness
* Temperature
* Assess Muscle Strength/Tone
* History will help guide complementary exams:
+ Risk for CA and Assoc Wt Loss-Examine high risk systems
+ Abdomen/Bowel Sx- Examine abdomen
+ Fever-Cardiac
+ Pulmonary Sx-Lung

Classification of Joints

* Synarthrosis-No Movement
+ Suture-Cranial
+ Synchondrosis-Epiphysis/Diaphysis
* Amphiarthrosis-Slight movement
* Diarthrosis-Synovial
* Ball and Socket Saddle-Thumb Carpal/MC
* Hinge Gliding-intervertebral
* Pivot-Atlantoaxial
* Condyloid-Wrist

Examination

* Waiting Room Diagnosis
* Inspect Gait
* Ability to Disrobe etc- good eval of ROM
* Inspect Muscles
* Goniometer for ROM

Motor Examination

* S.I.T.S.
+ Size-measure all major muscle groups
* upper/lower arms
* upper/lower legs
* Inspect for Involuntary Movements
* Evaluate Tone
* Strength Testing
+ 0-4 grading

Motor Strength Testing

* 0- No Movement
* 1-Slight Contraction
* 2-Full Range of Motion/No Gravity
* 3-Full Range of Motion/Gravity
* 4- Some resistance
* 5- Full Resistance

Examination of the Upper Extremities

* Shoulder
+ Inspect
* Contour
* Girdle
* Clavicles
* Scapulae
* Muscles-SITT/Biceps/Deltoid/Traps
* AC Joint
* Bicipital Groove
* Shoulder Shrug-Inspect for symmetry
* Abduction-180
* Adduction-50
* Internal Rotation(behind small of back)-90
* External Rotation(behind neck)-90

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Rheumatologic Examination.ppt