Physical examination

A key part of the assessment during your first visit to your doctor will be the physical examination. In addition to checking general health parameters, including blood pressure, pulse rate, heart and lung function, your doctor will evaluate your joints in great detail.

Your doctor will examine how your joints function and ask whether they are painful when used (for example, whether your knees hurt when walking, bending, and stretching). Your doctor will also assess your joints for swelling and warmth that may indicate inflammation. He or she will take note of the number of swollen and tender joints and the degree of swelling and tenderness involved and examine you for evidence of signs of disease outside of the joints (extra-articular manifestations).1

Not only will the results of your physical exam help your doctor diagnose your condition, they will serve as a baseline (a starting point, so to speak) for determining the severity of your condition, as well as your response to treatment.

 

Physical examination: joint assessment

Assessment
Description
Function
  • Evaluate active motion: active use of a joint, such as bending a finger of raising an arm
  • Evaluate passive motion: your physician will articulate a joint for you and may measure the range of motion using a device such as a goniometer
Swelling
  • Evaluate joint swelling resulting from thickening of synovial membrane and accumulation of synovial fluid
  • Your doctor will be able to detect minor swelling by applying pressure to a joint with fingers or, with larger joints, using a tape measure
Pain
  • Evaluate joint for pain by applying pressure and noting pain during movement

 

What will my doctor be looking for during the physical exam?

While symmetrical swelling of the joints (the same joints on both sides of the body) is a typical finding in RA patients who have had the disease for a long time, early in the disease only a few joints may be affected and there may not be symmetrical involvement at this stage. Your doctor will feel your joints (the technical term is palpate) to determine if there is any swelling from inflammation or bony enlargement that may be a sign of osteoarthritis.

In RA, joint swelling is typically spongy or doughy as opposed to firm and knobby (as in osteoarthritis). If your joint symptoms have only been present for short period of time, for instance, less than 6 weeks, you may have another type of arthritis caused by a viral infection rather than RA. However, the longer your joint symptoms have persisted, the greater the likelihood is that you have RA. Therefore, if you have very early disease, your doctor may need to assess you over the course of several visits to determine your diagnosis.1
 

Hands

Early signs of RA can be typically found in the hands, with swelling that occurs symmetrically (both sides of the body), in the metacarpophalangeal (MCP) joints and proximal interphalangeal (PIP) joints. These joints will be painful and tender to the touch and the range of motion will be restricted. Later in the course of RA, unless effective treatment is used, structural deformities of the hands may occur. Your doctor will also test your grip. Reduced grip strength can be a sign of RA, even in the early stages.1
 

Upper limbs

All of the joints of the upper limbs, including the wrist, elbow, and shoulder, may be affected by RA. The wrist is perhaps the most commonly involved in RA, with loss of extension evident in the early stages of the disease. The elbow is a common location for RA nodules. Shoulder involvement tends to occur later in the course of RA.1
 

Lower limbs

Involvement in the joints of the feet (with a similar pattern to those of the hands) is common early in the course of RA. Your doctor will check your feet for tenderness in the metatarsophalangeal (MTP) joints, that sometimes causes patients with RA to hyperextend their toes or distribute weight to their heels. Other signs of RA in the feet include heel pain and pain in the toes. As RA progresses, it can be associated with changes to the front of the foot, including development of bunions and claw toes.

Diffuse swelling of the ankle may also be a sign of RA. Your doctor will look for signs of knee involvement, including a thickening or swelling of the joint, with restriction of movement. Involvement of the hips tends to occur later in the course of RA, and may be associated with pain in the thigh, lower back, or groin, and restriction of movement that affects gait.1
 

Cervical spine

The joints of the cervical spine may be affected by RA, causing stiffness and pain in the neck.1

Written by: Jonathan Simmons | Last reviewed: September 2013.
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