DIY Joint Assessment

Before we begin, it is important to know how we define joint swelling, joint tenderness, and pressure:

Swelling is an enlarged area of soft tissue or a collection of fluid in the joint area. It feels soft and ‘boggy’. It is NOT a hard bony swelling, nodule, or a joint deformity.

Tenderness is pain at the joint that is felt either when the joint is pressed or moved.

Pressure is ‘gentle’. Think about the pressure you would apply to make your nail blanch. This is the pressure to use when checking your joints.

DIY Joint Assessment

Counting your tender and swollen joints is a way to measure your disease activity. When you count your tender and swollen joints they add up to give a final score. Doctors and nurses use this score so that they can easily see if your symptoms are getting better or worse.

Here is a description of how you can assess yourself to measure your disease activity for recording in the Self Assessment Tool. You will need to apply gentle pressure – so that you can check each joint for tenderness and swelling.

If your hands are painful you may not want to press the joints. You can just move the joint instead. For each joint, do the movements first. Then you use pressure. Finally you check for swelling. If you know a joint is painful you can just mark it as tender; you don’t need to apply pressure.

Start at the top and work down, going from the right to the left, but you can do this in any order.

Use movement to check for tenderness in the shoulder joints. Just lift or raise your arm and record any pain. Now do the same for the left shoulder. It’s hard to see shoulder swelling; but this is the area where swelling can sometimes be seen. If your shoulder is swollen it will look larger than normal. Looking in the mirror may make this easier. Mark your results on the self screener.

Flex the elbows to check for pain. Then apply gentle pressure in the elbow using the fingers on your left hand to check for tenderness. This is also the area to look and feel for swelling. When you’re doing it yourself it can be difficult to see swelling in this joint. Again, a mirror may be helpful.

Now it gets easier because we can see our wrists, hands and knees. We will start with the wrists. Move the hand up and down, flexing your right and then left wrist to check for pain and tenderness. Press here to check for pain using the thumb from your other hand. Look also at both wrists for signs of swelling.

Now we check the knuckles (the “MCP joints”). Start with the thumb and work through the five MCP joints of the right hand and then the five on the left hand. Use the thumb and fingers of your other hand to move each of the five MCP joints. This is called passive movement. Alternatively you can move the MCP joints actively. Applying pressure on each side (front and back) of the joint, again using the thumb and fingers, is the easiest way to check for pain and tenderness. Check for swelling using just the two fingers to press both sides of the joint.

The next finger joints that need to be checked are called PIP joints. Again start with the thumb and work through the five PIP joints of the right hand and then the five on the left hand. As before, use the thumb and fingers of your other hand to move each of the five PIP joints either passively or actively. Applying pressure on the sides of the joint using just two fingers is the easiest way to check for pain. Check for swelling using just the two fingers to press both sides of the joint. Remember, swelling will feel soft and boggy.

The next joints are the knees. To check them, bend and extend: first the right and then the left. Applying pressure using a couple of fingers along the joint each side of the knee like this can be used to check for pain and tenderness. To check for swelling it may be easier lying down to see and feel if they are swollen.