An Introduction to the Musculoskeletal Clinical Exam

'Big Muscles' via Zecode.info

Musculoskeletal Clinical Exams are used in conjunction with the appropriate history taking to ascertain the likelihood of a disorder within the bone or muscles structures. The two main categories into which these disorders can be split into are Disease and Trauma, as summarised below.


Disorders of the Musculoskeletal System by Aaron Sparshott (CC 3.0 license)

This will be a brief overview of the principles of a Musculoskeletal Exam, with a closer look later at the assessment of the;
  • Spine
  • Upper Limb
  • Lower Limb
Each segment will take a look at the anatomy associated with the area, methods to assess function and clinical signs.

In cases particularly involving trauma, it is important to try and determine the mechanism of action. For example the circumstances that led up to and after the patient breaking their arm.

Symptoms
Symptoms to look for when diagnosing a musculoskeletal disorder;
  • Pain
  • Joint Instability
  • Stiffness
  • Skin Changes
  • Tenderness
  • Swelling and,
  • probably the most important from the patient's perspective is a loss of function
If pain is present it's is important to investigate further. A helpful mnemonic for exploring aspects of pain is NILDOCAAFIAT. Shown below is what each letter stands for;

Nature
Intensity
Location
Duration
Onset
Contributing
Aggravating
Alleviating
Frequency
Impact
Attribute
Treatment

The nature of the Musculoskeletal exam can probably be best summed up by this quote from Kenneth E. Sack, MD.
A comprehensive assessment of the musculoskeletal system includes inspection and palpation of joints and soft tissues as well as evaluation of joint range of motion and neuromuscular function. CURRENT Rheumatology Diagnosis & Treatment.

Below is a diagram outlining the general process of a musculoskeletal clinical exam.

General Steps in a Musculoskeletal exam by Aaron Sparshott (CC 3.0 license)


The most common further investigation to perform is some form of diagnostic imaging. Such as;
  • Xray
  • Ultrasound
  • Computed Tomography (CT)
  • Magnetic Resonance Imaging (MRI)
Resources

An overview of the Musculoskeletal Exam by Colon H. Wilson is freely available from the NCBI.

Clinical Assessment of the Musculoskeletal System provided by Arthritis Research UK.
Download Here
    Other Clinical Exams
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