Physical exam and history for osteoarthritis

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Exam Overview

A doctor often discovers important information about the possible causes of symptoms through a discussion about your medical history. During this discussion, the doctor may ask questions such as the following:

• How long have you had symptoms? (Osteoarthritis usually develops slowly.)
• Are your joints stiff in the morning? If so, for how long?
• Have you tried any medicines that have helped the pain? If yes, how much do they help?
• Do exercises help your pain or make it worse? Which kinds of exercises have you tried? Have you tried bicycling or swimming for your hips or knees?
• Has there been a pattern to your symptoms? (Osteoarthritis symptoms typically begin on one side of the body and often affect just one set of joints.)
• Do you have a family history of arthritis?
• Do you have any general symptoms that seem to affect your whole body, such as fatigue, weight loss, or fever? (Osteoarthritis usually doesn't cause whole-body symptoms.)
• Has there been any recent or past injury to the affected joints, especially a major joint injury or injuries related to repetitive motion? (A recent injury may mean painful symptoms are related to the injury, not an underlying disease.)

During the physical exam, the doctor will look at, feel, and move each joint, evaluating it:

• For swelling, warmth, or tenderness.
• For range of motion.
• To determine the pattern of affected joints (such as one knee, both knees, knuckles, wrists, or shoulders). Often, the pattern of joints affected can help a doctor tell the difference between osteoarthritis and other types of arthritis such as rheumatoid arthritis.
• To note any bony knobs (osteophytic changes) on joints (especially the fingers).

The doctor will also look for any signs of unequal leg lengths, muscle weakness, or muscle wasting.

During a physical exam, the doctor also will do an evaluation of the lungs, heart, liver, and kidneys.

Why It Is Done

A medical history and physical exam are a normal and important part of the evaluation of joint pain and stiffness.

Results

The key to diagnosing osteoarthritis is determining the pattern of joints that are affected . For example, if you have symptoms in the set of knuckle joints between the wrists and finger joints (metacarpal-phalangeal joints), the balls of the feet (metatarsal-phalangeal joints), wrists, ankles, or elbows, you probably have a different, inflammatory form of arthritis such as rheumatoid arthritis.

Normal

A normal joint is not painful, tender, or swollen, has a full range of motion, and appears structurally normal.

Abnormal

In an abnormal joint, an exam may detect pain or swelling along with a bony hardness. Other abnormal findings that suggest osteoarthritis include:

• Bony bumps on the finger joint closest to the fingernail (Heberden's nodes ), bony bumps on the middle joint of the finger (Bouchard's nodes ), or bony bumps at the base of the thumb.
• Tenderness and/or swelling in weight-bearing joints such as the hips and knees.
• Pain, limited movement, and/or a creaking noise or feeling (crepitus) that occurs when the joints are moved.
• Joints that have been affected by injury or infection. These joints may also show signs of bone or tissue damage.

What To Think About

Distinguishing between osteoarthritis and other types of arthritis may be difficult based on individual joint symptoms but a pattern of symptoms may indicate the type of arthritis.

Characteristics of rheumatoid arthritis and osteoarthritis

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Credits

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Last updated:	April 20, 2007
Author:	Robin Parks, MS
Reviewed By:	E. Gregory Thompson, MD - Internal Medicine, Stanford M. Shoor, MD - Rheumatology
Editors:	Kathleen M. Ariss, MS, Pat Truman