1. CLINICAL EXAMINATION

2. Diagnostic approach depends upon assessment of function

3. SELECTIVE TENSION Passive movements stress inert structures Resisted movements test contractile structures

4. EXAMINATION FOLLOWS A SET ROUTINE

5. OBSERVATION Face Posture Gait

6. HISTORY Age and occupation, sports hobbies, lifestyle Site and spread Onset and duration

7. HISTORY Symptoms and behaviour Other joint involvement Past medical history Medications

8. INSPECTION Bony deformity Colour changes Wasting Swelling

9. PERIPHERAL JOINTS Palpate for: Heat Swelling Synovial thickness Not for tenderness

10. STATE AT REST Position of the pain

11. ACTIVE MOVEMENTS Pain Range Willingness

12. OTHER FINDINGS Painful arc

13. PASSIVE MOVEMENTS FOR INERT STRUCTURES Joint capsule Bursa Dura mater Nerve root Ligament Fascia Dural nerve root sleeve Relaxed muscle and tendon

14. PASSIVE MOVEMENTS FOR INERT STRUCTURES Pain Range End-feel

15. PASSIVE MOVEMENTS Capsular pattern Non-capsular pattern

16. NORMAL END-FEEL Hard Soft Elastic

17. ABNORMAL END- FEEL ‘ Hard ’ Spasm Springy Empty

18. CAPSULAR PATTERN Arthritis Varies from joint to joint Limitation in a fixed proportion which varies according to the joint Same whatever the cause of the arthritis

19. NON-CAPSULAR PATTERN Intra-articular displacement Ligamentous lesion Extra-articular lesion

20. RESISTED TESTS FOR CONTRACTILE STRUCTURES Muscle Tendon Attachments to bone

21. RESISTED TESTS Pain Power Relaxed contractile unit may produce pain on passive stretching

22. RESISTED TESTS Joint in mid position No joint movement Eliminate muscles not tested Test muscles strongly Patient and examiner positioned to advantage

23. RESISTED TESTS Strong and painless Strong and painful Weak and painless Weak and painful Painful on repetition All painful/juddering

24. NEUROLOGICAL EXAMINATION Reflexes Power Sensation Plantar response

25. OTHER TESTS Mechanical/neural tests Blood tests X-ray EMG Scans

26. PALPATION Once the structure at fault has been identified