The Goal

• The goal of the physical examination is
• To ascertain the structures involved
• The nature of the underlying pathology
• The extent and functional consequences of the process
• The presence of systemic or extraarticular manifestations.

A knowledge of anatomy is necessary to identify the primary site(s) of involvement and differentiate articular from nonarticular disorders.

Mehtodology

The musculoskeletal examination depends largely follows as

• Inspection or looking at the problem without touching the patient
• Palpation- Feel the problem and correlate and add upon the findings with findings in inspection
• Movements- To note any loss of movement in the involved or neighbouring joint.
• Measurments-To look for any lengthening or shortening in case of limb involvement.

• Special Tests and Maneuvers depending upon the area involved.

Examination of involved and uninvolved joints will determine whether warmth, erythema, or swelling is present.

The examination should distinguish true articular swelling caused by synovial effusion or synovial proliferation from nonarticular or periarticular involvement, which usually extends beyond the normal joint margins or the full extent of the synovial space.

Synovial effusion can be distinguished from synovial hypertrophy by palpation or specific maneuvers.

Joints stability can be assessed by palpation and by the application of manual stress.

Subluxation or dislocation, which may be secondary to traumatic, mechanical, or inflammatory causes, can be assessed by inspection and palpation.

Joint volume can be assessed by palpation. Distention of the articular capsule usually causes pain. The patient will attempt to minimize the pain by keeping the joint in the position of least intraarticular pressure and greatest volume, usually partial flexion.

Clinically, joint distention may be detected as

• Swelling
• Voluntary or fixed flexion deformities
• Diminished range of motion-especially on extension, which decreases joint volume.

Active and passive range of motion should be assessed in all planes and compared with contralateral side.

Serial evaluations of joint motion may be made using a goniometer to quantify the arc of movement. Each joint should be passively manipulated through its full range of motion (including, as appropriate, flexion, extension, rotation, abduction, adduction, inversion, eversion, supination, pronation, and medial or lataral deviation or bending).

Limitation of motion is frequently caused by effusion, pain, deformity, or contracture.

Contractures may reflect antecedent synovial inflammation or trauma. Joint crepitus may be felt during palpation or maneuvers and may be prominent in osteoarthritis.

Joint deformity usually indicates a long-standing or aggressive pathologic process. Deformities may result from ligamentous destruction, soft tissue contracture, bony enlargement, ankylosis, erosive disease or subluxation.

Examination of the musculature will permit assessment of strength and reveal atrophy, pain, or spasm. The examiner should look carefully for nonarticular or periarticular involvement, especially when articular complaints are not supported by objective findings referable to the joint capsule.

The identification of nonarticular pain will prevent unwarranted and often expensive additional evaluations.

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