Which physical findings are characteristic of cricoarytenoid (CA) fixation?

Updated: Jul 27, 2021
  • Author: Paul C Bryson, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

In patients with an appropriate clinical history for cricoarytenoid (CA) fixation, physical examination should include complete head-and-neck examination, indirect laryngoscopy, and at least a cursory musculoskeletal survey. Operative direct laryngoscopy is the standard for clinical evaluation and definitive diagnosis of cricoarytenoid (CA) joint fixation (see Diagnostic Procedures).

In laryngeal rheumatoid arthritis, indirect laryngoscopy in the acute phase reveals erythema and swelling of the arytenoid mucosa. On clinical evaluation, 17-33% of patients with rheumatoid arthritis have identifiable laryngeal disease. Manipulation of the larynx is painful if the patient is awake. In the chronic stages of the disease, pain is unusual, and mucosal changes are somewhat less pronounced than before because they appear rough and thickened. Lateral bowing of the cords in inspiration, an uncommon finding in laryngeal paralysis, may be observed in both acute and chronic phases if both joints are involved.


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