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Muscle-wasting

Swelling

Detailed regional examination involves ‘look’ (at rest and during movement), ‘feel’ and ^;move'

Global wasting from

glenohumeral

arthritis

▼

Guarded. held in loose-pack position for capsule (adduction. internal rotation for shoulder) -characteristic of joint problem

Periarticular: £    Joint: e.g. A

e.g. olecranon    synovitis of

bursitis index and middle proximal interphalangeal joints

Erythema: e.g. sepbc arthritis ot the ankle Sears Psoriasis Vasculitic rash

Skin changes

A.    Inspection at rest

(See figurę above for examptes)

•    Skin changes

•    Swelling

•    Wasting of muscle

•    Attitude

•    Deformity

B.    Inspection during movement

•    Restriction

Limited to one plane-penarticular les»on Affecting most or all movements-joint problem

•    Increased rangę

Hypermobility, instability

•    Pain on usage

Stress pain = inereasing pain towards

extremes of movement

Universal stress pain (in most/all directions)

-synovitis

Selective stress pain (one piane only) -periarticular lesion

▼

w A Joint: e.g. A Bonę: e.g.

genu valgus Pagets disease of tibia

C. Palpation with movement

•    Tenderness

Joint line-intra-articular/}oint problem Periarticular-periarticular lesion

•    Increased warmth

Inflammation (e.g. syrvovitis. bursitis)

•    Swelling

Fluid (fluctuant)

Soft tissue (soft. non-fluctuant)

Bonę (hard)

•    Crepitus

Coarse, easily felt, may be readily audible-toint damage Fine, k>calised, heard with stethoscope-tendon sheatn, bursa

•    Stability

•    Resisted active movements

Reproduce pain from muscle, tendon, enthesis

•    Stress tests

Reproduce pain from ligament or tendon sheath

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