Musculoskeletal Exam

last written: Oct 2009, David LaPierre and Susan Tyler

 

Musculoskeletal injuries or conditions fall into a few broad categories. Common signs and symptoms for each include:

mechanical/degenerative: pain worse at end of day, better with rest/worse with increased use (also are ligamentous or meniscal sx: instability, locking, clicking, joint giving away suddenly).

inflammatory: pain, erythema, warmth, swelling, AM stiffness for greater than 30 mins.

neoplastic/infectious: weakness, fatigue, anorexia, wt loss, fevers/chills/night sweats, night pain, constant pain
neurological: paresthesias (numbness, tingling), bowel/bladder problems, weakness, headache

 

 

History

  • history of presenting complaint
  • past medical history
  • medications
  • social history
  • family history

History of Presenting Complaint

 

CHLORIDE FPP

Character- What is the pain like?

Location- Where does it start? Ask specifically.

  • joint distribution

Onset- When and how did it come on? (acute vs. gradual/insidious)

Radiation- Does the pain move/travel anywhere? Deep pain can be poorly localized.

Intensity- Scale of 1 to 10; effect on ADL and IADLs. Is it getting better, worse, the same?

Duration- How long as it been there?

  • Pattern: intermittent, migratory, or additive

Events associated

  • Falls (frail elderly!)
  • morning stiffness/swelling/redness (less or more than ½ hr helps differentiate inflammatory vs mechanical arthritides)
  • joint clicking or locking (think meniscal tears in the knee)
  • muscle pain/cramping
  • wasting
  • limitation of movement/weakness
  • numbness/tingling (neurological sequelae)
  • fevers/chills/night sweats/wt loss
  • trauma (always describe how injury happened!)
  • job vs sports vs repetitive movements?

Frequency- New vs recurrent pain (intermittent vs. constant)

Palliative factors- What makes the pain better? (rest/activity/pain meds/heat or cold?)

Provocative factors- As above, but what makes pain worse?

 

 


Physical Exam

Always compare the joint in question with the one above and the one below, as well as left to right.

A good way to remember approach: look, feel, move, function.

  • inspection
  • palpation
  • range of motion
  • power
  • gait
  • other
  • pediatric testing

Inspection

(SEADS)

S: Swelling

E: Erythema, ecchymosis

A: Atrophy/asymmetry (muscle bulk)

D: Deformity

S: Skin changes/scars/bruising


Also, gait, posture, position of comfort

 

 

 

Resources and References

University of Sasketchewan physical exam resources