Muscular Exam

Question 1

What are common msk complaints?

Answer 1

1. Low back pain
2. Neck pain
3. Monoarticular or polyarticular joint pain
4. INflammatory or infectious joint pain
5. joint pain with systemic sxs such as fever, chills, rash, anorexia, weight loss, weakness
6. joint pain with sxs from other organ systems

Question 2

What examinations need to be performed over each joint?

Answer 2

1. Inspect for joint symmetry, alignment, or any bony deformities
2. Inspect and palpate surrounding tissues for any skin changes, nodules, muscle atrophy, or crepitus
3. Assess any degenerative or inflammatory changes, especially swelling, warmth, tenderness, or redness
4. Perform range of motion; use joint-specific maneuvers to test:
   A. Joint function and stability
   B. Integrity of ligaments, tendons, and bursae

Question 3

What should be inspected and palpated on the shoulder joint?

Answer 3

1. swelling, deformity, muscle atrophy or abnormal positioning
2. Bony landmarks, areas of tenderness

Question 4

What motions need to be performed to assess shoulder ROM?

Answer 4

flexion, extension, abduction, adduction, internal & external rotation

Question 5

What should be inspected and palpated on the elbow joint?

Answer 5

1. Inspect for swelling or masses

2. Palpate the olecranon process, medial & lateral epicondyles, and extensor surface of forearm

Question 6

What motions need to be performed to assess elbow ROM?

Answer 6

flexion, extension, supination, & pronation

Question 7

What should be inspected and palpated on the wrist joint?

Answer 7

1. Inspect palmar & dorsal surfaces of wrist for swelling or deformities.
2. Palpate distal radius and ulna on the lateral and medial surfaces. Palpate the groove of each wrist joint with your thumbs.

Question 8

What motions need to be performed to assess wrist ROM?

Answer 8

extension, flexion, ulnar & radial deviation, supination & pronation.

Question 9

What should be inspected and palpated on the fingers and hands?

Answer 9

Inspect for swelling, deformities, or redness.

Palpate all MCP joints and the medial and lateral aspects of each PIP and DIP joint.

Question 10

What motions need to be performed to assess finger and hand ROM?

Answer 10

flexion, extension, abduction, adduction. Also opposition of thumb.

Question 11

What should be inspected on the spine?

Answer 11

1. From the side:
Cervical, thoracic, and lumbar curves
2. From behind: 
Upright spinal column
Alignment of the shoulders, iliac crests, and the gluteal folds
Skin markings, tags, or masses

Question 12

What should be palpated on the spine?

Answer 12

1. With patient standing or sitting:
   A. Spinous processes of each vertebrae
   B. Paravertebral muscles for tenderness or spasm
   C. Sacroiliac joint

Question 13

What motions need to be performed to assess neck ROM?

Answer 13

1. Flexion and extension: chin to chest, look up at ceiling

2. Rotation and lateral bending: look over one shoulder and then the other; bring ear to shoulder

Question 14

What motions need to be performed to assess spine ROM?

Answer 14

1. Flexion and extension: bend forward and try to touch toes; bend backward
2. Rotation and lateral bending: rotate trunk from side to side, reach down and touch the side of each calf

Question 15

What should be inspected and palpated on the hips?

Answer 15

1. Inspect anterior and posterior surfaces of the hip for muscle atrophy or bruising
2. Palpate bony landmarks
   A. Anterior aspect: iliac crest, anterior superior iliac spine, greater trochanter, pubic symphysis
   B. Posterior aspect: posterior superior iliac spine, greater trochanter, ischial tuberosity, sacroiliac joint
   C. Inguinal ligament

Question 16

What motions need to be performed to assess hip ROM?

Answer 16

1. Flexion – bend knee to chest and pull against abdomen
2. Extension – leg extends posteriorly with patient carefully positioned near edge of table
3. Abduction and adduction – reach across andgrasp opposite hip; grasp ankle and move leg laterally, then medially, toward opposite hip
4. External and internal rotation – flex hip and knee to 90°, grasp ankle, rotate flexed lower leg medially then laterally

Question 17

What should be inspected and palpated on the knees?

Answer 17

1. Inspect:
   A. Contours and alignment of knees for swelling
   B. Atrophy of quadriceps muscle
2. Palpate, with the knee flexed, and note any tenderness:
   A. Along the joint line, including menisci and bursae
   B. Along the medial and lateral collateral ligaments (MCL and LCL)
   C. Over the patellar tendon.

Question 18

What motions need to be performed to assess knee ROM?

Answer 18

Flexion and extension

Question 19

What should be inspected and palpated on the ankles and feet?

Answer 19

1. Inspect the surfaces of the ankles and feet for any deformities, nodules, swellings, calluses, or corns
2. Palpate:
   A. Anterior aspect of each ankle joint for swelling, tenderness
   B. Achilles tendon for nodules or tenderness
   C. Heel for tenderness
   D. Medial and lateral malleolus for tenderness
   E. Metatarsophalangeal joints for tenderness
   F. Heads of the 5 metatarsals by compressing between your thumb and index finger

Question 20

What motions need to be performed to assess ankle and foot ROM?

Answer 20

1. Ankle flexion (plantar flexion)
A. Point foot toward the floor
2. Ankle extension (dorsiflexion) 
A. Point foot toward the ceiling
3. Inversion
A. Bend heel inward
4. Eversion 
A. Bend heel outward