Polymyalgia rheumatica physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
Physical examination of patients with polymyalgia rheumatica reveals limitation of the active and passive range of motion of the affected joint. | Physical examination of patients with polymyalgia rheumatica reveals limitation of the active and passive [[range of motion]] of the affected [[joint]]. There is no true [[muscle weakness]]. There are no changes in the [[Joint|joints]]. [[Ophthalmoscope|Ophthalmoscopic]] exams in patients with polymyalgia rheumatica associated with [[Temporal arteritis|giant cell arteritis]] might be abnormal. | ||
==Physical Examination== | ==Physical Examination== | ||
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=== HEENT === | === HEENT === | ||
* The following findings are associated with cases of polymyalgia rheumatica associated with giant cell arteritis:<ref name="pmid11177002">{{cite journal| author=Casson RJ, Fleming FK, Shaikh A, James B| title=Bilateral ocular ischemic syndrome secondary to giant cell arteritis. | journal=Arch Ophthalmol | year= 2001 | volume= 119 | issue= 2 | pages= 306-7 | pmid=11177002 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11177002 }}</ref><ref name="pmid12972779">{{cite journal| author=Al-Abdulla NA, Kelley JS, Green WR, Miller NR| title=Herpes zoster vasculitis presenting as giant cell arteritis with choroidal infarction. | journal=Retina | year= 2003 | volume= 23 | issue= 4 | pages= 567-9 | pmid=12972779 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12972779 }}</ref> | * The following findings are associated with cases of polymyalgia rheumatica associated with [[Temporal arteritis|giant cell arteritis]]:<ref name="pmid11177002">{{cite journal| author=Casson RJ, Fleming FK, Shaikh A, James B| title=Bilateral ocular ischemic syndrome secondary to giant cell arteritis. | journal=Arch Ophthalmol | year= 2001 | volume= 119 | issue= 2 | pages= 306-7 | pmid=11177002 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11177002 }}</ref><ref name="pmid12972779">{{cite journal| author=Al-Abdulla NA, Kelley JS, Green WR, Miller NR| title=Herpes zoster vasculitis presenting as giant cell arteritis with choroidal infarction. | journal=Retina | year= 2003 | volume= 23 | issue= 4 | pages= 567-9 | pmid=12972779 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12972779 }}</ref> | ||
** [[Ophthalmoscope|Ophthalmoscopic]] exam may be abnormal with findings of sludging of [[blood]] in [[retinal]] [[Arteriole|arterioles]], [[optic disc]] may show chalky white [[pallor]] and [[edema]], with or without [[Splinter hemorrhage|splinter hemorrhages]], [[Posterior ischemic optic neuropathy|posterior ischemic (retrobulbar) optic]] neuropathy, [[central retinal artery]] [[occlusion]], branch of [[Central retinal artery|retinal artery]] [[occlusion]], and [[Choroid|choroidal]] [[ischemia]]. | ** [[Ophthalmoscope|Ophthalmoscopic]] exam may be abnormal with findings of sludging of [[blood]] in [[retinal]] [[Arteriole|arterioles]], [[optic disc]] may show chalky white [[pallor]] and [[edema]], with or without [[Splinter hemorrhage|splinter hemorrhages]], [[Posterior ischemic optic neuropathy|posterior ischemic (retrobulbar) optic]] neuropathy, [[central retinal artery]] [[occlusion]], branch of [[Central retinal artery|retinal artery]] [[occlusion]], and [[Choroid|choroidal]] [[ischemia]]. | ||
** [[Tenderness]] upon [[palpation]] of the [[temporal]] region including [[erythema]], nodularity, and thickening on affected side | ** [[Tenderness]] upon [[palpation]] of the [[temporal]] region including [[erythema]], nodularity, and thickening on the affected side | ||
** [[Facial]] [[tenderness]] | ** [[Facial]] [[tenderness]] | ||
** Neuro-[[Ophthalmic artery|ophthalmic]] manifestations of temporal arteritis include the following:<ref name="pmid18606086">{{cite journal| author=Borg FA, Salter VL, Dasgupta B| title=Neuro-ophthalmic complications in giant cell arteritis. | journal=Curr Allergy Asthma Rep | year= 2008 | volume= 8 | issue= 4 | pages= 323-30 | pmid=18606086 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18606086 }}</ref> | ** Neuro-[[Ophthalmic artery|ophthalmic]] manifestations of [[temporal arteritis]] include the following:<ref name="pmid18606086">{{cite journal| author=Borg FA, Salter VL, Dasgupta B| title=Neuro-ophthalmic complications in giant cell arteritis. | journal=Curr Allergy Asthma Rep | year= 2008 | volume= 8 | issue= 4 | pages= 323-30 | pmid=18606086 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18606086 }}</ref> | ||
*** [[Diplopia]] | *** [[Diplopia]] | ||
*** [[Ptosis]] | *** [[Ptosis]] | ||
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=== Musculoskeletal === | === Musculoskeletal === | ||
* Proximal joints | * Proximal joints [[tenderness]] typically in the [[shoulder]] and [[Hip|hip joints]] with active movement<ref name="pmid18640460">{{cite journal| author=Salvarani C, Cantini F, Hunder GG| title=Polymyalgia rheumatica and giant-cell arteritis. | journal=Lancet | year= 2008 | volume= 372 | issue= 9634 | pages= 234-45 | pmid=18640460 | doi=10.1016/S0140-6736(08)61077-6 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18640460 }} </ref> | ||
* Decrease of the active range of motion in the proximal joints | * Decrease of the active [[range of motion]] in the proximal [[Joint|joints]] | ||
* Normal muscle strength | * Normal [[muscle]] strength | ||
* No muscle atrophy | * No [[muscle atrophy]] | ||
* Transient synovitis of the knee, wrist, and sternoclavicular joints | * Transient [[synovitis]] of the [[knee]], [[wrist]], and [[Sternoclavicular joint|sternoclavicular joints]] | ||
* Arthritis in some cases | * [[Arthritis]] in some cases | ||
==References== | ==References== | ||
Revision as of 18:50, 8 May 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]
Overview
Physical examination of patients with polymyalgia rheumatica reveals limitation of the active and passive range of motion of the affected joint. There is no true muscle weakness. There are no changes in the joints. Ophthalmoscopic exams in patients with polymyalgia rheumatica associated with giant cell arteritis might be abnormal.
Physical Examination
Appearance of the patients
- Patients with polymyalgia rheumatica usually appear in pain.
Vital signs
- Hypothermia
HEENT
- The following findings are associated with cases of polymyalgia rheumatica associated with giant cell arteritis:[1][2]
- Ophthalmoscopic exam may be abnormal with findings of sludging of blood in retinal arterioles, optic disc may show chalky white pallor and edema, with or without splinter hemorrhages, posterior ischemic (retrobulbar) optic neuropathy, central retinal artery occlusion, branch of retinal artery occlusion, and choroidal ischemia.
- Tenderness upon palpation of the temporal region including erythema, nodularity, and thickening on the affected side
- Facial tenderness
- Neuro-ophthalmic manifestations of temporal arteritis include the following:[3]
- Diplopia
- Ptosis
- Nystagmus
- Internuclear ophthalmoplegia (INO)
- Pupillary abnormalities
Lungs
- Pulmonary examination of patients with polymylagia rheumatica is usually normal.
Heart
- Cardiovascular examination of patients with polymylagia rheumatica is usually normal.
Musculoskeletal
- Proximal joints tenderness typically in the shoulder and hip joints with active movement[4]
- Decrease of the active range of motion in the proximal joints
- Normal muscle strength
- No muscle atrophy
- Transient synovitis of the knee, wrist, and sternoclavicular joints
- Arthritis in some cases
References
- ↑ Casson RJ, Fleming FK, Shaikh A, James B (2001). "Bilateral ocular ischemic syndrome secondary to giant cell arteritis". Arch Ophthalmol. 119 (2): 306–7. PMID 11177002.
- ↑ Al-Abdulla NA, Kelley JS, Green WR, Miller NR (2003). "Herpes zoster vasculitis presenting as giant cell arteritis with choroidal infarction". Retina. 23 (4): 567–9. PMID 12972779.
- ↑ Borg FA, Salter VL, Dasgupta B (2008). "Neuro-ophthalmic complications in giant cell arteritis". Curr Allergy Asthma Rep. 8 (4): 323–30. PMID 18606086.
- ↑ Salvarani C, Cantini F, Hunder GG (2008). "Polymyalgia rheumatica and giant-cell arteritis". Lancet. 372 (9634): 234–45. doi:10.1016/S0140-6736(08)61077-6. PMID 18640460.