Detailed joint examination is often omitted from routine medical assessments. However, musculoskeletal complaints are prevalent, making a solid understanding of normal and pathological joint anatomy and physiology essential for evaluating patients. By grasping the fundamentals of joint structure and function, you can systematically approach examinations, even if you can’t recall specific test names.
This guide offers detailed descriptions of shoulder, knee, and lower back examinations, as these areas are frequently affected. Furthermore, it provides a review of relevant anatomy, function, and common disorders for most major joints. Note that this is not an exhaustive list.
General Considerations for Musculoskeletal Examination
Key historical aspects to consider when assessing joint-related complaints:
- What functional limitations exist?
- Are symptoms localized to a single region or affecting multiple joints?
- Is the onset acute or gradually progressive?
- If an injury occurred, what was the mechanism?
- Has the patient experienced prior issues with the affected area?
- Are there any systemic symptoms present?
A standardized approach to joint examination is recommended:
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Ensure adequate exposure of the area, removing any obstructing clothing. Gowns can be useful.
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Carefully inspect the joint(s) in question for signs of inflammation or injury (swelling, redness, warmth), and deformity. Compare bilaterally, as many joints are symmetrical.
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Understand normal functional anatomy. What movements does the joint typically perform?
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Observe the joint during attempted normal activity. What limitations are present? What specifically restricts them? Was a specific event (e.g., trauma) responsible? If so, what was the injury mechanism?
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Palpate the joint. Is warmth present? Is there point tenderness? If so, identify the underlying anatomical structures.
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Assess range of motion, both active (patient-initiated movement) and passive (examiner-assisted movement) if active motion is restricted or painful.
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Evaluate strength and neurovascular status.
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Perform specific provocative maneuvers relevant to potential pathology within that joint (see descriptions under each joint).
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In acute injuries and pain, joint assessment can be challenging due to patient guarding, limiting movement and hindering examination. Examining the unaffected side first can build patient confidence and establish their baseline.
For Additional Information See: Digital DDx: Joint Pain or Swelling and Digital DDx: Muscle Aches
