Transcript Slide 1

Locomotor systems
Examination
General examination related to rheumatological
diseases :1- Hair :- Alopecia
2-Face: - *Skin e.g. tightness.
*Eye e.g. redness, upper eye lids
(Heliotrope rash)
*Malar rash.
*Discoid rash.
*Mouth ulcers.
*Tongue dryness.
*Face wrinkles
*Nose e.g. peaked nose.
3- Hands:-
*Gottron papules.
*Raynaud’s phenomena.
*Joints &muscles.
*Skin:- shiny & tight.
*Fingers:- ulcers, scars, gangrene,
sclerodactly.
4- Neck:- lymphadenpathy.
5- Feet :- *Ulcers.
*Raynaud’s phenomena.
*Amputation.
*Skin tightness.
*gangrene
*Joints & muscles.
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Rheumatoid hand examination
Inspection
Deformity, muscle wasting, swelling, redness.
Palpation
Temperature, tenderness, type of swelling.
Active movement
Done by the patient.
Passive movement
Try to increase the range of movement.
Restriction caused by pain or ankylosis.
• Power
• -5 movement of thumb:• Adduction, abduction, flexion, extension,
apposition .
• -flexion at MCP joint------ by lumbricals.
• -flexion at PIP joint-------- by flexor digitorum
superficialis.
• -flexion at DIP joint-------- by flexor digitorum
profundus.
• -adduction of fingers ------ by palmer interossii.
• -abduction of fingers ------ by dorsal interossii .
• Check forearms
• For subcutaneous rheumatoid nodules.
Investigations
1- CBC.
2- ESR.
3- CRP.
4- Rheumatoid factor.
5- X- ray in chronic disease.
6- Arthrosonography.
7- Serological tests.
8- Arthrocentesis:- Joint aspiration.
9- synovial fluid analysis:- Number of cells.
- Glucose level.
- Gram stain.
- AFB.
- Culture & sensitivity.
10- Arthroescopy & synovial biopsy.
11- MRI of the joint. eg Sacroiliac joint.
12- Investigations related to underlying disease.