Five-minute Rheumatologic Exam

• Gait and posture
• Ease or difficulty with which he/she gets out of a chair and onto the exam table

Hands and wrists

• Skin: signs of vasculitis, periungual telangiectasias or erythema, palmar erythema, and digital infarcts
• DIP, PIP, MCP, base of thumbs: synovial distention, bony marginal enlargement, other deformities
• Palmar surface: thickening of the fascia or flexor tenosynovitis
• Grip, pinch, form a fist
• Wrist and ulnar styloids:  painful or painless limitation of range of motion to less than the normal 90 degrees of flexion and extension may indicate the presence of current or previous inflammatory disease;
• Thenar wasting?
• Ventral aspect of wrist: carpal tunnel syndrome?

Elbows

• Palpate for subcutaneous nodules and olecranon bursal enlargement
• Examine throughout ROM , full extension 180 degrees.
• Synovial distension is best palpated directly over the small area lying between the olecranon process and lateral epicondyle of the humerus; A distended elbow joint is obvious only at this sight
• Palpate over the medial and lateral epicondyles to obtain evidence of epicondylitis or tendinitis

Shoulders

• Raise the arms behind the head with fingers clasped (abduction, external rotation)
• Lower the arms
• Place the backs of the hands into the small of the back (internal rotation)
• Directly palpate subacromial bursa, AC joint, bicipital tendon within the bicipital groove, entire shoulder capsule, anteriorly and posteriorly

Neck

• Check ROM with flexion, extension, rotation, lateral flexion
• TMP: direct palpation over temporal condyle with mouth wide open
• TTP: cartilaginous joints of the anterior torse and the sternoclavicular, sternomandibular, and costochondral junctions

Hips

• Lie down, supine
• Assess hips
• Faber’s test – flexion, abduction, external rotation
• Check for flexion contractures (these may be evident only after eliminating lumbar lordosis by fully flexing the unaffected hip
• Consider lateral decubitis position for hyperextension of hip
• TTP: greater trochanters

Knees

• Inspection: synovial distension directly over, above, either side of patella
• Palpation: include popliteal space for posterior cyst formation
• ROM: full flexion and extension (180)
• Stability in extension: attempt to move tibia laterally
• Stability in flexion: foot flat on table, rock tibia anterior and posterior with relation to femur
• Palpation: knee-joint margins, patella, prepatellar and anserine bursa

Lower limbs

• Inspection: ankle joint swelling
• Palpation: joint margin for synovial proliferation
• ROM: plantar flexion, subtalar joint’s lateral motion
• Achilles tendon, Achilles bursa, posterior margin of calcaneum, insertion of the plantar fascia beneath the calcaneum (periarthritis, spur formation)
• Twisting tarsal bones: grasp ankle joint in one hand and the forefoot in the other, gently twist (general concept of mid-foot or tarsal pain)
• Palpate MTP joints (tenderness, swelling, subluxation, deformities)

Back

• Stand for examination of the spine and posterior pelvis
• Inspect: curvatures (scoliosis, kyphosis), leg discrepancies (hands overiliac crests, look for differences)
• Palpate: spinous processes, soft tissue trigger spots (trapezius, subscapular, subgluteal, ischial bursae)
• Flexion, extension, rotation, lateral bend
• Full respiratory effort to assess costovertebral joint function