Locomotor systems Examination General examination related to rheumatological

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.

• • • 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.