SCHOOL of HEALTH PROFESSIONS
Department of Physical Therapy
PT 7890 - Case Mgmt I - Acute & Chronic Medical / Surgical Conditions
Physical Therapy Examination in Arthritis—Selected Procedures
I.
II.
Shoulder Girdle and Elbow
A.
Functional Ability: Shoulder and elbow orthopedic “quick tests”
1.
arms straight up in front
2.
arms straight out to side (“angels in the snow”)
3.
hand to back or head
4.
hand behind back
5.
hand to opposite shoulder (A-C Joints)
B.
Observation and Palpation
1.
S-C (also sternomanubrial jt.)
2.
Shoulder
3.
Elbow and forearm (site for rheumatoid nodules)
C.
Strength
Wrist and Hand
A.
Functional Ability
1.
buttoning and unbuttoning
2.
OT or CHT have tools for thorough exam
B.
Observation and Palpation (the hand often is key to preliminary
medical diagnosis: skin, fingernails, deformity)
1.
Distal radioulnar (piano key deformity)
2.
Wrist (synovitis, subluxation, rheumatoid nodules, Tinel test)
3.
MCP (synovitis, subluxation and ulnar drift)
4.
PIP
(synovitis vs. Bouchard’s nodes)
5.
DIP
(synovitis vs. Heberden’s nodes)
C.
Special Tests
1.
Finkelstein’s
2.
Bunnell-Littler (PIP intrinsic mm. vs. capsular tightness)
3.
Retinacular
(DIP retinacular ligs. vs. capsular tightness)
D.
Strength
1.
Grip: sphygmomanometer inflated to 30 mm Hg
2.
Standard dynamometer
-1-
III.
3.
Pinch dynamometer
Head
A.
TMJ
1.
should admit minimum of two vertically held fingers
2.
micrognatha (JRA)
B.
Temporal artery dilation, head pain, and polymyalgia rheumatica
C.
Laryngeal arthritis
III.
Spine and Ribs (Thorax)
A.
Cervical spine
1.
Risky in possible RA: Active movements only
2.
“Clunk” with forward flexion – atlanto-axial instability
B.
Chest expansion
IV.
Hip and Knee
A.
Functional ability: rise from chair without arms, squat
B.
Observation and palpation (knee):
1.
alignment
2.
atrophy accentuated by effusion
3.
palpation of suprapatellar synovial pouch
4.
knee joint effusion – bulge sign and Ballottement
5.
Baker’s cyst
C.
Joint stability (medial-lateral stress in full knee extension)
D.
Special tests for screening
1.
Thomas test
2.
Patrick test (fabere)
E.
Elements of usual orthopedic examination as indicated
V.
Ankle and Foot
A.
Functional ability: tiptoes, heels, squat
B.
Observation: similarities to the hand
1.
skin (rheumatoid vasculitis similar to arterial insufficiency)
2.
deformities:
subtalar joint collapse
hallux valgus
cock-up or overlapping toes
C.
Palpation
1.
ankle joint effusion
2.
tarsal joints
3.
MTP joints
4.
PIP and DIP joints
Swelling
(S)
S0
No swelling
Tenderness
(T)
T0
No
Tenderness
Limitation
of Motion
(L)
L0
Normal joint
motion
S1
Joint swelling which may not be
apparent on casual inspection,
but should be recognizable to an
experienced examiner
T1
Slight or mild tolerable
discomfort on palpation
S2
Joint swelling
obvious even on
casual observation
S3
Markedly abnormal
swelling
S4
Joint swelling to a
maximally abnormal
degree
T2
More severe pain on
ordinary palpation,
which the patient
prefers not to tolerate
T3
More intolerable pain
even with light
palpation or pressure.
L1
About 25% loss of motion
L2
About 50% loss of
motion
L3
About 75% loss of
motion
T4
Pain which may be caused
by even a mild stimulus
such as a sheet touching
the joint; often
characteristic of acute
gout.
L4
100% loss of motion or
complete ankyloses of the
joint
-2-