The Importance of A Complete Exam

Many arthritis patients present to the office complaining of joint, muscle, tendon, ligament or bone pain. Joint pain and inflammation can lead to disability, immobility, and decreased quality of life. Many arthritis patients want to SOLELY focus on the musculoskeletal system.

In medical school and residency, I was always taught to focus on the WHOLE individual so I would not miss a diagnosis or sign of a certain disease.  Patients are often shocked when I ask them about almost every organ system in the body and do a head to toe physical examination.  Some types of arthritis like wear and tear arthritis (osteoarthritis) or a local tendon or muscle ailment like tennis elbow or meniscal injury mainly affects the local joint or tendon.  People are often surprised to learn that  joint inflammation associated with rheumatoid arthritis, lupus, psoriatic arthritis, scleroderma, Sjorgren’s Syndrome, myositis and vasculitis CAN also lead to inflammation of other organs.  

At every visit, I ask questions about the eyes, heart, lungs, skin, stomach and other systems. It  is crucial to do a thorough and extensive exam to detect abnormalities of the immune system. 
So what I am looking for on the exam?

Eyes: eye redness, eye discharge, eye lid swelling, visual impairment
Nose: nasal ulcers, nose cartilage deformity
Ear: ear cartilage deformity
Upper face/neck region: enlarged parotid glands ( salivary gland/cheek area), thyroid enlargement or tenderness
Heart: abnormality of heart sounds or increase heart rate  may suggest inflammation of sac surrounding the heart or enlargement 
Lungs: wheezes, decreased breath sounds or other abnormal sounds may indicate lung scarring/ interstitial lung disease
Abdomen: enlargement of  liver or spleen can mean damage or failure
Nervous system: absent reflexes, decreased sensation or muscle strength
Skin: any diffuse flat or raised rash, scarring lesions, skin discoloration or skin tightening
Hair: Thinning or patches of bald spots
Extremities: decreased or absent pulses from abnormalities in circulatory system, evidence of leg clot, discoloration of fingers and toes
Joints and Muscles: Tenderness, swelling, warmth, redness  of joints and tendons, joint deformities, “bumps or nodes” on fingers/ feet, muscle weakness, nail abnormalities, spine alignment and range of motion of neck and back
I also do ask my patients about their mood and conduct depression screening!