Musculoskeletal Physical Examination

Terminology• Valgus: describes the position of a joint when the distal segment is

angled away from the midline of the body• Varus: opposite of valgus, the distal segment is angled toward the

midline of the body• Abduction: refers to motion away from the midline of the body• Adduction: refers to motion toward the midline of the body• Proximal: means closer to any point of reference, opposed to distal• Distal: means further from any point of reference, opposed to

proximal• Volar: the palmar surface of the hand• Dorsal: the posterior surface (back) of the hand

Basic principal• Look

– Swelling, scar, simetrical, deformity, atrophy of muscle? Always compare side to side

– Look from anterior, lateral, posterior• Feel

– Locate important anatomic landmarks– Any tenderness, increase or decrease temperature, mass, muscle spasm?

• Move– Active and passive, muscle power

• Special Test– Perform essential exam manuevers needed to effectively diagnose

problems

Basic Principal

• Examine based on history of:– Pain• Location, character

– Stiffness– Locking or popping– Instability

Skin

Soft Tissue

Bone

Shoulder• Look

– Scapula winging?• Feel

– Sternoclavicular joint, clavicula, acromioclavicular joint, anterior and posterior glenoid rim, spina scapula, both supraspinatus and infraspinatus muscle

• Move– Flexion, Extension, Abduction, Internal & External Rotation

• Special Test– Neer’s sign, Hawkin test, Crossover test– Lift off test– Labrum grind test– Anterior apprehension test,

Inferior apprehension test, Sulcus sign

Elbow

• Look– Cubital valgum or cubital varus?

• Feel– Epicondylus medial and lateral, olecranon, head of radius,

thickening of ulnar nerve?• Move– Flexion, extension, pronation, supination

• Special test– Test for Tennis Elbow– Test for Golfer Elbow

Hand• Look

– Finger deformity, thenar or hypothenar muscle wasting• Feel

– Distal and proximal interphalang joint, metacarpophalang joint, Radiocarpal Joint

• Move– Finger: flexion, extension, abduction, adduction– Thumb: extension, abduction, adduction, flexion, opposition– Radiocarpal joint: flexion, extension, radial and ulnar deviation

• Special Test– Tinel test– Phalen test– Finkelstein test

Hip• Look

– Trendelenburg sign?– Gait– Leg length discrepancy?

• Feel– Trochanter major tenderness?

• Move– Test for iliopsoas dysfunction at sitting position– Flexion, extension, adduction, abduction, external and internal rotation

• Special Test– Thomas test– FABER– Ober’s test

Knee• Look

– Anterior-> genu valgum or genu varum?– Lateral-> genu recurvatum?– Posterior-> baker’s cyst, aneurysm?– Q-line

• Feel– Tibial tuberosity, both tibial and femoral condyle, patella margin, pes anserine, iliotibial tract

(knee flexion 90 degrees)• Move

– Flexion, extension• Special Test

– Patellar tap test, Bulge sign– Patellar apprehension test– Anterior drawer test, Posterior drawer test, Lag sign– Valgus stress test, Varus stress test– McMurray test

Ankle

• Look• Feel– Both malleolus, deltoid ligament, talofibular ant and

post ligament, Calcaneofibular ligament, Achilles tendon• Move– Dorsoflexion, plantarflexion, inversion, eversion

• Special Test– Thompson test– Anterior drawer test

Cervical• Look• Feel– Processus spinosum (C3-T1), paraspinal muscle,

lymphadenopaty?• Move– Flexion, Extension, Lateral rotation, Lateral flexion

• Special Test– Spurling Test

Lumbal• Look

– Hair? -> spina bifida– Scoliosis, lordosis, kifosis?

• Feel– Processus spinosum, paraspinal muscle

• Move – Flexion, extension,

lateral flexion, rotation• Special Test

– Lasegue test– Bowstring sign

Reference

• Apley’s System of Orthopaedics and Fractures, Ninth ed.

• Hattam P, Smeatham A. Special tests in Musculoskeletal Examination. Elsevier.