Physical Examination - Diagnosing Arthritis: Arthritis

Content provided by the Faculty of the Harvard Medical School

Physical examination

Because many other disorders can masquerade as arthritis, a complete physical examination is a necessary part of the diagnostic process. During your visit, the doctor watches how you move and looks at joints for abnormalities. The doctor moves your joints through their range of motion to detect any pain, resistance, unusual sounds, or instability. The doctor also gains information from a visual assessment of how you use your joints, and so may ask you to take a few steps, move your hands and arms, and so forth.

Swelling. An inflamed synovial membrane often produces mild joint swelling. People may describe a sensation of tightness or fullness inside the joint, or it may feel tender. Doctors describe the joint as feeling "boggy" or soft to the touch. Marked swelling usually indicates excessive joint fluid, a sign of inflammation or perhaps bleeding into the joint.

Enlargement. Enlargement of a joint is not the same as swelling. Bony enlargement without joint swelling feels hard to the touch and is not usually tender. This finding is typical of osteoarthritis, although it may also occur in people who have no joint pain and as a consequence of other joint disease, such as rheumatoid arthritis.

Limited motion. Doctors assess joint mobility in two ways: active range of motion in which the person voluntarily moves the joints, and passive range of motion in which the examiner moves the person's joints. By comparing active and passive movement, doctors can often determine whether the cause is muscle weakness, bursitis, or tendonitis (in which case the joint has wider range of motion during passive movement), or whether the problem is with the joint itself. Doctors listen and feel for crepitus, a crunching or grating sensation that is sometimes audible and is caused by rough surfaces rubbing together inside the joint.

Spine flexibility. To evaluate spine flexibility, the doctor may ask you to stand and, without moving your pelvis, bend forward as if touching your toes, bend backward, lean from one side to the other, and twist your upper body from side to side.

Last updated:	September 05, 2008