General examination of musculoskeletal Clinically we can seen and help to easy diagnosis

1. MUSCULOSKELTAL
EXAMINATION
DR.VIJAYALAKSHMI
PG-SCHOLAR
GUIDED BY
DEPARTMENT OF
PANCHAKARMA
SVMAMC ILKAL

2. INTRODUCTION
Musculoskeletal Symptoms are a major cause of pain and
Disability
Musculo skeletal are the Single most important cause of disabilty,
requiring considerable,health and Social service resouce.
Objectives of peforming a Musuloskettal disease assesment are
1) To make accurate Dignosis
2) To asscess the sevirity and consequence of the condition.
3) To construct a clear management plan.

3. JOINT

4. Assessment of Musculo Skeltal System
1) Subjective Data: History
2)Objectives Data: Physical Examination

5. History
Pain
Site:
Onset:
-Pain from traumatic injury is usually immidiate
Exacerbated by movements like Haemtosis (bleeding in
joint)
-Inflmatory arthritis can develop 24hors
- Crystal athritis cause acute/severe
- -joint sepsis cause pain that develps over 1-2 days.

6. Charterstic of pain
 Bone pain: Deep or boring pain worse at Night.
 Localised pain : Tumour – Osteonecrosis
 Fracture pain: Sharp and Stabbing
 Muscle Pain: stiffness / aching agrivated by use of
affected muscle.
 Shoting pain:Impingment of peripheral nerve or root
 Ex: Buttock pain ……………….

7.  Associate complaints
 Swelling
 Redness of joints
Past Medical History : Note any past episodes of
musciloskeletal involvement,extra-articular disease ,
any fractures and anu comorbidities such as Diabectuc
etc.
Drug History: Any

8. Physical Examination
 General Principle
 Firstly, examine the patient’s over all appearnce for
features such as pallor,rash,skin tightening and hair
changes.
 Skin, Nail and Soft tissues.
 Weight loss, muscle loss,fever and lymphadenopathy are
all features of systemic involment in inflammatory
arthritis and connective tissue disease

9. GALS
Gait:
Ask the patient to
walk ahead in a
straight line, then
turn and walk
back towords you.
Look for
Smoothmess and
Symetery of the
gait.

10. Arms
Stand in front of
patient
Inspect the dorsum of
the hands and check
for extension of joints

11. Legs
Ask the patient to
lie supine on the
cough
Palpate each knee
for
warm.swelling,nd
patellar tap

12. Spine
Stand behind the
partient , asscess the
strighness of spine
and muscle bulk and
symmetry in the
trunk,legs,ankle and
foot.
Stand beside the
patient, ask them to
bend down and try to
touch their toes, wtc

13. Detailed examination
 Gait
 Gait is the Cyclical pattern of Musculoskeletal motion that
carries the body forwords.
 Normal gait is Smooth, symmetrical
 It has phase
 1. Stance : this phase is from foot stike to toe off,when
foot is on the ground and load bearing.
 2. Swing: thus phase is fom toe-off to foot strike ,when the
foot clars the grounds.

14. Examination:
 Ask the patient to walk barefoot in stright line,then repeat
the shoes.
 Observe the patiennt from behind, front andfrom side.
 Evaluvate what happens at each level (foot,ankle,knee,hip,
pelvis and spine)during both tance and swing phases.

15. To observe
 Pain:
 Structral changes:Assess the limb-length dispencery
 - other structural changes producing an abnormal gait
include joint fusion ,bone malunionand contracture.
 Weakness:it may be due to nerve or muscle pathology.Ex:
pain full hip joint problems in osteparthritis.
 Weak hip abductos as in poliomylities or after hip
replacment.
 Strctursl hip joint : congenitsl dislocztion.

16. SPINE
 The Spine is divided into
 Cervical Spine
 Thoracic
 Lumbar
 Sacral

17. INSPECTION OF SPINE
Ask the aptient to undress down to their underwear
 Inspect from the front , sides and behind ideally with patient
sitting and standing.
 Perticularly, pigmentation,abnormal hair growth etc.
 Alignment of the neck and shoulder symmetry.
 Kyphosis( thoracic spine curves giving a round shouldered
appearance)
 Lordosis ( lumbar spine curves pushing abdomen out, seen in
late stages of pregancy)
 Scoliosis ( thoracic and lumbar spine curve laterally forming S
or C shaped)

18. Palpation
 Palpate the shoulder and neck muscles for tenderness.
 Palpate each of the spinal process nothing any prominance
or steps
 Palpate the paraspinal muscles for tenderness or spasm.
 Palpate the sacroiliac joints.

19. Movements of the
cervical spine
Flexion
Extension
Flexion- ask the patient
to touch their chin to
their chest normal about
45degree.
Extension – ask the
patient to look upwords
and back – normal
about 45 degree.

20. Movements of the
cervical spine
Lateral flexion-
ask the patient to
touch their ears to
their shoulders,
without raising the
shoulders. Normal
45 degree.

21. thoracolumbar spine
 Flexion
 The patient is asked to
touch their toes whilst
keeping their knees
straight.
 Extension- is assessed by
asking the patient to
bend back as far as
possible.
 from above. Lateral
flexion- ask the patient
to place a hand on the
outer thigh and to run
the hand down that side
without bending
 Rotation: assessed with
the patient seated on low
stool and viewed

22. Schober test

23. Sacroiliac joint examination

24. Strech test:
Femoral nerve
A:pain may be
triggeed by knee
flexion alobe.
B: pain may be
triggered by knee
flexion in
combination with hip
extension.

25. Sciatic nerve
:Flip test
A; Divert the patient
attention to the
tendon reflexes
B; thw patient with
physical nerve root
compression cannot
permi full extension
of the leg.

26. Stretch test :
Sciatic neve
A; straight leg raising
limited by the tension
of the root over a
prolapsed disc.
B: tension is
increased by
dorsiflexion of the
foot

27. Stretch test :
Sciatic neve
C: Root tension is
relived by flexion at
the knee.
D;
Pressure over the
popliteal fossa bears
on the posterior tibial
nerve causing pain
locally and radiation
into the back.

28. EXAMINATION OF HIP JOINT

29.  Inspection
 The hip joint is not visible externally, but inspect ( ideally
with patient standing) for any deformity.
 Palpation
 Palapte bony prominance such as anterior iliac spine and
iliac crest to ensure they are anatomically where they
should be.

30. Movements of hip joint
 Flexion
 Extension
 Abduction
 Adduction
 Internal & external rotation

31.  Flexion – with the patient lying supine and the knee flexed
passively flex the hip joint- app 115degree
 Extension
 With the patient lying prone support the knee and with a
hand on the buttock passively extend the joint app
30degree. Abduction- apprix 45 degrees
 Adduction- judged by carrying limb immediately in front
of the other app.30degree

32. Rotation
 The person flex the knee and hip
 The knee is held in one hand and the foot in other hand.
 External rotation is achived by passivly moving the foot
medially.
 Internal rotation is tested by moving the foot laterally

33. knee
 Inspection
 Swelling may detected by a loss of the medial and lateral
dimples suggestive of an effusion.
 Palpation
 Presence/absence of patella and its mobility
 Collateral ligaments
 tenderness

34. Knee movements
 Active Flexion- the knee is flxed with one hand resting
on the patella app135degee
 Active Extension- the leg is straightened to its fullest
exent

35. Ligament test
Anterior cruciate
ligament
Anterior drawer
test
Lachmann test
Posterior drawer
test

36. Patella
Inspection
Look for patellar
burase swelling.
Patellar
apprehension test

37. Ankle and foot
 INSPECTION
 Foot and ankles ideally with patient standing and
more carefully with thepatient supine.
 Palpation
 Palpate the tenderness perticularly over bony
priminance placing thumbs on sole of foot and finger
tips on dorsum.
 Assess the metatarsophlangal joints by gently
squeezing between index finge and thumb.

38. Movements of
ankle
Inversion and
Eversion attempt
inversion and
eversion by
twisting the m

39. Movements of ankle
 Dorsiflexion- ak the patient to bend their foo down into
plante tendon 50degree
 Planter flexion- ask the person to bend the foot upwods
into dorsiflexion.
 i.e foot medially and laterally.

40. Thomson test
Squeeze the calf
just distal to the
level of maximum
cicumference. If
the achilles tendon
intact, flexion of
the foot will occur.

41. Molder's sign for
matron's neuroma
Squeeze the
metatarsal heads
together with one
hand ,at the same
time putting pressure
on the interdigital
space with your hand
, the pain of the
neucroma will be
localised.

42. Hands and wrist joint
 Inspection
 Bith the hands and wrist as one
 Inspect the front ,back and sides of all joints
 Compare sides
 Palpation
 Palpate jointd between finger and thumb.

43. Thumb
 Flexion
 Extension
 Abduction
 Adduction

44. WRIST JOINT
 Palmar flexion
 Dorsiflexion
 Ulnar flexion
 Radial flexion
 compare one wrist with the other.

45. Wrist

46. Elbow joints
• Inspection
• The elbow joint from front,sidesand behind
• Elbow movements
• Flexion
• Extension

47. Special test
• Tenis elbow (lateral epicondylitis)
• Golfer’s elbow (medial epicondylitis)

48. shoulder
• Shoulder movements
• Flexion
• Extension
• Abduction
• Adduction
• Internal rotation
• External rotation

49. EXAMINATION
• Movements
• Active movements
• Rotator cuff muscles
• Bicipital tendonitis
• Impigment (pain full arc)
• Neer test
• Hawkins – kennedy test

50. Special test
NEER TEST
HAWKIN’S TEST

51. THANK YOU