Musculoskeletal Exam The basic screening musculoskeletal examination involves inspection, palpation, and range of motion. Muscular strength is covered under the motor exam in the neurological exam. The musculoskeltal examination may be divided into spine, upper extremities, and lower extremities. Besides the basic screening exam there are many special maneuvers when examining a patient with musculoskeletal complaints.
196. Inspection of cervical, thoracic, and lumbar spine
197. Percussion of cervical, thoracic, lumbar and sacral vertebrae
198. Cervical spine: flexion and extension (be sure full extension is done) may be done from front or back, +/- palpate
200.Cervical spine Rotary movement, left and right, palpate
201. Lumbar spine: flexion and extension (be sure full extension is done), +/- palpate
202. Lumbar spine: lateral movement, left and right, OK from front or back, +/- palpate 203. Lumbar spine: rotary movement, left and right, OK from front or back, +/- palpate
The Shoulder Areas to palpate in a more thorough exam of the shoulder. Sternoclavicular joint Acromioclavicular joint Clavicle Scapulae Coracoid process Greater trochanter of the humerus Bicepts groove The area muscles
204. Shoulders: arms over head 207. Note: Shoulders: palpation during maneuvers (not over gown)
205. Shoulders: hands behind head
206. Shoulders: hands behind small of back
208. Elbows: flexion and extension (be sure full extension is done)
209. Elbows: palpation of elbows Palpate: Medial and lateral epichondyles; Olecranon process
210. Wrists: flexion and extension 211. Wrists: radial and ulnar deviation
Palpate - Distal radius and ulna Groove of joint Anatomic snuff box 212. Wrists--Palpations of Wrist
213. Hands: bilateral fists/grip, extend/hyperextend fingers
214: Hands: palpation of metacarpalphalangeal joints 215: Hands: palpation of IPJs (PIP and DIP joints)
Hip Joint
216. Hips: flexion (be sure full flexion is done and bilaterally) Note draping of sheet
217. Hips: internal and external rotation (hip at 90 0 and knee at 90 0 rotate on axis of femur)
218. Hips: abduction (away from the body with hip and knee at 0 degrees)
The Knee
219. Knees: flexion and extension (may do with hip flexion) (be sure full extension is done)
220. Palpation of Knees Palpate Patella Patellar tendon Tibial tuburosisty Medial and lateral joint lines
221. Ankles: Dorsi and plantar flexion
222. Ankles: Inversion, eversion of foot (stabilize at ankle and invert and evert by heel) subtalar joint
223. Ankles inversion eversion of foot (stabilize at heel and invert and evert by forefoot) transverse tarsal joint
Ankles: palpation of ankle Palpate: Anterior aspect of joint Achilles tendon Medial and lateral malleoli
225. Feet Palpation of metatarsophalangeal joints (may put pressure across foot from the 1 st to the 5 th metatarsals)