Physical examination

In addition to the above-mentioned symptoms such as morning stiffness, joint pain, rapid fatigue, the physician finds characteristic clinical changes or deformities (rheumatism – caused deviation of the joints) during the physical examination in chronic polyarthritis (cP). The examination usually includes the examination of the:

HandHands
FeetFeet
Knee
Hip
Shoulder
Elbows
Spine
Laboratory values
X-ray
Further diagnostic investigations

Rheumatoid arthritis in different localizations

There is painful swelling of the joints of the hand, the base of the finger and the middle finger joints, usually symmetrically on both sides of the body. The joints are sensitive to pressure, e.g. when shaking hands. Movement of the hand and finger joints may be restricted so that the fist closure is no longer complete.

The musculature of the ball of the thumb and little finger as well as the muscles of the palm may be diminished and powerless. Tendon swellings or tendon tears occur. In advanced stages of the disease, typical deformities of the hands occur:

Hand scoliosis: Deviation of the wrist root outwards (ulnar = ulnar),
Caput ulnae – syndrome: protrusion and hypermobility of the ulnar head on the wrist
Buttonhole deformity: fixed flexion position in the middle finger joint and hyperextension of the end finger joint
Gooseneck deformity: hyperextension in the middle finger joint and fixed flexion position in the end finger joint
90°90°-deformation of the thumb: fixed flexion position in the metacarpophalangeal joint of the thumb and hyperextension of the thumb’s end joint

There is painful swelling of the foot and toe joints, usually symmetrical on both sides of the body.

The joints are sensitive to pressure. Tendon swelling occurs on the extensor side and behind the inner or outer ankle. In advanced stages of the disease, typical deformities occur in the area of the feet:

Hallux valgus: deviation of the big toe outwards
Hallux rigidus: Arthrosis of the metatarsophalangeal joint of the big toe with painful mobility and possible hyperextension of the end joint of the big toe
Hammer toes: fixed flexion of the toe end joints
Splayfoot
Windmill forefoot: Deviation of all toes to the outside, due to rheumatic attack of tendons and ligaments of the foot
Flat and twisted foot: also due to softening of the connective tissue caused by rheumatism

Usually there is a soft tissue swelling and an articular effusion with a dancing patella (the effusion in the knee joint lifts the kneecap (patella), resulting in an elastic resistance when pressure is applied to the kneecap), sometimes there is also a Baker’s cyst in the hollow of the knee.

The mobility during flexion and extension is limited. Muscular diminution of the thigh muscle. Increasing instability can lead to the O – leg or X – leg.

The consequences are usually gonarthrosis (arthrosis of the knee joint). This often requires the implantation of an artificial knee joint. A swelling is usually not visible or palpable.

Pressure pain is located in the groin or above the outside of the thigh and the large rolling mound (greater trochanter). The mobility of the joint may be limited. If this restriction occurs mainly in the morning, it is called morning stiffness.

The consequences of long-standing rheumatism are usually arthrosis of the hip joint (coxarthrosis). Frequently, the hip socket moves into the pelvis (Protrusio actetabuli). In severe cases an artificial hip joint must be implanted.

There is a pressure-painful swelling, most likely to be palpated from the front, since a relatively strong muscle mantle covers the shoulder joint at the back. The mobility of the joint is limited. The tendons surrounding the shoulder joint are usually pressure-painful, as is the acromioclavicular joint.

Also in the area of the elbow, there is a pressure-painful swelling and a movement restriction of the joint, usually an extension deficit. Pressure pain occurs in the area of the spinous processes and in the musculature adjacent to the spinous processes. Movement restriction of the head and trunk. Depending on the position of the head, discomfort in the arms, legs or trunk may occur. Sensory disturbances and muscle weakness of the arms and legs occur, as well as dizziness, nausea or even swallowing or breathing disorders.