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Haem Exam
 
 

Joints of the Lower Limb

February 15th, 2021
 
 
 
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Joint Swelling

  • Look For

  • Generalised swelling over one or both lower limbs. May be associated with redness, tenderness or warmth.
  • Significance

  • May be a sign of an intra-articular bleed.
  • Causes of Joint Swelling

  • Intra-articular haemorrhage
  • Arthritis - osteoarthritis, rheumatoid arthritis, septic arthritis, gout, pseudogout, reactive arthritis, psoriatic arthritis
  • Trauma - fracture, dislocation, muscle sprain or rupture, compartment syndrome
  • Skin / soft tissue infection - cellulitis, abscess
  • Vascular - acute ischaemia, DVT, superficial thrombophlebitis, venous insufficiency, lymphoedema
  • Systemic - heart failure, cirrhosis, nephrotic syndrome, malnutrition
  • Tendinitis / bursitis

Joint Range of Motion

  • How to Assess

  • Ask the patient to move the joint themselves, and then passively move it for them. Note the range of motion and whether it is limited by pain, swelling or stiffness
  • Significance

  • May be a sign of an intra-articular bleed.
  • Causes of Limited Range of Motion

  • Intra-articular haemorrhage
  • Arthritis - osteoarthritis, rheumatoid arthritis, septic arthritis, gout, pseudogout, reactive arthritis, psoriatic arthritis, Reiter's syndrome
  • Trauma - dislocation, fracture, ligamentous / menisceal tear
  • Loose intra-articular body
  • Fibrous adhesions
  • Muscle tightness
  • Prolonged joint immobilisation
  • Compartment syndrome
  • Tendinitis / bursitis
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