Polymyositis and dermatomyositis physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]

Physical examination of patients with polymyositis and dermatomyositis is usually remarkable for muscle weakness, hyporeflexia, skin lesions, respiratory symptoms. The presence of Gottron’s papules and the heliotrope eruption on physical examination is pathognomonic of dermatomyositis. Muscle atrophy in severe, long standing disease might occur.

• Physical examination of patients with polymyositis and dermatomyositis is usually remarkable for muscle weakness, hyporeflexia, skin lesions, respiratory symptoms.^{[1][2][3][4][5]}
• The presence of Gottron’s papules and the heliotrope eruption on physical examination is pathognomonic of dermatomyositis.

• Patients with polymyositis and dermatomyositis usually appear normal. They might be weak in severe cases.

• Low-grade fever

• Skin manifestations of dermatomyositis are as follow:^[1]

• Periorbital edema

• Neck examination of patients with polymyositis and dermatomyositis is usually normal.

• Asymmetric chest expansion
• Lungs are hyporesonant
• Fine crackles upon auscultation of the lung bilaterally
• Wheezing may be present

• Cardiovascular examination of patients with polymyositis and dermatomyositis is usually normal.

• Abdominal examination of patients with polymyositis and dermatomyositis is usually normal.

• Back examination of patients with polymyositis and dermatomyositis is usually normal.

• Genitourinary examination of patients with polymyositis and dermatomyositis is usually normal.

• Patient is usually oriented to persons, place, and time.
• Symmetric proximal muscle weakness mostly in:
  • Deltoids
  • Hips
  • Neck flexors
• Mild distal muscle weakness

• Hyporeflexia / areflexia
• Muscle rigidity

• Muscle atrophy in severe, long standing disease
• Fasciculations in the upper/lower extremity