Clinical examination

This section is important for both orthopaedics and rheumatology. However the emphasis placed on certain features is likely to be different, for each speciality.

An orthopaedic surgeon is likely to be interested in joints in isolation, particularly with the view to potential operability. A rheumatologist however more often deals with polyarticular disease and is more likely to consider all the joints together.

Initially inspection should reveal the pattern of joint involvement, any associated skin conditions, muscle wasting or deformity. Observation of the patient walking should also allow the assessment of any gait abnormalities. Examination then generally takes the form of look, feel and move for each particular joint.

Particular features to identify are:

• inflammation
• swelling
• points of tenderness
• range of movement
• instability