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COMPLETE EXAMINATION OF THE MSK Warmth. Use the backs of your fingers to compare the involved joint with it
tissues if both joints are involved.
seffcausapinmd™ - Warmness may indicate Arthritis, tendinitis, bursitis, osteomyelitis
§ Tenderness. Try to identify the specific anatomic structure that is tender. Tra
There are several points to remember prior to beginning the MSK examination. These include: - Tenderness and warmth over a thickened synovium may suggest arthritis or
• Inspection for joint symmetry, alignment, bony deformities § Redness. Redness of the overlying skin is the least common sign of inflamm
- Redness over a tender joint suggests septic or gouty arthritis, or possibly rh
• Inspection and palpation of surrounding tissues for skin changes, nodules, muscle atrophy, crepitus
• Range of motion and maneuvers to test joint function and stability, integrity of ligaments, tendons, bursae,
especially if pain or trauma
• Assessment of inflammation or arthritis, especially swelling, warmth, tenderness, redness
TEMPOROMANDIBULAR JOINT
TECHNIQUES ASSESS
• Initial survey of the patient you have assessed general appearance, body proportions, and ease of movement
• It should include inspection, palpation of bony landmarks as well as related joint and soft-tissue structures, Inspection Symmetry Symm
assessment of range of motion, and special maneuvers to test specific movements. Swelling, redness Swelli
INSPECTION Palpate Joint Swelli
§ Symmetry Muscles of mastication – masseter, temporalis, Pain,
- Acute involvement of only one joint suggests trauma, septic arthritis, gout. pterygoid (external, internal)
- Rheumatoid arthritis typically involves several joints, symmetrically distributed. ROM Open/close mouth Full ra
§ Joint deformities or mal- alignment of bones Protrusion/retraction Limite
- Dupuytren’s contracture sides
- bowlegs or knock-knees
§ Use inspection and palpation to assess the surrounding tissues, noting skin changes, subcutaneous nodules, and muscle SHOULDER
atrophy.
- Subcutaneous nodules in rheumatoid arthritis or rheumatic fever; effusions in trauma; crepitus over inflamed joints, in TECHNIQUES ASSESS
osteoarthritis, or inflamed tendon sheaths Inspection Shoulder girdle, scapula Symm
§ Note any crepitus, an audible and/or palpable crunching during movement of tendons or ligaments over bone. This may Swell
occur in normal joints but is more significant when associated with symptoms or signs. Musc
§ Testing range of motion and maneuvers Joint capsule Swell
- may demonstrate limitations in range of motion or increased mobility and joint instability from excess mobility of joint Palpate Bony landmarks tende
ligaments, called ligamentous laxity. Acromion
- Decreased range of motion in arthritis, inflammation of tissues around a joint, fibrosis in or around a joint, or bony fixation Coracoid process of the scapula
(ankylosis). Ligamentous laxity of the ACL in knee trauma Greater tubercle
§ Testing muscle strength may aid in the assessment of joint function Subacromial bursae, subdeltoid bursae
- Muscle atrophy or weakness in rheumatoid arthritis Sits muscles (lift elbow posteriorly – extend)
Fibrous articular capsule Tend
Be especially alert to signs of inflammation and arthritis.
Tendons of rotator cuff
§ Swelling. Palpable swelling may involve:
1. the synovial membrane, which can feel boggy or doughy ROM Flexion – infront and upward Full r
2. effusion from excess synovial fluid within the joint space Extension – raise behind (back) Limit
Abduction – out to the side and overhead
3. soft-tissue structures such as bursae, tendons, and tendon sheaths.
Adduction – cross in front of body
- Palpable bogginess or doughiness of the synovial membrane indicates synovitis, which is often accompanied by effusion.
Internal rotation – behind back & touch
- Palpable joint fluid in effusion, tenderness over the tendon sheaths in tendinitis
shoulder blade
 External rotation – “behind head (brushing Flexion (fist with thumb across)
hair) Extension – open hand
Maneuvers Crossover test (acromioclavicular joint) Adduction and abduction _ spread an
Apley Scratch Test (external rotate-overhead, back together
touch scapula, internal rotate –back, touch Thumb:
scapula) Flex
Neer’s Impingement test Positive/negative Extend
Hawkin’s impingement sign +/- Abduction
Supraspinatus strength (empty can test) Weakness Adduction
Infraspinatus strength Weakness opposition
Forearm supination +/-
Drop arm sign +/-
SPINE
WRIST TECHNIQUES ASSESS
Inspection Posture
TECHNIQUES ASSESS REPORT/ NOTE
Erect position of head, smooth
Inspection Position of hands in motion Smooth- natural movements
coordinated neck movement
Finger alignment Ease of gait
Palmar and dorsal surface of wrist Swelling over joints Standing: deviations scoliosis, kyphos
Deformities (wrist finger bones, hand) Skin markings, skin tags
contractures Palpate Spinous processes
Contour of the thenar and hypothenar Atrophy Facet joints c2-c7 lateral
eminences Lumbar spinous processes
Palpate Distal radius and ulna Swelling, bogginess, tenderness Sacroiliac area (dimple)
groove of the wrist joints Paravertebral muscles
Anatomical snuffbox tenderness Sciatic nerve (hip flexed and lie to oth
Carpals, metacarpals and phalanges tenderess side
Squeeze mcps Swelling, bogginess tenderness ROM Neck
PIP and DIP joints Nodules, tenderness Flex, extend, rotate, lateral bending
ROM Flexion Limitation to range of motion
Extension Full range of motion/no impairment in
Adduction the range of motion of the wrist HIP
Abduction TECHNIQUES ASSESS
Maneuvers Hand grip strength (patient will grasp) weakness Inspection Gait
Thumb movement (finkelstein test) Pain + - stance
Carpal tunnel - swing
Thumb abduction (with resistance) weakness Observe position for lordosis
Tinel’s sign (median nerve aching, numbing Anterior and posterior surfaces of the
compression) numbness, tingling hip
Phalen’s sign Palpate Bony landmarks:
Fingers: Iliac crest
Asis
 Greater trochanter -lateral collateral ligament
Symphysis pubis Patellofemoral compartment
Psis - patella
Ischial tuberosity -patellar tendon
Sacroiliac joint – not palpable -tibial tuberosity
Inguinal ligament Tenderness, enlargement of lymph Patello femoral grinding test
Femoral nerve, artery, vein lymph node nodes Suprapatellar pouch
Trochanteric bursa Prepatellar bursa over the anserine
Ischiogluteal bursa – not palpable bursa
ROM Flexion Palpation for effusion
Extension Bulge sign
Adduction Balloon sign
Abduction Balloting the patella
External rotation Gastrocnemius and soleus
Internal rotation Achilles tendon - palpate
Maneuvers Flexion – with hand at lumbar spine Flexion deformity of the hip Integrity of achilles tendon: Grasp calf
Extension muscles – note for plantar flexion
Abduction ROM Flexion
Adduction Extension
External and internal rotation Internal rotation
External rotation
KNEE Maneuvers Medial and lateral meniscus:
McMurray test
Abduction (valgus) stress test -mcl
TECHNIQUES ASSESS REPORT/ NOTE Adduction (varus) stress test - lcl
Inspection Gait Smooth rhythmic flow Anterior and posterior drawer sign –
Alignment and contours of knee Aligned, contours ACL,PCL
Atrophy of the quadriceps muscles atrophy Lachman test
Swelling around the knee swelling

Palpate Tibiofemoral joint Tenderness, swelling, effusion ANKLE AND FOOT

Irregular bony ridges TECHNIQUES ASSESS
Medial meniscus tenderness Inspection Surfaces
Lateral meniscus
Medial joint compartment Palpate Anterior ankle
- medial femoral condyle Achilles tendon
- Adductor tubercle Heel
- medial tibial plateau
Metatarsophalangeal joint
-medial collateral ligament
Metatarsals and groovees
Lateral joint compartment
ROM Dorsiflexion (ankle extension)
- lateral femoral condyle
Plantar flexion
- lateral tibial plateau
 Inversion
eversion
Maneuvers Ankle (tibiotalar) joint
Dorsiflex and plantar flex
Subtalar (talocalcaneal) joint
Invert and evert foot – stabilize ankle
Transverse tarsal joint
Stabilize heel – invert and evert forefoot
Metatarsophalangeal joint
Flex toes in relation to the feet

Special Techniques
Measuring the length of the legs
Describing limited motion of joint – degree of movement