Polymyalgia rheumatica physical examination

Physical examination of patients with polymyalgia rheumatica reveals limitation of the active and passive range of motion of the affected joint. There is no true muscle weakness. There are no changes in the joints. Ophthalmoscopic exams in patients with polymyalgia rheumatica associated with giant cell arteritis might be abnormal.

• Patients with polymyalgia rheumatica usually appear in pain.

• Hypothermia

• The following findings are associated with cases of polymyalgia rheumatica associated with giant cell arteritis:^[1][2]
  • Ophthalmoscopic exam may be abnormal with findings of sludging of blood in retinal arterioles, optic disc may show chalky white pallor and edema, with or without splinter hemorrhages, posterior ischemic (retrobulbar) optic neuropathy, central retinal artery occlusion, branch of retinal artery occlusion, and choroidal ischemia.
  • Tenderness upon palpation of the temporal region including erythema, nodularity, and thickening on the affected side
  • Facial tenderness
  • Neuro-ophthalmic manifestations of temporal arteritis include the following:^[3]
    • Diplopia
    • Ptosis
    • Nystagmus
    • Internuclear ophthalmoplegia (INO)
    • Pupillary abnormalities

• Pulmonary examination of patients with polymylagia rheumatica is usually normal.

• Cardiovascular examination of patients with polymylagia rheumatica is usually normal.

• Proximal joints tenderness typically in the shoulder and hip joints with active movement^[4]
• Decrease of the active range of motion in the proximal joints
• Normal muscle strength
• No muscle atrophy
• Transient synovitis of the knee, wrist, and sternoclavicular joints
• Arthritis in some cases