Rheumatoid Arthritis

1. Inspection

Deformities
*Symmetrical deforming arthropathy
*Involving MCP/PIP joints
*Sparing DIP joints
*Swan neck
*Boutonniere’s deformity
*Z deformity of the thumb
*Ulnar deviation

*Wasting of small muscles of hands

*Palmar Erythema

*Vasculitic nail changes

2. Palpation

*Warmth, redness, tenderness (active ??)
*Bony swellings (suggest subluxation)
*Synovial swellings

3. Percussion

*Carpal tunnel syndrome (Tinel sign)

4. Movement

*Grip
*Claw
*Flex/extend wrist

*Check ulnar/median nerve (abduct thumb, abduct fingers)


5. Functions

*Unbutton shirt
*Key holding
*Write

6. Check for Rh nodules

7. End examination

*Eyes – scleromalacia, scleritis, Sjogren’s, keratoconjunctivitis sicca
*Lungs – pulm. Fibrosis, nodules
*Hepatosplenomegaly – amyloidosis, Felty
*Leg – Pyoderma gangrenosum
*Cervical – atlantoaxial dislocation

My diagnosis is Rheumatoid arthritis with limited hand function and the disease is currently not active