Musculoskeletal Examination Flashcards
(25 cards)
Musculoskeletal examination of relevant joints
- Inspection
- Palpation
- Range of Motion (ROM)
- Strength testing
Musculoskeletal pain - Joint Pains
Most common musculoskeletal disorders
Can be symmetrical or asymmetrical
Arthritic pains usually worse by motion
Rheumatoid arthritis usually affects symmetric synovial joints, more often the small joints such as fingers and wrists. The pain is more in the morning.
Osteoarthritis can be unilateral and usually affects the weight bearing joints of the body. The pain is worse by motion
Musculoskeletal pain - Muscular Pains
Usually felt as cramping or aching pain.
It can suggest intermittent claudication and it can
be accompanied with muscle weakness or atrophy.
Viral illnesses often present with
myalgia.
Musculoskeletal pain - Bone Pains
The pain caused by a broken bone is usually very sharp and severe.
It increases with movement. A dull, or deep pain can be from degenerative changes to the bone.
Inspection - Musculoskeletal
Completely expose affected joint, use appropriate draping
Compare right and left
note following features bilaterally:
* Contour
* Symmetry
* Size
* Visible masses or deformities
* Visible swellings
* Discolorations of the skin
* Lesions or scars
* Alignment (if examining the spine)
Presence of swelling and redness indicates joint irritation or inflammation.
Palpation - Musculoskeletal
Use gentle circular motion of the fingers with intermittent pressure.
Palpate:
* Bony articulations
* Associated landmarks
* Associated lymph nodes
* Relevant soft tissue including tendons, muscles, and joint capsule
* Any visible deformities
Comment on:
* presence of any pain, tenderness, swelling, or crepitus
* the temperature of the joint examined bilaterally and any change in temperature
* muscle atrophy or hypertrophy, restricted movements, rigidity or flaccidity in the muscles
* any enlarged or palpable lymph nodes
* consistency of relevant soft tissue structures palpated
Heat tenderness and swelling indicates Inflammation. Swelling could be due to a mass and need further assessment.
Range of motion (ROM) - Musculoskeletal
Test the active (voluntary) ROM by modelling the specific movements at each joint.
Joint motion normally causes no tenderness, pain, or crepitation.
Any limited range of motion or pain with ROM indicates joint involvement and need to be investigated further.
Muscle strength assessment - Musculoskeletal
Strength of the prime-mover muscle group should be checked for each joint.
Done by asking the person to flex and hold as you apply
opposing force.
The muscle strength should be equal bilaterally and fully
resist your opposing force
ROM and Muscle Strength Grading Scale
0 - No contraction, 0% Normal, Zero
1 - Slight visible contraction, 10% Normal,
Trace
2 - Full ROM with gravity eliminated (passive movements), 25% Normal,
Poor
3 - Full ROM against gravity, No resistance, 50% normal,
Fair
4 - Full ROM against gravity, some resistance, 75% Normal,
Good
5 - Full ROM against gravity, full resistance, 100% Normal,
Normal
Musculoskeletal examination of Head, Neck and Spine
TMJ, Cervical Spine and Lumbar Spine
Musculoskeletal examination of Upper Limbs
Shoulder, Elbow, Wrist and Hand
Musculoskeletal examination of Lower Limbs
Hip, Knee, Ankle and Foot
Examination of the TMJ (Temporomandibular Joint)
Inspection:
Anterior to the ears.
Compare for contour and
symmetry on both sides.
Note visible swelling, colour
changes, lesions, deformities or masses.
Palpation:
* Place tips of first two fingers in front of each ear, ask to open and close mouth.
Drop fingers into depressed area over joint, note smooth motion of mandible.
(An audible and palpable snap or click occurs in many healthy people as the mouth opens.)
* Palpate contracted temporalis and masseter
muscles when person clenches teeth.
Note size and firmness.
ROM:
* Open and close mouth, normal space between upper
and lower teeth is 3-6cms (3 fingers inserted sideways)
* Lateral motion side to side is about 1-2 cm
* Protraction without deviation
Muscle strength:
Ask to move jaw forward and
laterally against your resistance and open mouth against resistance.
Abnormal findings:
* Visible swelling, Crepitus or pain while chewing.
* Decreased ROM, with earlier loss of lateral motion.
Examination of the Cervical spine
Inspection:
Inspect alignment of the head and neck.
Spine should be straight.
Head erect.
Palpation:
* Palpate spinous processes of cervical spines.
* Palpate muscles in neck.
Note the firmness, any presence of pain or tenderness, any muscle spasm.
ROM:
* Movements possible: Flexion, extension, hyperextension, lateral bending and lateral rotations
Muscle strength:
Check the strength by resisting all the motions.
Abnormal findings:
* Head tilted to one side (Torticollis).
* Scapulae not symmetric on both sides
* Reduced ROMs
* Pronounced Thoracic curve (Kyphosis) or Lateral curve (Scoliosis)
Examination of the Lumbar spine
Inspection:
Inspect alignment of the spine. Note horizontal positions for shoulders, iliac crests, and
gluteal folds. From side, inspect the lumbar and thoracic curvatures.
Palpation:
* Palpate spinous processes of cervical spines.
* Palpate muscles in back.
Note pain, tenderness or hypertrophy
ROM:
* Movements possible: flexion, extension, hyperextension, lateral bending and lateral
rotations.
Ensure you stabilise the hips before checking these ROMs.
Abnormal findings:
* Reduced ROMs
* Asymmetry of muscles, Hypertonic muscles
* Pronounced Lumbar curve (Lordosis) or Lateral curve
(Scoliosis)
Examination for the Shoulder Joint
Inspection:
Inspect and compare both shoulders posteriorly and
anteriorly.
Check size and contour of the joint, compare shoulders for symmetry of the bony landmarks.
Normally no redness, muscular atrophy, deformity, or swelling is present.
Palpation:
Palpate both shoulders
note any muscular spasm or
atrophy, swelling, heat, or tenderness.
Beginning at clavicle, explore major landmarks such as
acromioclavicular joint, scapula, greater tubercule of
humerus, the biceps muscles, and anterior aspect of
the joint capsule.
Palpate axilla for presence of any masses or lymph nodes.
ROM:
Forward flexion of 180°, hyperextension up to 50°,
Internal and external rotations of 90° , Abduction of 180°
and Adduction of 50°
Muscle strength:
Check strength by resisting the flexion, extension,
abduction and adduction at the shoulders.
Examination for the Elbow Joint
Inspection:
Inspect size and contour of elbow in both flexed and extended positions.
Look for any deformity, redness, or swelling.
Palpation:
Palpate extensor surface of elbow, olecranon
process and medial and lateral epicondyles of the humerus.
Check olecranon bursa and hollows on either side of olecranon process for any abnormal swelling, synovial thickening, nodules or tenderness.
ROM:
Formation of hinge joint allows flexion and extension.
Pivot joint between radius and ulna allows supination and pronation.
Muscle strength:
Ask to flex the elbow against resistance, while you stabilize
the arm with one hand
Examination for the Wrist and Hand
Inspection:
Hands and wrists on the dorsal and palmar sides
note the position, contour, and shape. Normally no swelling or redness, deformity, or nodules are present.
Check the palm for thenar eminence in the palm.
Palpation:
Each joint in the wrist and hands.
Normally the joint surfaces feel smooth, with no swelling, bogginess, nodules, or tenderness.
ROM:
Flexion, extension, hyperextension of the wrist,
Ulnar deviation, radial deviation, Flexion , extension of
fingers, abduction, adduction of fingers, opposition of the
thumb.
Muscle strength:
Position forearm supinated and resting on the table.
Ask to flex the wrist against
resistance at the palm, while you stabilize at the mid
forearm.
Phalen’s test
Compression of the median nerve in the carpal tunnel can cause numbness, tingling and pain in the median nerve distribution.
Phalen’s test can be conducted to rule of any compression of the median nerve.
Examination for the Hip
Inspection:
Hip joints in standing position. Note level of iliac crest, gluteal folds, and equally sized buttocks.
Ask to walk across the room, observe the gait.
Palpation:
Ask to lie down (supine),
palpate hip joint for symmetry,
tenderness and crepitus.
ROM:
Hip flexion of 90° with knee extended, Hip flexion of 120° with knee bend, external rotation, internal rotation, abduction, adduction and hyperextension.
Muscle strength:
Ask to flex the hip with knee extended against resistance, abduct and adduct the leg
against resistance.
Examination for the Knee
Inspection:
Knees from front for shape, contour, distinct concavities or hollows present on either side of patella.
Quadricep muscles in anterior thigh for atrophy.
Note any swelling, redness or inflammation in suprapatellar region.
Check lower leg alignment.
Palpation:
temperature, swelling, deformities, thickening or nodularity.
Check for any pain or tenderness
ROM:
Flexion and Extension of the knees.
Muscle strength:
Ask to maintain knee flexion while you oppose by trying to pull the leg forward.
Muscle extension can be assessed by person successfully rising from the seated position in a low chair or squat position without support.
Examination for the Ankle and foot
Inspection:
Inspect and compare both feet, noting position of feet
and toes, contour of joints, and skin characteristics.
Inspect all the toe joints, and alignment of the foot.
Palpation:
Palpate each joint in the ankle and foot. Normally the joint surfaces feel smooth, with no swelling, bogginess, nodules, or tenderness.
ROM:
Dorsiflexion, plantar flexion, inversion and eversion
Muscle strength:
Check the strength for dorsiflexion and plantar flexion
against resistance.
Straight leg raise test
- Also known as Lasègue test
helps to confirm presence of sciatica and a herniated disc.
It stretches the nerve route
over the protruding disc and gives a painful response of the muscle contraction. - Although the SLR was originally described as a passive test, it is also often performed actively in the clinical setting.
Bulge Sign
Assess for swelling in the suprapatellar pouch
Firmly stroke up on medial
aspect of the knee 2 or 3 times to displace any fluid.
Tap the lateral aspect of the
knee, watch medial side in the hollow for a distinct bulge from a fluid wave.
