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Physical Examination in Rheumatology

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Assessment of Grip Strength

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Evaluates functional impairment and potential muscle weakness, which may indicate systemic involvement in conditions like systemic lupus erythematosus.

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Inspection of Hands and Fingers

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Assesses shape, swelling, skin changes, and deformities such as ulnar deviation or swan-neck deformity often seen in rheumatoid arthritis.

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Varus Stress Test on the Knee

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Evaluates the lateral collateral ligament; increased laxity or pain may indicate ligament injury or joint disease.

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Murphy's Sign

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Primarily for assessing acute abdomen conditions like cholecystitis, however palpation in this area may also reveal discomfort related to lower rib or upper abdominal musculoskeletal issues.

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Bunnel-Littler Test

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Differentiates between joint contracture and intrinsic muscle tightness in the hand, which may arise from chronic joint inflammation.

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Scapular Winging

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Observation and assessment for protrusion of the scapula away from the rib cage, which may indicate neurological dysfunction or muscle illness related to systemic conditions.

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Hawkins-Kennedy Impingement Test

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Identifies shoulder impingement involving the rotator cuff tendons, commonly affected in rheumatologic conditions.

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Froment's Sign

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Used to assess for ulnar nerve palsy, which could be due to entrapment or pressure from inflamed tissues in rheumatologic conditions.

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Tinel's Sign at the Wrist

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Assesses for carpal tunnel syndrome, which may be associated with rheumatoid arthritis due to synovial inflammation.

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Valgus Stress Test on the Knee

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Assesses the medial collateral ligament integrity; laxity or pain may suggest ligamentous injury or associated joint disease.

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Bulge Sign for Knee Effusion

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Detects small amounts of fluid in the knee joint, as might be seen in conditions such as rheumatoid arthritis or osteoarthritis.

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Painful Arc Test for Shoulder

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Assesses for subacromial impingement or rotator cuff pathology, which may be present in rheumatologic conditions affecting the shoulder.

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McMurray Test

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Detects meniscal tears within the knee, which may be concurrent with degenerative arthritic processes.

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Finkelstein's Test

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Evaluates for De Quervain's tenosynovitis, an inflammation of the wrist tendons, sometimes associated with rheumatic diseases.

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Fabere/Patrick's Test

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Assesses for hip or sacroiliac joint pathology; pain may indicate osteoarthritis or sacroiliitis.

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Bounce Home Test

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Assesses for meniscal injury or significant intra-articular pathology which may coexist with arthritic changes.

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Mann's Test

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Assesses for extensor tendon inflammation or rupture in rheumatoid arthritis, which may affect the MCP joints.

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Palpation of Metacarpophalangeal (MCP) and Proximal Interphalangeal (PIP) Joints

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Determines the presence of tenderness, warmth, or synovitis suggestive of active inflammation, such as in rheumatoid arthritis.

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Heel Drop Test

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Evaluates for sacroiliitis. Pain elicited by dropping from toes to heels suggests inflammation in the sacroiliac joints as seen in ankylosing spondylitis.

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Ely's Test

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Evaluates for rectus femoris contracture, which may be secondary to hip diseases or knee joint pathologies.

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Schober's Test

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Measures lumbar spine flexion to assess for ankylosing spondylitis or other causes of spinal stiffness.

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Quadriceps Wasting (Atrophy) Assessment

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Evaluates for muscle wasting which may occur due to disuse or neurogenic causes secondary to inflammatory arthropathies.

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Gaenslen's Test

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Used to detect sacroiliac joint dysfunction; pain while performing the test suggests sacroiliitis.

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Neer's Impingement Sign

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Used to detect rotator cuff impingement, which may be worsened by inflammatory processes in the shoulder.

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Phalen's Maneuver

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Tests for carpal tunnel syndrome where the median nerve is compressed by swollen synovium and tendons in rheumatoid patients.

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Trendelenburg Test

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Identifies weakness of the hip abductor muscles like the gluteus medius, which can be affected by degenerative or inflammatory hip diseases.

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Thomas Test

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Assesses for hip flexion contractures which could happen secondary to hip joint diseases or lower spinal problems.

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Nailfold Capillaroscopy

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Examines capillary microcirculation at the nailfold to assess for microvascular changes seen in systemic sclerosis and dermatomyositis.

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Straight Leg Raise Test

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Evaluates for radiculopathy or sciatic nerve irritation which can be seen in inflammatory spinal conditions.

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