Back

Musculoskeletal Exam

Edit

General Notes

The MSK exam can be divided into three broad sections: visual inspection, palpation, and the evaluation of joint motion (LOOK, FEEL and MOVE.)

Evaluate the patient visually for signs of deformity, swelling, scars, inflammation or muscle atrophy.
Surface anatomy landmarks are used to evaluate for localization of points of tenderness or fluid collection.
Involved joints are moved actively by the patient, then passively by the examiner. If indicated, stress maneuvers are performed on joints in order to evaluate stability.

Perform each of the following for each joint (as indicated): I PROMS (I promise...)

Palpation
Range Of Motion
Special Maneuvers

Note that use of the anatomic terms specific to the structure and function of individual joint problems makes your write-up of musculoskeletal findings more meaningful and informative.

Note that initially you may use sentences to describe the findings; later you will use phrases appropriate for most write-ups.

Remember to only use approved medical abbreviations.

TMJ

Index finger anterior to tragusPt opens and closes jawProtrusion/retractionLateral movement of jaw

Neck

Flexion/ExtensionRotationLateral bending

Shoulder

Inspection/Palpation:

ClavicleAcromionCoracoid processGreater tubercle of humerusDeltoid muscleDeltoid bursaBicipital tendon

Range of Motion:

Flexion/ExtensionAbduction/AdductionInternal Rotation (touch lumbar spine)External Rotation (touch occiput)

Special Maneuvers:

Perform impingement sign (Modified Hawkins/Neer/Empty Can)Perform Drop Arm Test

Elbow

Inspection/Palpation:

Medial/lateral epicondylesUlnar nerve (in groove)Olecranon process

Range of Motion:

Flexion/ExtensionPronation/Supination

Wrist and Hand

Inspection/Palpation:

Distal radius/ulnaAnatomic snuffboxMCP/PIP/DIPCarpal BonesMetacarpals/phalanges

Range of Motion:

Wrist: Flexion, extension, ulnar, and radial deviationFingers: Flexion, extension, abduction, and adduction

Hip

Inspection/Palpation:

Inguinal ligamentTrochanteric bursaIschiogluteal bursa

Range of Motion:

Flexion/ExtensionAbduction/AdductionExternal/Internal Rotation

Special Maneuvers:

Straight leg raise

Knee

Inspection/Palpation:

Alignment/swellingPatella/patellar tendonMedial/lateral condylesMedial collateral ligamentLateral collateral ligamentSupra-patellar pouchPre-patellar pouchPes anserine bursaPopliteal space

Range of Motion:

Flexion/Extension

Special Maneuvers:

Bulge sign (small effusion)Ballon sign (moderate effusion)Ballotting (large effusion)MCL stress testLCL stress testAnterior drawer sign or LachmanPosterior drawer sign

Ankle and Foot

Inspection/Palpation:

Anterior and lateral ankle jointHeelAchilles tendonMetatarsal bone

Range of Motion:

DorsiflexionPlantar flexionInversionEversion

Lumbosacral Spine

Inspection/Palpation:

PostureSpinous processParavertebral muscles

Range of Motion:

Flexion/ExtensionRotationLateral bending

Write-up Examples

Good range of motion in all joints. No evidence of swelling or deformity.

Good range of motion in all joints. Hands with degenerative changes of Heberden's nodes at the distal interphalangeal joints, Bouchard's nodes at proximal interphalangeal joints. Mild pain with flexion, extension, and rotation of both hips. Good range of motion in the knees, with moderate crepitus; no effusion but boggy synovium and osteophytes along the tibiofemoral joint line bilaterally. Both feet with hallux valgus at the first metatarsophalangeal joints.

Right knee with moderate effusion and tenderness over medial meniscus along the joint line. Moderate laxity of anterior cruciate ligament (ACL) on anterior drawer test; posterior cruciate ligament (PCL) and medial and lateral collateral ligaments (MCL, LCL) intact – no posterior drawer sign or tenderness with varus or valgus stress. Patellar tendon intact – patient able to extend lower extremity. All other joints with good range of motion, no other deformity or swelling.

Review of Systems

Muscle or joint pains, stiffness, arthritis, gout, and backache. If present, describe location of affected joints or muscles, presence of any swelling, redness, pain, tenderness, stiffness, weakness, or limitation of motion or activity; including timing of symptoms, duration and any history of trauma.