Body temperature and anthropometry

Assessment of systemic and local temperature

Measurement of systemic and local temperature provides crucial diagnostic information about the nature of the developing pathology. An increase in general body temperature is the most characteristic symptom of inflammatory diseases, with purulent processes always accompanied by a significant rise. If the febrile state is accompanied by severe chills, this is considered a clear sign of septicopyemia, a severe form of purulent infection.

The physician must carefully evaluate the dynamics of these indicators. A decrease and subsequent normalization of temperature in intermittent fever indicate a favorable course of the disease. Conversely, a critical unfavorable prognostic sign is pulse-temperature dissociation: if a noticeable acceleration of the pulse occurs against the background of decreasing temperature, this directly indicates a serious deterioration in the patient's condition.

The examination of local body temperature is carried out using a simple contact method. To do this, the physician applies the back of the hand to strictly symmetrical areas of the patient's body, evaluating the difference.

• Increase in local temperature (Hyperthermia localis): typical for foci of active inflammation, such as phlegmon, acute arthritis, or osteomyelitis. Hyperthermia also accompanies the growth of malignant neoplasms (it is important to remember that local temperature does not rise in benign tumors).
• Decrease in local temperature (Hypothermia localis): unequivocally indicates impaired arterial blood supply and tissue ischemia. This symptom occurs in vasospasm of small arteries, occlusion of large arterial trunks, and the development of gangrene.

Anthropometry and limb measurement

Anthropometric studies aim to objectively record changes in body volume (the appearance of edema, the development of atrophy, or tumor growth) over time. The main tool for measurements is a standard measuring tape. An immutable rule of anthropometry is the mandatory comparison of the indicators of the affected side with the corresponding indicators of the healthy side of the body.

Circumference measurement has its specifics depending on the region:

• Abdomen: regular measurements aid in the diagnosis of ascites or progressive intra-abdominal tumors.
• Limbs: an increase in volume indicates lymphedema, venous stasis, or the accumulation of fluid, whereas a noticeable decrease in volume indicates the development of muscle tissue atrophy.

Determining limb length requires proper patient positioning. The patient must lie flat, without pelvic tilt. The reference landmark for proper positioning is the imaginary line connecting the anterior superior iliac spines — it must be strictly perpendicular to the median-sagittal plane of the body.

Key landmarks for measurements:

1. Entire lower limb: measured from the anterior superior iliac spine (spina iliaca anterior superior) to the medial malleolus.
2. Thigh: from the greater trochanter of the femur to the joint line of the knee joint.
3. Leg: from the joint line of the knee joint to the lateral malleolus.
4. Arm: the distance from the acromion of the scapula to the olecranon (or alternatively, to the lateral epicondyle of the humerus).
5. Forearm: from the olecranon to the ulnar styloid process.

Assessment of joint function and muscle strength

The functional state of joints is evaluated visually and by accurately measuring the range of motion in degrees using a medical goniometer. Measurement always starts from the initial strictly vertical position of the examined limb.

All joint movements are divided into two categories:

• Active: movements performed by the patient independently using their own volitional muscular effort.
• Passive: movements performed exclusively by the physician's hands while the patient's muscles are completely relaxed.

Main pathological conditions of joints:

• Ankylosis: a severe condition characterized by the complete (or nearly complete) absence of both active and passive movements.
• Paralysis: a condition in which the patient completely lacks active movements, while passive movements performed by the examiner are fully preserved.
• Flail joint: pathologically excessive range and non-characteristic volume of motion, most commonly occurring in intra-articular bone fractures or major ligamentous ruptures.

Muscle strength can be tested in two ways. The subjective method involves the physician manually resisting the patient's movements in various directions, comparing the strength of symmetrical muscle groups on the right and left sides. The objective method involves instrumental measurement of strength using a specialized device — a dynamometer.

Class and exam questions

What else to study on this topic

• Characteristics of the temperature curve in septicopyemia
• Prognostic significance of the pulse-temperature ratio
• Technique for using a medical goniometer and dynamometer
• Clinical differences between a flail joint and ankylosis

Other Topics in «CHAPTER 9. EXAMINATION OF THE SURGICAL PATIENT»

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.