35 History taking and clinical examination in musculoskeletal disease

Ankle ( Figure 35.37 ) /uni25CF Dorsiflexion . Test dorsiflexion with the knee both flexed and exten...

Ankle stability Trauma to the ankle is a common cause of instability . Accurate assessment may b...

Anterior cruciate ligament The most sensitive test for evaluation of the ACL is the Lachman test...

Assessment of joint hypermobility Increased movement and flexibility of a joint can often cause j...

CLINICAL EXAMINATION OF THE FOOT AND ANKLE The foot can be divided into three parts: the hindfoot...

CLINICAL EXAMINATION OF THE HAND AND WRIST The hand and wrist should be thought of as one functio...

CLINICAL EXAMINATION OF THE HIP JOINT The hip is a synovium-lined ball-and-socket joint. Typical ...

CLINICAL EXAMINATION OF THE KNEE The knee is a synovial hinged joint. There are three compart - m...

CLINICAL EXAMINATION OF THE SHOULDER Pain arising from the shoulder joint may be felt anterolater...

Cervical spine Look Ensure that the shoulders, back muscles and scapulae can be seen. Look for mu...

ELBOW The elbow is a hinge joint formed by the articulation of the ulna and radius with the hume...

Extensors and flexors Asking the patient to grip two of your fingers in their fist tests the power ...

FURTHER READING Beighton PH, Horan F . Orthopedic aspects of the Ehlers-Danlos syndrome. J Bone ...

Feel Ask the patient if they have any areas of tenderness. Ensure that you do not cause the pat...

Finger flexors ). /uni25CF Superficialis tendon test . The flexor digitorum pro - fundus (FDP) usual...

Flat foot flexibility Use the windlass and Jack’s tests to distinguish a flexible from a fixed flat f...

General principles Apley described a useful and systematic approach to clinical examination. This...

HISTORY Introduction /uni25CF Ensure you have followed appropriate hand hygiene guid ance. /uni25...

Impingement syndrome This is impairment of rotator cu ff function within the subacromial bursa. I...

INTRODUCTION The components of the musculoskeletal (MSK) system include the bones, joints, ligam...

Learning objectives To understand how to: Take a comprehensive musculoskeletal history • Perform ...

Look The inspection begins as soon as you enter the examination room. Look for any walking aids. ...

Lumbar spine Examination should include the pelvis, hips, lower limbs, gait and peripheral vascul...

Metatarsophalangeal joint Test extension (70–90°) by asking the patient to lift the toes to the c...

Midtarsal joint Hold the heel with one hand and move the forefoot medially - (adduction = 20°) a...

Move There are three stages to assessing movement. The words used to describe a particular moveme...

Neurological Focus your examination on the C5 to T1 nerve roots. These supply the upper extremiti...

SPINE The spinal column consists of 33 vertebrae with 23 interver tebral discs. This is supporte...

Snapping hip Snapping hip is a condition in which the patient feels a snap ping sensation or hear...

Special tests Achilles tendon Feel the gastrocnemius and soleus bellies and the whole length of ...

Special tests and diagnoses

Special tests /uni25CF Trendelenburg test ( Figure 35.29 ). Face the patient and ask them to plac...

Subtalar joint ( Figures 35.38 and 35.39 ) Hold the talar neck and ask the patient to move their ...

Subtalar joint flexibility Ask the patient to stand on their toes and observe the heel from behind...

Take a history /uni25CF Presenting complaint . Start with an open-ended question. Ask the patient...

Tarsometatarsal joint stability Stability can be assessed by pushing each joint up and down. Stan...

Tarsometatarsal joint Hold the midfoot and manipulate each metatarsal up and down to estimate the...

Thoracic spine Pathology commonly presents with pain and deformity . The thoracic spine is normal...

Thumb and thenar eminence /uni25CF Abductor pollicis brevis, opponens pollicis and flexor pollicis...

Tibialis anterior Ask the patient to walk on their heels with their feet inverted; the tibialis a...