Guidelines established by the American College of Rheumatology were updated in 2010 to include careful joint assessment of each patient. One feature of the guidelines is the standardized rheumatoid arthritis (RA) Joint Count, which examines six joint areas for a total of 28 different joints. Included for routine examination are the wrists, elbows, shoulders and knees. To perform the RA Joint Count, a patient wears a standard gown and sits on the end of an examination table. The doctor then determines where and if joint swelling and tenderness exists by pressing on a specific joint. Each joint is then examined by palpation using the thumbs and index fingers. This can help identify increased fluid that may indicate RA. Patients are also instructed to move each joint in its respective range of motion, and results are recorded on a score sheet. Totals of swollen and tender joints are calculated independently and then added together to determine the total score for the RA Joint Count.
Joints may be subject to any number of injuries or damage. Arthritis is a common affliction and may be diagnosed with blood tests. In other instances, however, such as with non-specific pain or loss of mobility, doctors may need to perform additional joint assessment activities. Some of these are designed to identify specific conditions, such as rheumatoid arthritis, while others measure cartilage loss.
RA Joint Count Tool
Examining and evaluating joint mobility often helps doctors differentiate between vertebrae and chest pain. This is because mobility problems that originate in the ribs have been linked to pain of the lower back, neck and chest. Doctors thus use a joint mobility test known as the application of posteroanterior (PA) pressure to diagnose pain. This procedure involves pressure applied to the vertebrae with the doctor's palms. In turn, he asks the patient if any pain is present and assesses the range of vertebrae motion with regard to the applied force. Studies show that 98 percent of physical therapists determine a patient's treatment plan based on the results of PA pressure assessment. To illustrate, a hypermobile joint identified during PA pressure may serve as the source of non-specific back pain. Such treatment as stabilization exercises can then be used to improve a patient's pain and mobility.
Analysis of Joint Play Movement
Joint play movement is involuntary, yet according to doctors necessary for pain-free mobility. Examination of joint play is therefore an important component of joint testing. Some joint play movements may be similar to those of passive movements. For testing purposes, doctors are likely to put the joint in its resting, or loose pack, position. This causes the least amount of stress to the joint but is still within its comfortable range of motion. The ligaments are in the greatest laxity, and joint surface contact areas are minimal. In this position, the doctor may identify a treatment plane by drawing a line over the concave joint's articular surface. Keeping the patient well supported, the doctor can then determine joint mobilization and direction.
Magnetic Resonance Imaging
Magnetic resonance imaging (MRI) has shown to detect cartilage loss in greater definition than radiographs. According to doctors, the knee is the largest weight-bearing joint in the body and thus most commonly affected by osteoarthritis. The MRI may therefore be especially valuable in assessing this joint. Cartilage-sensitive imaging sequences must be used with an MRI to enhance the contrast for bone and cartilage analysis. T1-weighted gradient echo (GE) sequences have proven ideal for this. Three-dimensional GE sequences allow doctors to see the exact thickness and surface of cartilage, and synovial fluid is also visible in a bright pattern. Using the MRI technique, doctors can begin a treatment plan that may include physical therapy, surgery or a combination of both.
- "The Journal of Musculoskeletal Medicine"; Quantitative Joint Assessment to Improve RA Outcomes; Terrence W. Starz, M.D., et al; March 6, 2011
- "Hournal of Manual and Manipulative Therapy"; Reliability of Joint Mobility...; Bryan Heiderscheit, PT, PhD, and William Boissonnault, PT, DHS, FAAOMPT; 2008
- Orthopedic Physical Assessment; David J. Magee; 2008
- University of Oklahoma Health Sciences Center; Principles of Joint Mobilization; Vince Lepak, PT, MPH, CWS
- Non-invasive MRI Assessment of the Antricular Cartilage...; Yi-Xiang J. Wang, et al; January 28, 2010
- Arthritis Victoria: Blood Tests for Arthritis
- Photo Credit Jupiterimages/Goodshoot/Getty Images
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