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Rheumatological History and Examination Can't possibly do every joint in the body.

Start with screening for PASS (pain, activities/limitations, stiffening and swelling). Alternatively, 3 general questions used for screening are: 1. Any pain or stiffness in your muscles, joints or back? 2. Can you dress yourself completely without any difficulty? 3. Can you walk up and down stairs without any difficulty? Assessing Gait Is there pain or a limp? "Antalgic gait" - where the pain or deformity causes the patient to "hurry off" on one leg and to spend most of the gait cycle on the other. Potential sites of problems include lower back, hip, knee, hindfoot, midfoot and forefoot. Trendelenburg Gait - pelvis drops down on the opposite side during stance phase on the affected side due to ineffective hip abduction (gluteus medius or superior gluteal nerve). Waddling gait - bilateral trendelenburg gait Common fibromyalgia signs - apply pressure to the midpoint of the supraspinatus (positive in FM) and roll the skinfold overlying it. Both or either of these should elicit pain in FM. Inspection of patient... From Behind - straight spine (no scoliosis or ribcage asymmetry) - normal muscle bulk/symmetry, especially around the shoulder and pelvic girdles and the lumbar spine - similar level of both iliac crests - popliteal swelling - hindfoor deformity. From the Side - loss of normal cercial and llumbar lordosis, alterations of normal mild thoracic kyphosis - knee deformity (fixed flexion, genu recurvatum, posterior tibial subluxation) Test lumbar spine and hip flexion from here. Place fingers on the spinous processes of the lumbar vertebrae and ask patient to touch

their toes. Fingers should spread out in normal flexion. From the Front - Selling abnormal position, skin change over the sternoclavicular and acromioclavicular joint sites - Equal shoulder height - muscle wasting/asymmetry, especially of the deltoids and quads Inability to fully extend elbows - deformityof the knee - deformity of the forefoot r midfoot - normal arches When standing, ask the patient to do the following 1. Laterally flex the neck side to side (sensitive to cervical spine abnormalities) 2. Open the jaw wide and move it from side to side 3. Place both hands behind the head with elbowsright back (external rotation and abduction are the earliest and most severely affected glenohumeral moevements) 4. Place both hands out in front, palms down, fingers straight with elbows at 90 to the sides 5. Turn the hands over to check for supination 6. Make a tight fist with each hand 7.