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Musculoskeletal Exam 

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