Haem Exam

 
 
 

The Patient

The Hands

The Arms

The Face

The Neck

The Chest

The Abdomen

The Pelvis

The Back

The Legs

 
 
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Joints of the Lower Limb

 
 
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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