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UCSD's Practical Guide to Clinical Medicine UCSD's Practical Guide to Clinical Medicine A comprehensive physical examination and clinical education site for medical students and other health care professionals Web Site Design by Jan Thompson, Program Representative, UCSD School of Medicine. Content and Photographs by Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, California. Send Comments to: The 'daVinci Anatomy Icon' denotes a link to related gross anatomy pictures. Musculo-Skeletal Examination Detailed examination of the joints is usually not included in the routine medical examination. Spice girls live in istanbul torrent streaming.
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However, joint related complaints are rather common, and understanding anatomy and physiology of both normal function and pathologic conditions is critically important when evaluating the symptomatic patient. By gaining an appreciation for the basic structures and functioning of the joint, you'll be able to 'logic' your way thru the exam, even if you can't remember the eponym attached to each specific test! I have included detailed descriptions of the shoulder, knee, and low back examinations as these are the most commonly affected areas. In addition, a review of relevant anatomy, function, and common disorders are described for most of the other major joints. This is not meant to be an all-inclusive list. A few general comments about the musculoskeletal exam Historical clues when evaluating any joint related complaint: • What is the functional limitation?
• Symptoms within a single region or affecting multiple joints? • Acute or slowly progressive? • If injury, what was the mechanism?
• Prior problems with the affected area? • Systemic symptoms? Common approach to the examination of all joints: • Make sure the area is well exposed - no shirts, pants, etc covering either side - gowns come in handy • Carefully inspect the joint(s) in question. Are there signs of inflammation or injury (swelling, redness, warmth)? As many joints are symmetric, compare with the opposite side • Must understand normal functional anatomy - what does this joint normally do? • Observe the joint while patient attempts to perform normal activity - what can't they do? What specifically limits them?
Was there a discrete event (e.g. Trauma) that caused this?
If so, what was the mechanism of injury? • Palpate the joint in question.
Is there warmth? Point tenderness? If so, over what anatomic strucutres? • Assess the range of motion, both active (patient moves it) and passive (you move it) if active is limited/causes pain.
• Strength, neuro-vascular assessment. • Specific provocative maneuvers related to pathology occurring in that joint (see descriptions under each joint). • In the setting of acute injury and pain, it's often very difficult to assess a joint as patient 'protects' the affected area, limiting movement and thus your examination. It helps to examine the unaffected side first (gain patient's confidence, develop sense of their normal). The Knee Exam Video showing complete knee exam Observation: • Make sure that both knees are fully exposed.
The patient should be in either a gown or shorts. Rolled up pant legs do not provide good exposure! • Watch the patient walk. Do they limp or appear to be in pain? When standing, is there evidence of bowing (varus) or knock-kneed (valgus) deformity? There is a predilection for degenerative joint disease to affect the medical aspect of the knee, a common cause of bowing.
Varus Knee Deformity, more marked on the left leg. • Make note of any scars or asymmetry. Chronic/progressive damage, as in degenerative joint disease, may lead to abnormal contours and appearance. Is there obvious swelling as would occur in an effusion? Redness suggesting inflammation? • Is there evidence of atrophy of the quadriceps, hamstring, or calf muscle groups?