| Inflammatory arthritis (e.g., rheumatoid arthritis, seronegative spondyloarthropathies) |
| Observation and palpation: |
| Redness (may not be present if inflammation is mild) |
| Swelling due to synovial thickening (may be inflammatory effusion) |
| Heat |
| Tenderness |
| Functional: |
| Limitation of motion due to pain |
| Additional data if problem has been present for a long time (as in the nonspecific inflammatory arthritides such as rheumatoid arthritis): |
| Pain |
| Observation and palpation: Deformity due to subluxation may be present |
| Functional: |
| Motion may be limited due to: |
| Fibrous contractures of the periarticular soft tissues |
| Joint destruction |
| Joint may be unstable due to: |
| Destruction of cartilage and bone |
| Rupture of tendon(s) |
| Degenerative joint disease (osteoarthritis) |
| Observation and palpation: |
| Redness and increased warmth may be present if joint is secondarily inflamed due to trauma |
| No palpable synovial thickening |
| Effusion may be present |
| Bony enlargement at joint margins |
| Heberden's nodes on distal interphalangeal joints of fingers |
| Tenderness frequently over tendon insertions and bursae about joints |
| Functional: |
| Pain on motion |
| Palpable crepitus on passive motion |
| Instability frequently due to loss of cartilage and loosening of capsule |
| Traumatic arthritis |
| Observation and palpation: |
| May be ecchymosis |
| Soft tissue swelling (depending on severity of trauma may involve periarticular tissue or may be limited to effusion within joint capsule) |
| Tenderness to pressure |
| Functional: |
| Motion limited due to pain |
| Instability if trauma sufficient to tear tendon(s) or joint capsule |
| Primary muscle disease |
| Observation and palpation: |
| Swelling of muscles may be present |
| Tenderness to pressure over body of muscle may be present |
| Functional: Impairment of function due to muscle weakness; in the case of inflammatory muscle disease (polymyositis or dermatomyositis), weakness more pronounced proximally than distally |
From: Chapter 164, The Musculoskeletal Examination
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