The document outlines the objectives and components of a joint examination, emphasizing the importance of establishing patient rapport, cleanliness, and thorough assessment techniques. Key stages include inspection, palpation, movement evaluation, special tests for specific joints, neurovascular assessment, and proper patient closure after the exam. It provides detailed guidelines for clinicians to ensure a comprehensive and respectful examination process.

1. Joint examination
Ahmed Ghoname

2. Objectives
• General rules
• Components of joint examination
• Closure of the station

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General rules
• Introduce your self.
• Clarifying the purpose of the meeting.
• Offer analgesia.
• Clean your hands.
• Brief focused history.

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Components of joint examination
• Look (inspection)
• Feel (palpation)
• Move:
– Active movements
– Passive movements
– Grading muscular power
• Special tests
• Neurovascular assessment

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Look(inspection)
• General resting posture and/or gait
• Skin
• Subcutaneous tissue
• Muscle and tendons
• Bone
• Joint

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Look(inspection)
• Ideally expose the entire limb that is being
examined and the opposite limb to
compare the findings
• Ask for a chaperone as appropriate
• Positioning limbs correctly before
comparing
• If the patient can walk, inspect the gait

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Feel(palpation)
• Warn the patient you are going to touch
them
• Enquire about the presence of pain
• general palpation of the area in question (
use palmar (to check for tenderness) and
dorsal (to assess for warmth) aspect of the
examining hand

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Feel(palpation)
• Palpate bony landmarks, muscle and
tendon groups and any major nerves
• Localized tenderness ---injury or
inflammation of a particular structure
• Diffuse tenderness ---general process like
cellulitis or arthritis
• Palpate for a joint effusion.

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Movement
• Active movements
• Assisted movements
• Passive movements
• Power

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Special test
• Shoulder ---- rotator cuff, signs of
impingement and instability
• Knee---extensor mechanism, the collateral
and cruciate ligaments, and menisci and
look for signs of patella-femoral
dysfunction.
• Hip----fixed deformities, particularly
Thomas’ test for fixed flexion

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Neurovascular assessment
• Palpation of pulses
• Detailed examination of each nerve, and
its sensory and motor component
• A quick screening examination of the joint
above and below should also be
performed if time permits

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Closing the examination
• Make sure you leave the patient
comfortable
• Help them redress if necessary
• Thank them
• Wash hands

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Questions

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Summary
• General rules
• Inspection
• Palpation
• Movement
• Special tests
• Neurovascular assessment
• Closure