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Physical Examination in Rheumatology
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Inspection of Hands and Fingers
Assesses shape, swelling, skin changes, and deformities such as ulnar deviation or swan-neck deformity often seen in rheumatoid arthritis.
Palpation of Metacarpophalangeal (MCP) and Proximal Interphalangeal (PIP) Joints
Determines the presence of tenderness, warmth, or synovitis suggestive of active inflammation, such as in rheumatoid arthritis.
Assessment of Grip Strength
Evaluates functional impairment and potential muscle weakness, which may indicate systemic involvement in conditions like systemic lupus erythematosus.
Schober's Test
Measures lumbar spine flexion to assess for ankylosing spondylitis or other causes of spinal stiffness.
Heel Drop Test
Evaluates for sacroiliitis. Pain elicited by dropping from toes to heels suggests inflammation in the sacroiliac joints as seen in ankylosing spondylitis.
Fabere/Patrick's Test
Assesses for hip or sacroiliac joint pathology; pain may indicate osteoarthritis or sacroiliitis.
Gaenslen's Test
Used to detect sacroiliac joint dysfunction; pain while performing the test suggests sacroiliitis.
Valgus Stress Test on the Knee
Assesses the medial collateral ligament integrity; laxity or pain may suggest ligamentous injury or associated joint disease.
Varus Stress Test on the Knee
Evaluates the lateral collateral ligament; increased laxity or pain may indicate ligament injury or joint disease.
Bulge Sign for Knee Effusion
Detects small amounts of fluid in the knee joint, as might be seen in conditions such as rheumatoid arthritis or osteoarthritis.
Bounce Home Test
Assesses for meniscal injury or significant intra-articular pathology which may coexist with arthritic changes.
Quadriceps Wasting (Atrophy) Assessment
Evaluates for muscle wasting which may occur due to disuse or neurogenic causes secondary to inflammatory arthropathies.
Straight Leg Raise Test
Evaluates for radiculopathy or sciatic nerve irritation which can be seen in inflammatory spinal conditions.
Painful Arc Test for Shoulder
Assesses for subacromial impingement or rotator cuff pathology, which may be present in rheumatologic conditions affecting the shoulder.
Neer's Impingement Sign
Used to detect rotator cuff impingement, which may be worsened by inflammatory processes in the shoulder.
Hawkins-Kennedy Impingement Test
Identifies shoulder impingement involving the rotator cuff tendons, commonly affected in rheumatologic conditions.
Tinel's Sign at the Wrist
Assesses for carpal tunnel syndrome, which may be associated with rheumatoid arthritis due to synovial inflammation.
Phalen's Maneuver
Tests for carpal tunnel syndrome where the median nerve is compressed by swollen synovium and tendons in rheumatoid patients.
McMurray Test
Detects meniscal tears within the knee, which may be concurrent with degenerative arthritic processes.
Finkelstein's Test
Evaluates for De Quervain's tenosynovitis, an inflammation of the wrist tendons, sometimes associated with rheumatic diseases.
Bunnel-Littler Test
Differentiates between joint contracture and intrinsic muscle tightness in the hand, which may arise from chronic joint inflammation.
Mann's Test
Assesses for extensor tendon inflammation or rupture in rheumatoid arthritis, which may affect the MCP joints.
Froment's Sign
Used to assess for ulnar nerve palsy, which could be due to entrapment or pressure from inflamed tissues in rheumatologic conditions.
Trendelenburg Test
Identifies weakness of the hip abductor muscles like the gluteus medius, which can be affected by degenerative or inflammatory hip diseases.
Ely's Test
Evaluates for rectus femoris contracture, which may be secondary to hip diseases or knee joint pathologies.
Scapular Winging
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.
Thomas Test
Assesses for hip flexion contractures which could happen secondary to hip joint diseases or lower spinal problems.
Murphy's Sign
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.
Nailfold Capillaroscopy
Examines capillary microcirculation at the nailfold to assess for microvascular changes seen in systemic sclerosis and dermatomyositis.
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