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These checklists are just a guide – they are to assist with watching the normal PE videos
– although they do not perfectly follow the videos. Some of the videos go a little more in
depth just to show you a complete exam - but – as medical students – you are primarily
responsible for what is in your small group sessions, which is amplified in the below
checklists. This information is also in your MSK textbook as well, under the PE section.
Thus – you have multiple sources to assist you in learning the basics of the MSK PE.
Remember - the videos and this checklist are a guide – to supplement the small group
sessions and ultimately to teach you how to perform and understand an effective MSK
PE.
Shoulder:
Knee/leg
Inspection:
a) atrophy/deformity/skin changes – note knee is a superficial joint – see these
things well – versus hip – deep joint
b) normal knee contours –
a. quadriceps
b. patella
c. patella tendon
d. tibial tubercle
e. medial and lateral joint line
f. effusion versus no effusion – look to the supra-patellar pouch – which
will be full if there is a big effusion
c) evaluate alignment of knee
d) resting position of knee – (contractures/flexion)
Palpation:
a) quadriceps insertion
b) patella
c) patella tendon
d) tibial tubercle
e) medial and lateral joint line
f) medial and lateral epicondyle
g) MCL/LCL origin/insertion
h) Pes anserinus insertion
i) Fibular head
Special Testing:
a) ligamentous exam: check integrity of ligaments
a. MCL – valgus stress test
b. LCL – varus stress test
c. ACL – Lachmans/anterior drawer
d. PCL – posterior drawer
b) meniscus testing
a. joint line tenderness
b. McMurray’s – pain or click is a positive test if in location of presumed
meniscus tear – ie – medial joint line clicks or hurts with this
maneuver if you suspect a medial meniscus tear
c) patella ballottement to check for effusion - most times you will see this
effusion on inspection and if not – will check on the palpation part of the
exam.
d) Straight leg raise – to check for integrity of extension mechanism: this is
really part of your active knee extension test – patient should be able to fully
actively extend knee to full extension – which is 0 degrees.
e) Patella apprehension – if the patient has a history of patella dislocations – they
always occur laterally because the MPFL is torn. Lateral pressure on the
patella will cause apprehension – or fear – in the patient that you will dislocate
the patella.
f) Check quick hip exam as sometimes hip pain refers to the knee and the
hip is the issue!
g) Always check a neurovascular exam
Back Exam
Palpated costovertebral angles for tenderness
Palpated spinous processes of thoracic and lumbar spine
Palpated paraspinal muscles of lumbar spine
Assessed ROM of back (flexion, extension, lateral bending)