Musculoskeletal System

PHYSICAL EXAMINATION AND HEALTH ASSESSMENT
MUSCULOSKELETAL SYSTEM
By:
Masroni, S.Kep., Ns., M.S. (in Nursing)
Institute of Health Sciences Banyuwangi 2019
1
MUSCULOSKELETAL SYSTEM CONSIST OF :
1 • Bones
2 • Joints
3 • Muscles
2
HUMANS NEED THIS SYSTEM FOR :
NO NEEDS EXAMPLES
1 Support To stand erect
2 Movement Daily activity
Encase and Inner vital organs: brain, spinal
3
Protect cords, heart, lung
Hematopoiesis: Red Blood
4 Produce cells, White Bloods Cells and
Platelets
Reservoir for Essential minerals: calcium,
5
Storage phosphorus in the bones 3
MUSCULOSKELETAL COMPONENTS
NO COMPONENTS PART AND FUNCTION
1 Skeleton • The bony frameworks that
has 206 bones.
• It supports the body like the
posts and beams of a
building
2 Joints • Is the place of union of two
(Articulation) or more bones.
• Permit the mobility needed
for ADLs (Activity of Daily
Living)
4
3-1 Non synovial Bones:
Joints • are united by fibrous
tissue/cartilage &
• are immovable(e.g. sutures
in the skull) / only slightly
movable(e.g. the vertebrae).
5
3-2 Synovial • are freely movable.
Joints • have bone that are separated
and enclosed in joint cavity.
• Cavity is filled with a lubricant
6
4-1 Muscles account for 40-50% body
1.Skeletal M. weight that contract when
2.Smooth M. produce movement.
3.Cardiac M.
7
4-2 Muscles • is composed of bundles of
-Skeletal M. muscle fibers (fasciculi).
• is attached to bone by a
tendon.
8
4-3 Muscles Produce the following
-Skeletal M. movements.
9
5 Temporomandibular is the articulation of the
Joint (TMJ) mandible and the
temporal bone that
allows 3 functions :
1. to open and close jaw
2. for protrusion and
retraction
3. side-to-side
movement of the
lower jaw
10
6-1 Spine • The vertebrae are 33
connecting bones
stacked in a vertical
column.
• A lateral view shows that
the vertebral column has
four curves
(a-double-S-shape)
11
6-2 Spine • The inter vertebral
disks are elastic fibro-
cartilaginous plates that
constitute ¼ of the
length of column.
• Each disk center has a
nucleus pulposus.
12
7 Shoulder The important part are :
1. Glenohumoral joint
2. Rotator cuff
3. Subacromial bursa
4. Acromion process
5. Greater tubercle
6. Coracoid process
13
8 Elbow Palpable landmark are
the medial and lateral
epicondyles of the
humerus and large
olecranon process of the
ulna between them.
14
9 Wrist and Carpal 1. Radiocarpal joint: the
articulation of the radius
(on the thumb side) and a
row of carpal bones.
2. Midcarpal joint: articulation
between two parallel row of
carpal bones.
3. Metacorpophalangeal and
the interphalangeal joints:
permit finger flexion and
extension
15
10 Hip joint • is the articulation between
the acetabulum and the
head of femur.
• The palpation of the bony
landmark can feel the entire
iliac crest :
1. Anterior superior iliac spine
2. Ischial tuberosity
3. Greater trochanter
16
11 Knee joint The largest and complex joint in
the body.
Articulation of 3 bones: femur,
tibia and patella (kneecap).
17
12 Ankle and Foot Landmark of ankle (tibiotalar
joint) are two bony
preminences: medial malleolus
and lateral malleolus.
18
DEVELOPMENTAL COMPETENCE
NO PERIOD COMPETENCE
1 Infants Form the “scaled model” by 3 months
and gestation
 ossifies into true bone
Children
 grow rapidly during infants
 growth spurt during adolescence.
2 Pregnant Increased hormones level (estrogen, relaxin,
Woman and corticosteroids)
 increase joint mobility in sacrococcygeal,
sacroiliac and symphysis pubis
 changes in maternal posture (lordosis)
3 Aging After 40 years old, loss of bone matric
Adult (resorption) occurs more rapidly than new
bone formation  osteoporosis.
19
DEVELOPMENTAL COMPETENCE
20
SUBJECTIVE DATA
1. Joints: Pain, stiffness, swelling, heat,

redness, limitation of movement
2. Knee joint (if injured)
3. Muscles: Pain (cramps), weakness
4. Bones: Pain, deformity, trauma (fracture,
strain, sprain, dislocation)
5. Functional assessment (ADLs)
21
OBJECTIVE DATA
Preparation
 The purposes : to assess function for ADLs and to screen
for any abnormalities

 Make the person comfortable before and throughout the
examination
 Use firm support, gentle movement, and gentle return to a
relaxed tate
Equipment Needed: 1. Tape measure; 2.Skin marking pen
22
ORDER OF THE EXAMINATION:
INSPECTION
Procedures Abnormal findings
• Note the size and  Swelling
contour of every joint.  Deformities include :
• Inspect the skin and • Dislocation,
tissue over the joints • Subluxation,
for color, swelling, • Contracture
and any masses or • Ankylosis
deformity.
23
ORDER OF THE EXAMINATION:
PALPATION
Procedures Abnormal findings
• Palpate each joint, • Warmth and
including skin for tenderness
temperature, muscles, • Palpable fluids
bony articulations and
joint capsule.
• Notice any heat,
tenderness, swelling,
or masses.
24
RANGE OF MOTION
• Ask for active (voluntary) ROM while modeling the

movements yourself as appropriate; thus you can use
your own movements as a control.
• If you see a limitation, gently attempt passive motion
with the person’s muscles relaxed while move the
body part.
Abnormal findings:
• Limitation in ROM :
• Articular disease or Extra-articular disease
(Rheumatoid arthritis)
• Crepitation
25
MUSCLE TESTING
(TEST STRENGTH OF THE PRIME-MOVER MUSCLE GROUPS
FOR EACH JOINT)
GRADE DESCRIPTION % NORMAL ASSESSMEN
T
Full ROM against gravity, full
5 100 Normal
resistance
Full ROM against gravity,
4 75 Good
some resitance
3 Full ROM with gravity 50 Fair
Full ROM with gravity
2 25 Poor
eliminated (possive motion)
1 Slight contraction 10 Trace
0 No contraction 0 Zero 26
TEMPOROMANDIBULAR JOINT (TMJ)
1. Inspection
 Inspect the area just anterior to the ear.
 Place the tips of your first two fingers in front of each
ear ask the person to open and close the mouth.
 Drop your fingers into the depressed area over the joint
and note smooth motion of the mandible.
 Ask the person to :
Fig. A
 Open mouth maximally (Fig. A)
 Vertical motion. You can measure the space
between the upper and lower incisors. Normal is
3 to 6 cm or three fingers inserted sideways.
 Partially open mouth, protrude lower jaw, and move
it side to side (Fig. B)
 Lateral motion. Normal extent is 1 to 2 cm Fig. B
 Stick out lower jaw
27
TEMPOROMANDIBULAR JOINT (TMJ)
2. Palpation
 Palpate the contracted temporalis and masseter
muscles as the person clences the teeth.
 Compare right and left sides for size, firmness,
and strength.
 Ask the person to move the jaw forward and
laterally against your resistance and open mouth

against resistance
 This also tests the integrity of cranial nerve V
(trigeminal)
28
CERVICAL SPINE
1. Inspect the alignment of head and neck
2. Palpate the spinous processes and the
sternomastoid, trapezius, and paravertebral
muscles.
3. Ask the person to follow these motion :
 Touch chin to chest.
 Flexion of 45 degree (Fig. A)
 Lift the chin toward the ceiling.
 Hyperextension of 55 degrees.
 Touch each ear toward the corresponding
shoulder. Do not lift the shoulder.
 Lateral bending of 40 degrees (Fig. B)
 Turn the chin toward each shoulder.
 Rotation of 70 degrees (Fig. C)
 Repeat the motions while applying opposing
force
29
UPPER EXTREMITY: SHOULDER
1. Inspect and compare both shoulders posteriorly and anteriorly.
 Check the size and contour of the joint and compare
shoulders for equality of bony landmarks.
 Check the anterior aspect of the joint capsule and the
subacromial bursa for abnormal swelling.
 If the person reports any shoulder pain, ask that he or she
point to the spot with the hand of the unaffected side.
2. Palpate both shoulders while standing in front of the person,
noting any muscular spasm or atrophy, swelling, heat, or tenderness.
Palpate the pyramid-shaped axilla.
3. Test the strength of the shoulder muscles by asking the person to
shrug the shoulders, flex forward and up, and abduct against your
resistance (test the integrity of cranial nerve XI, the spinal
accessory).
30
4. Test ROM by asking the person to
perform four motions:
1) With arms at sides and elbows
extended, move both arms forward
and up in wide vertical arcs and then
move them back.
 Forward flexion of 180 degrees.
Hyperextension up to 50 degrees
(Fig. A).
2) Rotate arms internally behind back;
please back of hands as high as
possible toward scapulae.
Internal rotation of 90 degrees
(Fig. B).
31
4. Test ROM by asking the person
to perform four motions:
3) With arms at sides and elbows
extended, raise both arms in
wide arcs in the coronal plane.
Touch palms together above
head.
Abduction of 180 degrees.
Adduction of 50 degrees
(Fig. C).
4) Touch both hands behind the
head with elbows flexed and
rotated posteriorly.
External rotation of 90
degrees (Fig. D).
32
Fig. A
UPPER EXTREMITY : ELBOW

1. Inspect the size and contour of the elbow in both flexed
and extended positions.
 Look for any deformity, redness, or swelling
 Check the olecranon bursa and the normally present hollows on either
side of the olecranon process for abnormal swelling.
2. Palpate with the elbow flexed about 70 degrees and as as
relaxed as possible (Fig. A)
 Use your left hand to support the person’s left forearm and palpate the
extensor surface of the elbow-the olecranon process and the medial
and lateral epicondyles of the humerus-with your right thumb and
fingers.
 With your thumb in the lateral groove and your index and middle fingers
in the medial groove, palpate either side of the olecranon process using
varying pressure.
 Palpate the area of the olecranon bursa for heat, sweeling, tenderness,
consistency, or nodules.
33
Fig. A
UPPER EXTREMITY: ELBOW

3. Test ROM by asking the person to:
 Bend and straighten the elbow (Fig. A).
 Flexion of 150 to 160 degrees; extension at 0.

some healthy people lack 5 to 10 degrees of
Fig. B
full extension, and others have 5 to 10
degrees of hyperextension.
 Movement of 90 degrees in pronation and
supination (Fig. B).
 Hold the hand midway; then touch front and
back sides of hand to table.
4. While testing muscle strength, stabilize the person’s
arm with one hand (Fig. C). Have him or her flex the
elbow against your resistance applied just proximal to
the wrist. Then ask the person to extend the elbow Fig. C
against your resistance.
34
UPPER EXTREMITY: WRIST AND HAND
1. Inspect the hands and wrists on the dorsal and palmar sides,
noting position, contour, and shape.
2. Palpate each joint in the wrist and hands. Facing the person,
support the hand with your fingers under it and palpate the
wrist firmly with both of thumbs on its dorsum (Fig. A).
Palpate the metacarpophalangeal joints with your thumbs, just
distal to and on either side of the knuckle (Fig. B).
Use your thumb and index finger in a pinching motion to palpate
the sides of the interphalangeal joints (Fig. C).
Fig. B Fig. C
Fig. A 35
3. Test ROM by asking the person to:
 Bend hand up at wrist.
 Hyperextension of 70 degrees (Fig. A).
 Bend hand down at wrist.
 Palmar flexion of 90 degrees.
 Bend fingers up and down at metacarpophalangeal
joints.
 Flexion of 90 degrees.
 Hyperextension of 30 degrees (Fig. B).
 With palms flat on table, turn them outward and in.
 Ulnar deviation of 50 to 60 degrees
 Radial deviation of 20 degrees (Fig. C).
 Spread fingers apart; make a fist.
 Abduction of 20 degrees; fist tight.
 should be equal bilaterally (Fig. D and E).
 Touch thumb to each finger and to base of little finger.
 The person is able to perform, and the responses
are equal bilaterally (Fig. F). 36
4. Muscle testing, position the person’s forearm supinated (palm up) and resting
on a table (Fig. A). Stabilize by holding your hand at the person’s midforearm. Ask
the person to flex the wrist against your resistance at the palm.
 Phalen test
 Ask the person to hold both hands back to back while flexing the wrists 90
degrees. Acute flexion of the wrist for 60 seconds produces no symptoms
in the normal hand (Fig. B).
 Tinel Sign
 Direct percussion of the location of the median nerve at the wrist

produces no symptoms in the normal hand (Fig. C).
Fig. A Fig. B Fig. C 37

LOWER EXTREMITY: HIPS
1. Inspect:
 note symmetric levels of iliac crests, gluteal folds, and
equally sized buttocks
 smooth, even gait reflects equal leg lengths and functional
hip motion
2. Palpate:
 help person into supine position and palpate hip joints
 note stability, symmetric, tenderness, and crepitation
3. Assess range of motion (ROM)
assess flexion and extension with the knee straight and with
it bent. Also observe internal and external rotation, abduction,
and adduction.
38
LOWER EXTREMITY: HIPS
3. Assess range of motion (ROM)
1) Raise each leg with knee extended
(hip flexion of 90 degrees)
2) Bend each knee up to the chest
while keeping the other leg straight
(hip flexion of 120 degrees)
3) Flex knee and hip to 90 degrees
(internal rotation of 40 degrees and
external rotation of 45 degrees)
4) Swing leg laterally, then medially,
with the knee straight (abduction of
40-50 degrees and adduction of 20-
30 degrees)
5) When standing, swing straight leg
back behind body (hyperextension of
15 degrees)
39
LOWER EXTREMITY: KNEE
 Person should remain supine with legs extended
1. Inspect: the knee’s shape, color, and contour,
check them for any sign of fullness or swelling,
and the quadriceps muscle in the anterior thigh
for any atrophy.
2. Palpate: start high on the anterior thigh, about
10 cm above the patella. Palpate with your left
thumb and region of the supra-patellar pouch.
Note the consistency of the tissues. The
muscles and soft tissues should feel solid, and
the joint should feel smooth, no warmth,
tenderness, thickening or nodularity.
3. Assess ROM
4. Assess muscle strength： asking the person to
maintain knee flexion while you oppose by
trying to pull the leg forward.
40
 When swelling occurs, test for bulge sign &
ballottement.
 Bulge Sign
 For swelling in supra-patellar pouch, bulge
sign confirms presence of fluid as you try
to move fluid from one side of joint to
other
 Firmly stroke up on medial aspect of knee
two or three times to displace any fluid;
tap lateral aspect and watch medial side
in hollow for distinct bulge from a fluid
wave; normally, none is present
 The bulge sign occurs with very small
amounts of effusion, 4-8 ml, from fluid
flowing across the joint
41
 Ballottement of patella
Test reliable when larger amounts of
fluid present
Use left hand to compress supra-
patellar pouch to move any fluid into
knee joint
With right hand, push patella sharply
against femur; if no fluid is present,
patella is already snug against femur
Palpate infrapatellar fat pad and
patella; check for crepitus by holding
hand on patella as knee is flexed and
extended; some crepitus in knee is
not uncommon
42
Assess ROM
1. Bend each knee (flexion of 130-150
degrees)
2. Extend each knee (a straight line of 0
degrees; a hyperextension of 15
degrees)
3. Check knee ROM during ambulation
4. If able, squat and try a duck walk
5. Flexion: expect 130 degrees
NOTE: limited ROM; contracture; pain;

sudden locking; limp.
43
 McMurray’s test
Special test for meniscal tears:
 Perform test when person has history of trauma followed by locking,
giving way, or local pain in knee
 Position person supine as you stand on affected side
 Hold heel and flex knee and hip;
 Place your other hand on knee with fingers on medial side
 Rotate leg in and out to loosen joint
 Externally rotate leg and push a valgus (inward) stress on knee; then
slowly extend knee; normally leg extends smoothly with no pain
 NOTE: “click” if you hear or feel, McMurray test is positive.
44
LOWER EXTREMITY: ANKLE AND FOOT
1. Inspect: Contour and position, size and
number of toes, alignment, weight bearing,
arch.
2. Palpate: Heat, swelling, tenderness.
3. Assess ROM
4. Assess muscle strength: maintain
dorsiflexion and plantar flexion against your
resistance.
45
1.Inspection
1) Inspect while person sitting and when standing
and walking
2) Compare both feet, noting contour of joints; foot
should align with long axis of lower leg
3) Weight-bearing should fall on middle of foot;
most feet have longitudinal arch, but can vary
normally from “flat feet” to high instep
4) Toes point straight forward and lie flat; note
locations of calluses or bursal reactions as they
reveal areas of abnormal friction
5) Examining well-worn shoes helps assess areas
of wear and accommodation
NOTE: swelling; calluses; ulcers; tenderness;
hammertoes; hallux valgus
46
2. Palpation
1) Support ankle by grasping heel with
your fingers while palpating with your
thumbs; joint spaces should feel
smooth, with no swelling or tenderness
2) Palpate metatarsophalangeal joints
between your thumb on dorsum and
fingers on plantar surface
3) Using a pinching motion of your thumb
and forefinger, palpate the
interphalangeal joints on the medial
and lateral sides of the toes
NOTE: swelling; tenderness
47
3. Assess ROM
1) Point toes toward the floor (plantar flexion of 45 degrees)
2) Point toes toward the nose (dorsiflexion of 20 degrees)
3) Turn soles of feet out, then in (eversion of 20 degrees; inversion of
30 degrees)
4) Flex and straighten toes
NOTE: limited ROM; pain
48
LOWER EXTREMITY: SPINE
Person should be standing, draped in gown open at back. Place
yourself far enough back so that you can see entire back
1. Inspect: note if spine is straight by following imaginary vertical line
from head through spinous processes
to gluteal cleft, and noting equal
horizontal positions for shoulders,
scapulae, iliac crests, and gluteal folds.
Knees and feet should be aligned with
trunk and be should pointing forward.
From the side note the normal convex
thoracic curve and concave lumbar curve.
2. Palpate: the spinous processes
(normally: straight & not tender); the
paravertebral muscles (feel firm,
no tenderness or spasm)
3. Assess ROM
49
3. Assess ROM
1) Asking person to touch toes; look for flexion
of 75 to 90 degrees, and smoothness and
symmetry of movement. Concave lumbar
curve should disappear with this motion;
back should have single convex C-shaped
curve.
2) Bend sideways (lateral bending of 35
degrees)
3) Bend backward (hyperextension of 30
degrees)
4) Twist shoulders to one side, then the other
(rotation of degrees, bilaterally)
5) Asking person to walk on his/her toes for a
few steps and return walking on the heels
NOTE: limited ROM; pain
50
 Straight leg raising or Lasègue's test
 These maneuvers reproduce back and leg pain and may confirm presence
of herniated nucleus pulposus
 Straight leg raising while keeping the knee extended normally produces no
pain
 Raise affected leg just short of point where it produces pain; then dorsiflex
foot
 Test positive if it reproduces sciatic pain; if lifting affected leg reproduces
sciatic pain, it confirms presence of herniated nucleus pulposus
 Raise unaffected leg leaving other leg flat; inquire about involved side
51
 Measure leg length discrepancy
 Perform this measurement if you need to determine if one leg
shorter than other
 For true leg length, measure between fixed points, from anterior
iliac spine to medial malleolus, crossing medial side of knee
 Normally these measurements are equal or within 1 cm,
indicating no true bone discrepancy
52
DEVELOPMENTAL COMPETENCE: INFANTS
Examine infant fully undressed and lying on back; take care to place newborns
on warming table to maintain body temperature
1. Feet and Legs: Note any positional deformities, a residual of fetal positioning.
Note relationship of forefoot to hindfoot. Check for tibial torsion, a twisting of
tibia.
2. Hips: Check hips for congenital dislocation; most reliable is Ortolani’s
maneuver, which should be done at every visit until infant is 1 year old. Allis
test also used to check for hip dislocation.
53
DEVELOPMENTAL COMPETENCE: INFANTS
3. Hands and arms: Inspect hands, noting shape,

number, and position of fingers and palmar creases.
Palpate length of clavicles; the bone most frequently
fractured during birth.
4. Back: Lift infant and examine back; note normal
single C-curve of newborn’s spine. Inspect length of
spine for any tuft of hair, dimple in midline, cyst, or
mass; normally, none are present.
5. Back: Lift infant and examine back; note normal
single C-curve of newborn’s spine. Inspect length of
spine for any tuft of hair, dimple in midline, cyst, or
mass; normally, none are present.
6. Observe ROM through spontaneous movement: Test
muscle strength by lifting up the infant with your
hands under the axillae; baby with normal muscle
strength wedges securely between your hands
54
DEVELOPMENTAL COMPETENCE: PRESCHOOL-
AGE & SCHOOL-AGE CHILDREN
1. Back: note posture; you should note a “plumb line” from back
of head, along spine, to middle of sacrum
2. Shoulders: level within 1 cm; scapulae symmetric; lordosis
common throughout childhood. Lordosis marked with muscular
dystrophy and rickets
3. Legs and feet
 “Bowlegged” stance (genu varum) normal for 1 year after
child begins walking(fig.A)
 “Knock knees” (genu valgum) occurs normally between 2
and 3½ years; no treatment indicated (fig.B)
 Flatfoot (pes planus): pronation, or turning in, of medial side
of foot because normal longitudinal arch concealed by fat
pad until age 3 years
 When standing begins, child takes a broad-based stance,
causing pronation, common between 12 and 30 months
55
DEVELOPMENTAL COMPETENCE:
PRESCHOOL-AGE & SCHOOL-AGE CHILDREN
Legs and feet (cont.)
 Pigeon toes demonstrated when child tends to walk on
lateral side of foot, and longitudinal arch looks higher
than normal. Often starts as forefoot adduction, and
usually corrects spontaneously by age 3 years
 Check gait while child walking away from and returning
to you
 Check Trendelenburg’s sign to screen progressive
subluxation of hip
4. check arm for full ROM and presence of pain: Look for
subluxation of elbow (head of radius). Occurs most often
between 2 and 4 years of age as a result of forceful
removal of clothing or dangling while adults suspend child
by hands.
5. Palpate bones, joints, and muscles of extremities as in
adult examination 56
DEVELOPMENTAL COMPETENCE: ADOLESCENTS
Proceed with same musculoskeletal examination as for adult; pay special note
to spinal posture.
1. Kyphosis common during adolescence because of chronic poor posture
2. Screen for scoliosis with forward bend test: From behind standing child,
ask child to stand with feet shoulder width apart and bend forward slowly
to touch the toes
3. Expect straight vertical spine while standing and also while bending
forward; posterior ribs should be symmetric, with equal elevation of
shoulders, scapulae, and iliac crests
57
DEVELOPMENTAL COMPETENCE: PREGNANT
WOMAN
Proceed through same examination
as for adult. Expected postural
changes in pregnancy include:
1. Progressive lordosis
2. Toward third trimester, anterior

cervical flexion
3. Kyphosis, and slumped shoulders
4. When pregnancy at term,

protuberant abdomen and relaxed
mobility in joints create
characteristic “waddling” gait
58
DEVELOPMENTAL COMPETENCE: AGING
ADULT
1. Postural changes include decrease in
height, more apparent in eighth and ninth
decades
2. Kyphosis common, with backward head
tilt to compensate
3. Contour changes include a decrease of
fat in body periphery; fat deposition over
abdomen and hips
4. Bony prominences become more marked
5. ROM testing proceeds as described
earlier: ROM and muscle strength much
as younger adult, provided no
musculoskeletal illnesses or arthritic
present
59
DEVELOPMENTAL COMPETENCE: AGING
ADULT
Get Up and Go Test
Identify older adults at increased risk of fall. Watch the time it
takes the person to rise from an armchair, walk 10 feet, turn,
walk back, and sit down again. A healthy adult >60 years can
manage this test < 10 seconds.
Functional Assessment
 For those with advanced aging changes, arthritic changes,
or musculoskeletal disability, perform functional
assessment for ADLs
 Applies ROM and muscle strength assessments to
accomplishment of specific activities
 Goal to determine adequate and safe performance of
functions essential for independent home life
60
ABNORMAL FINDINGS
1. Abnormalities affecting multiple joints
2. Shoulder abnormalities
3. Elbow abnormalities
4. Wrist and hand abnormalities
5. Knee abnormalities
6. Ankle and foot abnormalities
7. Spine abnormalities
8. Congenital or pediatric abnormalities
9. Fibromyalgia syndrome
61
1. ABNORMALITIES AFFECTING MULTIPLE
JOINTS
 Inflammatory conditions
 Rheumatoid arthritis
 Ankylosing spondylitis
 Degenerative conditions
 Osteoarthritis (degenerative joint disease) fig.A
 Osteoporosis (fig.B)
Fig. A
Fig. B
62
2. ABNORMALITIES OF SHOULDER
 Atrophy
 Dislocated shoulder
 Joint effusion
 Tear of the rotator cuff (fig A)
 Frozen shoulder, adhesive capsulitis (fig B)
 Subacromial bursitis
Fig. A Fig. B
63
3. ABNORMALITIES OF ELBOW
 Olecranon bursitis (fig A)
 Gouty arthritis (fig B)
 Subcutaneous nodules (fig C)
 Epicondylitis, tennis elbow (fig D) Fig. A
Fig. C Fig. D Fig. B

64
4. ABNORMALITIES OF WRIST AND
HAND Fig. A
 Ganglion cyst (Fig A)

 Colles’ fracture
 Carpal tunnel syndrome
 Ankylosis
 Dupuytren’s contracture
 Conditions caused by chronic rheumatoid arthritis
 Swan-neck and boutonniere deformities
 Ulnar deviation or drift
 Degenerative joint disease or osteoarthritis
 Acute rheumatoid arthritis
 Syndactyly
 Polydactyly
65
5. ABNORMALITIES OF KNEE
 Mild synovitis
 Prepatellar bursitis
 Swelling of menisci
 Post polio (Fig A)
 Osgood-Schlatter disease
Fig. A
66
6. ABNORMALITIES OF ANKLE AND FOOT
 Achillestenosynovitis
 Chronic/acute gout
 Hallux valgus with bunion and hammer toes

(Fig A)
 CPlantar wart Fig. A
 allus
 Ingrown toenail
67
7. ABNORMALITIES OF SPINE
 Scoliosis(fig A)
 Herniated nucleus pulposus Fig. A
68
8. COMMON CONGENITAL OR PEDIATRIC
ABNORMALITIES
 Congenital dislocated hip
 Talipes equinovarus (clubfoot)
 Spina bifida (fig A)
 Coxa plana (Legg-Calvé-Perthes syndrome)
Fig. A
69
9. FIBROMYALGIA SYNDROME
 Chronic disorder of unknown cause
with widespread musculoskeletal
pain lasting >3 months, associated
with fatigue, insomnia, and
psychological distress.
 Diagnostic criteria:
1. A widespread pain index or a 0-
19 count of the person’s report
of the number of painful body
regions.
2. Fatigue, non-refreshed sleep,
cognitive problems, somatic
symptoms on a 0-3 severity
scale.
70
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PHYSICAL EXAMINATION AND HEALTH ASSESSMENT

1. Joints: Pain, stiffness, swelling, heat,

for any abnormalities

• Ask for active (voluntary) ROM while modeling the

laterally against your resistance and open mouth

UPPER EXTREMITY : ELBOW

UPPER EXTREMITY: ELBOW

 Flexion of 150 to 160 degrees; extension at 0.

 Direct percussion of the location of the median nerve at the wrist

Fig. A Fig. B Fig. C 37

4. If able, squat and try a duck walk

5. Flexion: expect 130 degrees

NOTE: limited ROM; contracture; pain;

NOTE: limited ROM; pain

3. Hands and arms: Inspect hands, noting shape,

2. Toward third trimester, anterior

4. When pregnancy at term,

 Osteoarthritis (degenerative joint disease) fig.A

 Subcutaneous nodules (fig C)

 Epicondylitis, tennis elbow (fig D) Fig. A

Fig. C Fig. D Fig. B

 Ganglion cyst (Fig A)

 Post polio (Fig A)

 Hallux valgus with bunion and hammer toes

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