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Physical Exam and History For Osteoarthritis

Your medical history, physical examination, and imaging studies help diagnose osteoarthritis. Imaging studies (x-rays) look for joint abnormalities and loss of cartilage. But what specific evidence is your doctor looking for during your physical examination? When you've been experiencing pain and finally schedule a physical examination with your doctor, what will she want to know and what will happen during the examination?

Detailed Medical History and Discussion of Your Symptoms
Two of the best diagnostic tools a doctor has are her ears. Taking a thorough medical history and discussion of the symptoms with you is very important for arriving at a diagnosis. Your medical history tells the doctor about the onset of osteoarthritis symptoms, past treatments or surgeries, a family history of the disease, or other significant details about your condition.

Be prepared in advance. Write down or record the information to bring with you so you won't leave out important clues. While you may think that these things should already be in the medical record, it is best to recap them when are being seen for a specific problem. Past surgeries and injuries, including any recent injuries, are important to discuss during your examination.

Questions you can expect: Where does it hurt and how much? How long have you been having these symptoms? Is there a pattern? Are your joints stiff in the morning? Do you feel the pain with certain activities and exercises, and which ones? Have you changed the way you stand or walk due to the pain? Do you have any other symptoms that are more general?

What Is the Doctor Is Looking for During a Physical Examination for Osteoarthritis?
The doctor will examine each of your joints, looking at it, feeling it and moving it through a range of motion. She will also be doing a full general exam to assess your heart, lungs, liver, and kidneys.

The physical examination looks for evidence of:

Mild to moderate firm swelling around the joint
Crepitus on movement. This is that crunching feeling, like the sound of bone rubbing on bone. If you have a "noisy knee" that is crepitus.
Limited range of motion, the joint can't flex as far as it once did.
Pain with movement of the joint (especially towards the end of its range of motion)
Joint tenderness
Mild inflammation and warmth over the joint

Other physical evidence that points to osteoarthritis includes:

Weakness of muscles surrounding the affected joint
Tenderness of structures surrounding the joint
Joint instability (with advanced osteoarthritis)
Joint deformity, such as bony enlargement (with advanced osteoarthritis)
Bony lumps, especially on the fingers
Unequal leg lengths
Altered walking gait
During the physical examination, your doctor will assess each of your joints for pain, tenderness, and range of motion. Determining the pattern of affected joints has significance and can often distinguish between rheumatoid arthritis and osteoarthritis (for example, one knee or both knees affected).

Also, from your initial physical examination, you establish a baseline with your doctor. When you doctor repeats the physical examination on follow-up visits, changes for better or worse will be evident. But it is wise to keep a log of your symptoms so you can discuss them fully with your doctor on follow-up examinations.

Further tests you can expect are x-rays. Blood tests will likely be performed to assess general health as well as to rule out rheumatoid arthritis, gout, and lupus.

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Dr. C  L Garg
Dr. C L Garg
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