Musculoskeletal Exam Physical Diagnosis I MPA 510

Initial Survey of Exam Washes hands and greets patient Establishes good rapport with patient Properly drapes patient Temporomandibular Joint Verbalize inspecting the TMJ for symmetry, redness, or swelling Palpate the TMJ and muscles of mastication (masseters, temporalis, pterygoids) Check TMJ ROM (opening, closing, protrusion, retraction-note any crepitus or pain) Shoulders Inspect for swelling, deformities, muscle atrophy, tremors, or malpositioning Palpate bony landmarks (acromiom, , coracoid process, AC joint, greater tubercle) Palpate bicipital grove Perform complete range of motionflexion extension abduction adduction external rotation internal rotation Perform strength tests Supraspinatus (empty can test arms at 90, internally rotated, thumbs down, resisting downward pressure) Infraspinatus (Arms at side, flexed at 90, thumbs up, resisting abduction) Perform Apley Scratch test Perform drop arm test Elbows Palpate bony landmarks (medial/lateral epicondyles, olecranon process) and note any abnormalities or tenderness Perform flexion/extension Perform ROM (supination/pronation ) Perform strength test Forearm supination- (Arms at side, flexed at 90, thumbs down, resisting resisting pronation) Wrists/Hands Inspect for any deformities or swelling Palpate bones (radius/ulnar/carpals/metacarpals) Palpate joints (MCP/PIP/DIP) for any tenderness, bogginess, or nodes Palpate anatomical snuff box Perform ROM of wrists (flexion/extension/abduction/adduction) Perform ROM of fingers including thumb opposition(flexion/extension/abduction/adduction) Perform Tinels sign Perform Phalens sign

Musculoskeletal Exam Physical Diagnosis I MPA 510

The Spine With patient standing, observe posture for any obvious abnormalities Palpate spinous processes and paraspinous muscles Palpate trapezius muscle Range of motion-cervical spine(flexion/extension/rotation/lateral bending) Locate palpate sacroiliac joint ROM of lumbar spine (flexion/extension/rotation/lateral bending) The Hip Palpate bony landmarks (iliac crest, iliac tubercle, ASIS, greater trochanter, pubic symphisis) ROM of hips (flexion/extension/abduction/adduction/external and internal rotation) The Knee Inspect knees look for genu valgum (knock knees)/varum (bowlegs) Inspect knees for any swelling, erythema, symmetry, atrophy of quadriceps Palpate knees while flexed for bony landmarks and joints (both medial & lateral) Extend knees and have patient tighten quadriceps and note patellar movement ROM of knees (flexion/extension) Perform Medical Collateral ligament testing (move thigh 30 laterally-place one hand against lateral knee and the other at the medial ankle-push medially and pull laterally to check the MCL-valgus stress) Perform Lateral Collateral ligament testing (move thigh 30 laterally-place one hand against medial knee and the other at the lateral ankle-push laterally and pull medially to check the LCLvarus stress) Perform Anterior/Posterior drawer test (ACL/PCL) McMurrays sign Bulge sign (for minor effusion) Ballottement (for major effusion) The Foot/Ankle Observe the feet and ankles for any deformities, swelling, lesions, calluses, or corns Palpate the bony anatomy in the foot Palpate the achilles tendon attachment at the calcaneus Palpate metatarsophalangeal joints (forefoot) and the five metatarsals and their grooves with thumb and index fingers ROM Plantar flexion (Point foot to the floor) Dorsiflexion (Point foot towards the ceiling) Inversion (Bend your heel inward) Eversion (Bend your heel outward)

Musculoskeletal Exam Physical Diagnosis I MPA 510