Logy System

Rheumatology system Clinical examination

History taking Major Sx -Joints : pain, swelling, morning stiffness,Loss of f(x), Deformity, weakness, instability, changes in sensation -Eyes: Dry eyes, mouth,red eyes -Systemic: Raynaud’s phenomenon, rash, fever, fatigue, weight loss, diarrhea,mucosal ulcers

Peripheral joints Pain & swelling: Arthralgia =joint pain w/o swelling Arthritis = joint pain w swelling One or more joints involve? Painful area & place? Acute or chronic? Getting better or worse? Effect of exercise and rest? Morning stiffness?(inflammatory type- RA >1hr,>6weeks) Deformity?progressive change in shape of the area? Joint instability?true dislocation or muscle weakness? Changes in sensation?numbness or para aesthesia?distinguish nerve entrapment.

Back Pain Began suddenly or gradually? Localised or diffused? Radiates? Aggrevated by movement?cough?straining?

Basically…. General inspection: As the pts walk into the room  walking(painful &difficult?) , require assistant (stick), obvious deformity?

LOOK: -compare rt and lt -from front to back and the sides -skin erythema (underlying infection,active arthritis), atrophy, scars, rashes (psoriasis) -vasculitic skin rash palpable purpura, lived reticularis, skin necrosis. -swelling over the joint (effusion, hyperthrophy, inflammation) - Deformity (chronic) destructive arthritis -subluxation -dislocation -muscle wasting

Feel…. Skin warmth( use back of finger) Swollen & warmth(active synovitis,infection, gout) Grade Pts complain tenderness Tenderness 1 Grade 2 Grade 1 + winces

Grade 3 Grade 2 + withdraw the joints Grade 4 Does not allow palpation

-synovitis(soft & spongy), effusion(fluctuant, shifted w/in joint), bony swelling (hard, immobile osteophyte, subchondral bone thickening)

Move.. Passive movement: Determine –tense effusion, fixed deformity, limited extension, limited flexion Active movement: joint f(x) Stability Joint crepitus LASTLY: measure range of movement