Exam
·
General inspection: observe them
closely as the walk into the room – pain, gait, getting out of chair
·
Joints: gait, look, feel, move
o Gait
o Inspection:
§ Need to expose the patient (discretely watch them taking of their clothes – eg undoing buttons), including the joint above and below. Have sheets available to cover the patient. Ensure adequate lighting
§ Compare left with right
§ Look from outside in:
·
Skin: scars, redness, swelling,
hairs, rashes (eg psoriasis)
· Soft tissue: swelling
· Muscle: wasting Þ chronic disuse, surrounding inflammation or nerve damage
·
Bone and joint: deformities –
usually a sign of destructive arthritis, also subluxation and dislocation
§ Other inspection: eg nails
o Palpation:
§ Warmth
§ Tenderness (watch their face)
§ Evidence of:
·
Synovitis: soft and boggy
swelling
· Effusion: can shift within the joint
·
Bony swelling (eg osteophyte
formation or subchondral bone thickening): hard and immobile
o Move – Range of movement:
§ Better information from passive rather than active movement
§ Fixed Flexion Deformity = Limited extension
§ Fixed Extension Deformity = Limited flexion
§ Stability: attempt to move the joint in abnormal directions
§ Joint crepitus: grating sensation or noise from the joint
§ Measure angles with a goniometer.
Anatomical position = 0°
o To finish:
§ Special tests
§ Joint above and below
§ Distal pulses
§ Neurology
§ Xray and/or aspirate
·
Think: acute, chronic, impact on
function, systemic effects
·
Is it broken?
o Can they walk/use it at all? If
they can hobble, fracture less likely
o Bony tenderness increases likelihood of fracture
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