Musculoskeletal Examination Under Graduates
Musculoskeletal Examination Under Graduates
Examination in
Rheumatology
Components of joint examination
Halux varus
Palpation
• For temperature
• For tenderness
• The ankle joint is palpated with the foot in slight plantar flexion. The joint is
supported by the fingers of both hands while the thumbs firmly palpate the
anterior aspect of the joint.
The capsule and synovial membrane are best palpated over the joint line,
just distal to the lower end of the tibia and medial to the tibialis anterior
tendon. The margins of a swollen synovium in other locations may be
difficult to outline because of the overlying tendons. A large ankle effusion
may bulge both medial and lateral to the extensor tendons and produce
fluctuance: pressure with one hand on one side of the joint causes a fluid
wave to be transmitted to the second hand placed on the other side of the
joint. Ankle tenosynovitis produces a superficial, linear, tender swelling that
extends beyond the joint margins.
Range of Movements
Test for Tarsal tunnel syndrome
Examination of the Spine and Sacroiliacs
• Look (inspection): Skin and SC, muscle , Spine Curvature
• Feel (palpation): for tenderness over vertebrae and para vertebral
muscles and SI joints
• Movement and functional assessment:
• Special tests: according to the segment being examined.
Observe the curve of the whole body and the
back
Scoliosis
Cervical Vertebrae • Look (inspection):
Cervical
Vertebrae
• Movement and
functional assessment:
Cervical Vertebrae • Movement and functional assessment:
Cervical, Special tests:
Occiput to wall test
Cervical, Special tests:
Thoracic vertebrae examination
• (a) Normal curvature, (b) Kyphosis and (c) Lordosis
Dhatt, S. et al. (2019). Dorsal Spine Clinical Examination. In: Dhatt, S., Prabhakar, S. (eds) Handbook of
Clinical Examination in Orthopedics. Springer, Singapore. https://doi.org/10.1007/978-981-13-1235-9_7
Thoracic vertebrae
• Abnormal curve
Thoracic vertebrae
• Don`t forget to comment on symmetry of the levels of both shoulders
and shoulder muscle status
The most common etiology of a winged scapula is usually due to damage or impaired innervation
to the serratus anterior muscle. The nerve that innervates this muscle is the long thoracic nerve.
Sometimes, this nerve can be damaged or impinged, leading to malfunction of the serratus anterior
muscle.
Lumber vertebrae
• Curve abnormality
Lumber vertebrae
Movement
Lumber vertebrae
• Special tests for lumber flexion:
1. modified schober
Lumber vertebrae
• Special tests for lumber flexion:
1. Finger to floor test
As forward bending flexibility is highly variable even in the
asymptomatic population no normative values exist.
May be used for follow up
Lumber
vertebrae
• Special tests testing lateral
flexion
• 1. spinal lateral flexion
• Normal value:
average of both sides >=18 cm
Lumber
vertebrae
• Special tests: attesting lateral
lumber flexion
2. lateral Schober:
Normally the measurement
should increase from 20 cm to
at least 25 cm
Sacroiliac examination
Sacral dimples
Direct palpaion of SI joints
• Tenderness of the sacroiliac joint with direct pressure
Sacroiliac tests
• Provocative tests are a • Tests for SIJ examination:
commonly used method to 1. pelvic compression
determine whether pain is
originating from the SI joint 2. Pelvic distraction/ eversion test
especially early in the disease. 3. Gaenslen’s test
• A positive result is indicated 4. Patrick`s/ FABER test
by pain or replication of the 5. Thigh Thrust test
patient's symptoms can indicate
a SIJ pathology. 6. Sacral thrust test
7. Yeoman`s test
Anteroposterior and lateral pelvic compression
Pelvic distraction/ eversion test
Gaenslen’s test
Patrick/ FABER test(flexion-abduction- external rotation of the hip)
Thigh Thrust test
Sacral Thrust test
Measuring intermalleolar distance for hip movement
Thank you &
Good Luck