Your Physical Exam

 

 

 


The Musculoskeletal Exam

Custom Search

 

  1. Magnitude: Over 3 7 million people in the United States suffer from one or another form of arthritis or related condition. It represents one of the five leading problems in patients presenting to the primary care physician. 
  2. Rheumatology: This is the branch of medicine dealing with arthritis and related disorders of the musculoskeletal system including the multi system autoimmune diseases. Rheumatologists are medical specialists in musculoskeletal disease.  
  3. Value of the History and Physical: The history and physical are critical to arriving at an accurate diagnosis of musculoskeletal disorders. Although the same might be said for all systems, it is particularly true in this area. In the diagnosis of musculoskeletal disease, 60% of the weight might be placed on the history, 3 0% on the physical and 10% on laboratory data.

A musculoskeletal exam nearly exclusively relies on inspection and palpation of the joints and some specialized tests involving those techniques. Rarely do percussion and auscultation play a role in the musculoskeletal exam. The key features to note and record on the examination of the joints are Swelling, Tenderness and Loss of motion.

Other important physical signs including temperature and color changes over the joint, crepitation and deformity can be added to complement the basic STL data

Rating: Swelling, tenderness and loss of motion can be graded conveniently on a scale of 0-4. In general terms, 0 means normal, I a mild abnormality, 2 moderate, 3 marked and 4 maximum abnormality. A more detailed explanation of the grading system is presented in the following table.

THE MUSCULOSKELETAL EXAM

       

     SO

    S1

    S2

    S3

    S4

    1. Swelling (S) No Swelling Join swelling which may not be apparent on casual inspection, but should be recognizable to an experienced examiner Joint swelling obvious even on casual observation Markedly abnormal swelling Joint swelling to a maximally abnormal degree
     

     TO

    T1

    T2

    T3

    T4

    2. Tenderness (T) No tenderness Slight or mild tolerable discomfort on palpation More severe pain on ordinary palpation, which the patient prefers not to tolerate More intolerable pain even with light palpation or pressure Pain which may be caused by even a mild stimulus such as a sheet touching the joint often characteristic of acute gout
     

     L0

    L1

    L2

    L3

    L4

    3. Limitation of motion (L) Normal joint motion About 25% loss of motion About 50% loss of motion About 75% loss of motion 100% loss of motion or complete ankyloses of the joint
     

    
       

Copyright 2010 All Rights Reserved.