Evaluate joint symptoms for:
• time pattern of involvement of joint(s)
• distribution of joint involvement
• range of motion (ROM)
• anatomical structure causing symptoms
• involvement of any extra-articular structures
• any inflammatory process
• function of joint
Earliest clinical signs of joint inflammation are joint line tenderness, effusion, swelling, heat/warmth, loss of range of motion and altered function of joint. Subtle joint inflammation may only result in the clinical sign of ‘stress pain’ – pain only at end of range of motion or a little beyond.
Key sign in detecting joint effusion is ‘fluctuance’ – principle is based on being able to compress the joint and this will generate an impulse that passes from one examining finger to another.