Joint diagnostics

First of all, when inquiring about the patient's possible complaints about pain in those or other joints, which may be permanent or, for example, volatile (ie, quickly disappear in one joint and appear in another), arise independently or when moving. Be sure to clarify whether the patient is experiencing morning stiffness in the joints, whether he marks the restriction of movements in those or other joints (stiffness) and the presence of a crunch when moving in the joints, etc.

Examination of joints is carried out at a different position of the patient (standing, sitting, lying, as well as walking), while observing a certain order. First assess the condition of the joints of the hand, then go on to the examination of the elbow and shoulder joints, temporomandibular joint, cervical, thoracic and lumbar spine, sacroiliac joints, sacrum and coccyx, hip and knee joints, foot joints. The results obtained in the study of each of the symmetrical joints are necessarily compared.

Examination and palpation of joints

When viewed, pay attention to the changes in the configuration of the joints (for example, their increase in volume, spindle shape), the smoothness of their contours, the change in the color of the skin over the joints (hyperemia, gloss).

When palpation of the joints, it is possible to better identify their swelling, which is due to both the presence of effusion in the joint cavity and inflammatory edema of the periarticular tissues. The accumulation of free fluid in the joint cavity is confirmed by the appearance in such cases of fluctuations - sensations during palpation of fluid fluctuation (swelling). Especially indicative in this respect is the symptom of ballotation of the patella. To identify him, the patient is laid horizontally with the maximum unbent lower limbs. The thumbs are on the patella, and the palms of both hands compress the lateral and medial areas of the knee joint. Further thumbs produce a patella push in the direction of the anterior surface of the joint end of the thigh. If there is free fluid in the cavity of the knee joint, the fingers feel a weak response thrust, caused by the impact of the patella on the surface of the thigh.

In the process of diagnosing joints, attention is also paid to the presence of soreness when they are felt. For this use a cautious, but at the same time, a deep enough palpation, covering one or the other joint with two fingers (large and index). In cases of presence in the joints of an active inflammatory process during palpation, a local increase in skin temperature over the area of the affected joints can also be detected . To this end, apply the back surface of the brush to the skin over the corresponding joints. The data obtained in this way is compared with the skin temperature over a symmetrical healthy joint. If the symmetrical joint is also involved in the pathological process, the results of the skin temperature determination are compared with the data obtained when examining the temperature of the skin over other unchanged joints. With the help of a centimeter tape measure, in addition, the circumference of symmetrical joints, for example, the shoulder, elbow, wrist, knee, ankle.

Of great importance in the diagnosis of various joint diseases is the determination of the volume of active and passive movements performed in various joints, the identification of stiffness, painful sensations during movement. The active movement is performed by the patient himself, and the passive (flexion, extension, retraction, reduction of the limb) is performed by the doctor with complete relaxation of the patient's muscles.

When performing a certain movement in the joints, a certain angle is formed, which, if necessary, can be measured. So, for example, the absolute mobility of the knee when bending should be about 150 °, the ankle - 45 °, the hip joint - 120 °, etc. More accurate data on the mobility of various joints can be obtained with the use of special instruments - goniometers, which are a graduated semicircle, to the base of which fixed and fixed branches are attached. When the movable jaw moves in synchronism with the movement of the limb, angles are formed of different magnitudes, marked on the scale of the goniometer.

With the development of ankylosis of the joints (fusion of the articular surfaces) during their movement, it is sometimes possible to identify a crunch or crepitus that becomes more distinct for perception in those cases when the doctor's palm rest on the corresponding joint. With auscultation of the joints, the friction noise of the intra-articular surfaces of the epiphyses can be heard.

In the absence of any pathological changes, this section is presented in the medical history rather succinctly. It is possible, for example, to describe this variant:

Diagnosis of joints

There are no complaints. When viewed, joints are normal. Skin over them with normal color. When palpation of the joints, their swelling and deformity, changes in the periarticular tissues, as well as painfulness is not noted. The volume of active and passive movements in the joints is fully preserved. Painful sensations, crunch and crepitation during movement are absent. Further (better in the form of a tablet), there is a circle of symmetrical joints in cm (shoulder, elbow, wrist, knee, ankle).

Having completed the general examination, they pass on to the direct study of the main systems of the body: respiration, circulation, digestion, etc. The features of the application of various methods of direct investigation of individual body systems will be consistently expounded in subsequent chapters.

[1], [2], [3], [4], [5]