How to perform joint examination general scheme general rules , inspection , palpation , movement ,special tests

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