Restless legs syndrome physical examination: Difference between revisions

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==Overview==
==Overview==
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
Physical examination of patients with restless leg syndrome is usually normal. Physical examination is performed to identify secondary causes and to rule out other disorders. A neurologic examination with emphasis on [[spinal cord]] and [[peripheral nerve]] function should performed in all patients with restless leg syndrome to diagnose the possible underlying neurological disease. A detailed [[vascular]] examination should performed in all patients with restless leg syndrome to diagnose the possible underlying [[vascular disease]]. A neurologic examination with emphasis on [[conjunctival]] [[pallor]] should performed in all patients with restless leg syndrome to diagnose the possible [[iron deficiency anemia]].
 
OR
 
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


==Physical Examination==
==Physical Examination==
* Physical examination of patients with restless leg syndrome is usually normal.<ref name="pmid27536462">{{cite journal| author=Koo BB, Bagai K, Walters AS| title=Restless Legs Syndrome: Current Concepts about Disease Pathophysiology. | journal=Tremor Other Hyperkinet Mov (N Y) | year= 2016 | volume= 6 | issue=  | pages= 401 | pmid=27536462 | doi=10.7916/D83J3D2G | pmc=4961894 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27536462  }} </ref>


The physical examination is usually normal in patients with RLS and is performed to identify secondary causes and to rule out other disorders. The following are areas of particular importance:
* Physical examination is performed to identify secondary causes and to rule out other disorders.
* A neurologic examination with emphasis on spinal cord and peripheral nerve function.
* The following are areas of particular importance:<ref name="pmid28065687">{{cite journal| author=Gottlieb DJ, Somers VK, Punjabi NM, Winkelman JW| title=Restless legs syndrome and cardiovascular disease: a research roadmap. | journal=Sleep Med | year= 2017 | volume= 31 | issue=  | pages= 10-17 | pmid=28065687 | doi=10.1016/j.sleep.2016.08.008 | pmc=5334194 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28065687  }} </ref><ref name="pmid23494945">{{cite journal| author=Allen RP, Auerbach S, Bahrain H, Auerbach M, Earley CJ| title=The prevalence and impact of restless legs syndrome on patients with iron deficiency anemia. | journal=Am J Hematol | year= 2013 | volume= 88 | issue= 4 | pages= 261-4 | pmid=23494945 | doi=10.1002/ajh.23397 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23494945  }} </ref>
* A vascular examination to rule out vascular disorders.
** A neurologic examination with emphasis on [[spinal cord]] and [[peripheral nerve]] function should performed in all patients with restless leg syndrome to diagnose the possible underlying neurological disease.
 
** A detailed [[vascular]] examination should performed in all patients with restless leg syndrome to diagnose the possible underlying [[vascular disease]].
* Physical examination of patients with [disease name] is usually normal.
** A neurologic examination with emphasis on [[conjunctival]] [[pallor]] should performed in all patients with restless leg syndrome to diagnose the possible [[iron deficiency anemia]].
OR
*Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
*The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


===Appearance of the Patient===
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].  
*Patients with restless leg syndrome usually appear normal.  


===Vital Signs===
===Vital Signs===


*High-grade / low-grade fever
*Patients with restless leg syndrome usually have normal vital signs.
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]


===Skin===
===Skin===
* Skin examination of patients with [disease name] is usually normal.
* Skin examination of patients with restless leg syndrome is usually normal.
OR
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* Bruises
 
<gallery widths="150px">
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>
 
===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
* HEENT examination of patients with restless leg syndrome is usually normal.
OR
* A neurologic examination with emphasis on [[conjunctival]] [[pallor]] should performed in all patients with restless leg syndrome to diagnose the possible [[iron deficiency anemia]].<ref name="pmid23494945" />
* Abnormalities of the head/hair may include ___
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]  
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
 
===Neck===
===Neck===
* Neck examination of patients with [disease name] is usually normal.
* Neck examination of patients with restless leg syndrome is usually normal.
OR
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]
 
===Lungs===
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
* Pulmonary examination of patients with restless leg syndrome is usually normal.
OR
* Asymmetric chest expansion / Decreased chest expansion
*Lungs are hypo/hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds / Distant breath sounds
*Expiratory/inspiratory wheezing with normal / delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]
 
===Heart===
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
* Cardiovascular examination of patients with restless leg syndrome is usually normal.
OR
* A detailed [[vascular]] examination should performed in all patients with restless leg syndrome to diagnose the possible underlying [[vascular disease]].<ref name="pmid28065687" />
*Chest tenderness upon palpation
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope
 
===Abdomen===
===Abdomen===
Abdominal examination of patients with [disease name] is usually normal.
* Abdominal examination of patients with restless leg syndrome is usually normal.
 
OR
*[[Abdominal distention]]
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test


===Back===
===Back===
* Back examination of patients with [disease name] is usually normal.
* Back examination of patients with restless leg syndrome is usually normal.
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump
 
===Genitourinary===
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
* Genitourinary examination of patients with restless leg syndrome is usually normal.
OR
===Neuromuscular===
*A pelvic/adnexal mass may be palpated
* Neuromuscular examination of patients with restless leg syndrome is usually normal.
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
* A neurologic examination with emphasis on [[spinal cord]] and [[peripheral nerve]] function should performed in all patients with restless leg syndrome to diagnose the possible underlying neurological disease.
* Neuromuscular examination of patients with [disease name] is usually normal.
OR
*Patient is usually oriented to persons, place, and time
* Altered mental status
* Glasgow coma scale is ___ / 15
* Clonus may be present
* Hyperreflexia / hyporeflexia / areflexia
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)


===Extremities===
===Extremities===
* Extremities examination of patients with [disease name] is usually normal.
* Extremities examination of patients with restless leg syndrome is usually normal.
OR
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity
 
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 19:15, 13 April 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

Physical examination of patients with restless leg syndrome is usually normal. Physical examination is performed to identify secondary causes and to rule out other disorders. A neurologic examination with emphasis on spinal cord and peripheral nerve function should performed in all patients with restless leg syndrome to diagnose the possible underlying neurological disease. A detailed vascular examination should performed in all patients with restless leg syndrome to diagnose the possible underlying vascular disease. A neurologic examination with emphasis on conjunctival pallor should performed in all patients with restless leg syndrome to diagnose the possible iron deficiency anemia.

Physical Examination

  • Physical examination of patients with restless leg syndrome is usually normal.[1]
  • Physical examination is performed to identify secondary causes and to rule out other disorders.
  • The following are areas of particular importance:[2][3]
    • A neurologic examination with emphasis on spinal cord and peripheral nerve function should performed in all patients with restless leg syndrome to diagnose the possible underlying neurological disease.
    • A detailed vascular examination should performed in all patients with restless leg syndrome to diagnose the possible underlying vascular disease.
    • A neurologic examination with emphasis on conjunctival pallor should performed in all patients with restless leg syndrome to diagnose the possible iron deficiency anemia.

Appearance of the Patient

  • Patients with restless leg syndrome usually appear normal.

Vital Signs

  • Patients with restless leg syndrome usually have normal vital signs.

Skin

  • Skin examination of patients with restless leg syndrome is usually normal.

HEENT

  • HEENT examination of patients with restless leg syndrome is usually normal.
  • A neurologic examination with emphasis on conjunctival pallor should performed in all patients with restless leg syndrome to diagnose the possible iron deficiency anemia.[3]

Neck

  • Neck examination of patients with restless leg syndrome is usually normal.

Lungs

  • Pulmonary examination of patients with restless leg syndrome is usually normal.

Heart

  • Cardiovascular examination of patients with restless leg syndrome is usually normal.
  • A detailed vascular examination should performed in all patients with restless leg syndrome to diagnose the possible underlying vascular disease.[2]

Abdomen

  • Abdominal examination of patients with restless leg syndrome is usually normal.

Back

  • Back examination of patients with restless leg syndrome is usually normal.

Genitourinary

  • Genitourinary examination of patients with restless leg syndrome is usually normal.

Neuromuscular

  • Neuromuscular examination of patients with restless leg syndrome is usually normal.
  • A neurologic examination with emphasis on spinal cord and peripheral nerve function should performed in all patients with restless leg syndrome to diagnose the possible underlying neurological disease.

Extremities

  • Extremities examination of patients with restless leg syndrome is usually normal.

References

  1. ↑ Koo BB, Bagai K, Walters AS (2016). "Restless Legs Syndrome: Current Concepts about Disease Pathophysiology". Tremor Other Hyperkinet Mov (N Y). 6: 401. doi:10.7916/D83J3D2G. PMC 4961894. PMID 27536462.
  2. ↑ 2.0 2.1 Gottlieb DJ, Somers VK, Punjabi NM, Winkelman JW (2017). "Restless legs syndrome and cardiovascular disease: a research roadmap". Sleep Med. 31: 10–17. doi:10.1016/j.sleep.2016.08.008. PMC 5334194. PMID 28065687.
  3. ↑ 3.0 3.1 Allen RP, Auerbach S, Bahrain H, Auerbach M, Earley CJ (2013). "The prevalence and impact of restless legs syndrome on patients with iron deficiency anemia". Am J Hematol. 88 (4): 261–4. doi:10.1002/ajh.23397. PMID 23494945.

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