Polymyalgia Rheumatica: Examination

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

  • General physical examination – including blood pressure (bilateral blood pressure measurement), pulse, body temperature, body weight, body height; furthermore:
    • Inspection (viewing).
      • Skin, mucous membranes and sclerae (white part of the eye).
      • Gait (fluid, limping).
      • Body or joint posture (upright, bent, gentle posture).
      • Joints [shoulder and hip joint] (abrasions/sores, swelling (tumor), redness (rubor), hyperthermia (calor); injury indications such as hematoma formation, arthritic joint lumpiness, leg axis assessment).
    • Palpation (palpation) of vertebral bodies, tendons, ligaments; musculature (tone, tenderness, contractures of paraverebral muscles); soft tissue swelling; tenderness (localization! ; restricted mobility (spinal movement restrictions); “tapping signs” (testing painfulness of spinous processes, transverse processes, and costotransverse joints (vertebral-rib joints) and back muscles); illiosacral joints (sacroiliac joint) (pressure and tapping pain?; compression pain, anterior, lateral or saggital; hyper- or hypomobility?
    • Palpation (palpation) of temporal artery (temporal artery).
    • Auscultation (listening) of the arteries including subclavian artery and axillary artery.
  • Ophthalmologic examination [due tosymptoms in giant cell arteritis (70% of cases):
    • Eye pain
    • Amaurosis fugax (transient blindness; regression of blindness within minutes).
  • Orthopedic examination [due tosymptoms of polymyalgia rheumatica:
    • Stiffness of the muscles, especially long-lasting morning stiffness (> 45 min).
    • Weakness of the musculature
    • Bilateral (bilateral) bursitis (bursitis) subdeltoid (between the joint capsule of the shoulder joint and the deltoid muscle)/subacromialis (under the coracoid process (acromion) of the scapula)]
  • Neurological examination [due tosymptoms of giant cell arteritis:
    • Polyneuropathy (generic term for diseases of the peripheral nervous system associated with chronic disorders of peripheral nerves or parts of nerves) – occurs in circa one quarter of affected individuals]
  • Cancer prevention
  • Health check

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

Caution. Polymyalgia rheumatica is associated with giant cell arteritis in more than 50% of cases.