The doctors in this study performed a bimanual examination on all 189 patients, and found that all had cervical motion tenderness or were tender over the uterus and/or the adnexa.
Almost half of the patients had tenderness over the uterus and/or motion tenderness of cervix and both adnexa, 20% were tender over the uterus and/or cervix only, 19% over the uterus and one of the adnexa and 12% over the adnexa only (Table 2).
Cervical motion tenderness (CMT), when present, is classically found on bimanual examination of the cervix and uterus.
However, the peculiar clinical signs of TOA are absent, such as lower abdominal tenderness, abnormal vaginal or cervical discharge, fever, abnormal vaginal bleeding, dyspareunia, cervical motion tenderness, and adnexal tenderness [18, 19].
On examination, the patient was not in distress, her abdomen was mildly tender with no guarding, and the gynecologic examination revealed a normal sized uterus, closed cervix, mild bleeding, and no cervical motion tenderness.
According to the 1991 Center for Disease Control guidelines for the prevention and management of PID, treatment should be initiated on the basis of the following minimum clinical criteria for pelvic inflammation: lower abdominal tenderness, bilateral adnexal tenderness, or cervical motion tenderness (CMT).
Fever, limitation in right shoulder range of motion, and tenderness in right shoulder and left thigh were detected following examination.
No statistically significant difference was observed for range of knee joint motion, joint tenderness, joint swelling, knee circumference and 50 feet walking time.
Patients also had to have five or more active joints, defined as the presence of swollen joints (or, in the absence of swelling, joints with limitation of movement (LOM) plus pain on motion and/or tenderness with palpation), with LOM present in at least three of the active joints.
Each knee is checked from signs of tenderness, knee instability, inappropriate range of motion, soreness at a particular area and incapacity to put pressure on the affected leg.
In the acute phase, the pain tends to be so severe so as to allow only limited shoulder motion with marked tenderness.
