Heberden’s Arthritis: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

• General physical examination – including blood pressure, pulse, body weight, height; furthermore:
  • Inspection (viewing) [Please note: Heberden’s arthritis usually occurs symmetrically].
    • Skin (Normal: intact; [Heberden’s nodes (partially reddened nodes at joints); abrasions/sores, redness, hematomas (bruises), scars]) and mucous membranes.
    • Joint (abrasions/sores, swelling (tumor), redness (rubor), hyperthermia (calor)); injury indications such as hematoma formation, arthritic joint lumpiness; [Infestation:
      • If the distal interphalangeal joints (DIP), often: index finger and little finger are affected, it is called Heberden’s arthrosis;
      • If the finger middle joints (proximal interphalangeal joints, PIP) are also affected, it is called Bouchard’s arthrosis, also known as Heberden-Bouchard arthrosis;
      • If the thumb saddle joint is affected, it is called rhizarthrosis].
  • Palpation (palpation) of prominent bone points, tendons, ligaments; musculature; [joint (joint effusion); soft tissue swelling; tenderness (localization!)]
  • Attention to the following differential diagnoses when affected by:
    • Finger joints: rheumatoid arthritis (chronic polyarthritis).
    • Psoriatic arthritis (PsA)
    • Medium and large joints:
      • Activated osteoarthritis due to gout
      • Post-traumatic inflammation
      • Reactive arthritis (synonym: post-infectious arthritis / joint inflammation) – second disease after gastrointestinal (gastrointestinal tract concerning), urogenital (urinary and genital organs concerning) or pulmonary (lungs concerning) infections; refers to an arthritis, where pathogens in the joint (usually) can not be found (sterile synovialitis).
      • Rare arthropathies; possibly also periarticular soft tissue affections.
• Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.