"

Musculoskeletal Exam

The approach to examining the musculoskeletal system is similar across joints.  The affected and contralateral side are inspected and palpated carefully, observing for side-to-side differences. Range of motion and strength testing may be followed by joint-specific exam maneuvers to differentiate between two possible causes of the problem. In FCM, we will introduce a few of these ‘stability and special tests’ but we don’t expect you to master them until you use them routinely in clerkships. Focus on developing a consistent approach to the basics.

Inspection

  • Observe alignment and relative sizes of the areas of interest, at rest and in motion
  • Observe any erythema, swelling, ecchymosis, deformity, or skin lesions

 Palpation

Use a systematic approach to palpation of:

  • Joint
  • Soft tissue
  • Bursae
  • Tendons
  • Muscles
  • Ligaments
  • Bony Prominences

 Range of motion

  • Active range of motion – the patient moves the joint
  • Passive range of motion – the examiner moves the joint

Strength testing

  • Muscles that move the joint, and in some cases, the joint above or below it.

Stability and special tests as directed by the differential diagnosis

For every joint, there are many stability and special tests that could be performed to differentiate between possible causes of your patient’s problem. Their sensitivity and specificity often varies based on examiner skill and different physicians often prefer and use different tests.

In Immersion, you will apply the general approach to the musculoskeletal exam to the lumbar spine.

In Term 2, you will practice the exam of other joints commonly assessed in primary care. Only the Lumbar Spine, Shoulder and Knee exams are included in the FCM Benchmarks.

License

Icon for the Public Domain license

This work (Musculoskeletal Exam by Karen McDonough) is free of known copyright restrictions.

Share This Book