Easier Exams for Cogwheel Rigidity

The assessment of cogwheel rigidity requires checking for smooth flexion and extension of the elbows and wrists. However, many patients stiffen their joints when they are aware that you are checking for stiffness. To obviate this problem, begin by asking whether they have any joint pain, then proceed to flex and extend their joints. Because the patients think you are only checking for pain, they don't stiffen. This approach also reminds you to assess for pain.

— Barbara E. Harrison, PhD, APRN-BC
  Rochester, Mich