CLINICAL EXAMINATION

Diagnostic approachdepends upon assessmentof function

SELECTIVE TENSION

• Passive movements stress inert structures

• Resisted movements test contractile structures

EXAMINATION FOLLOWS A SET ROUTINE

OBSERVATION

• Face• Posture• Gait

HISTORY

• Age and occupation, sports hobbies, lifestyle

• Site and spread• Onset and duration

HISTORY

• Symptoms and behaviour• Other joint involvement• Past medical history• Medications

INSPECTION

• Bony deformity• Colour changes• Wasting• Swelling

PERIPHERAL JOINTS

Palpate for:• Heat• Swelling• Synovial thickness•Not for tenderness

STATE AT REST

•Position of the pain

ACTIVE MOVEMENTS

•Pain•Range•Willingness

OTHER FINDINGS

•Painful arc

PASSIVE MOVEMENTS

FOR INERT STRUCTURES

• Joint capsule• Bursa• Dura mater• Nerve root

• Ligament• Fascia• Dural nerve

root sleeve• Relaxed muscle

and tendon

PASSIVE MOVEMENTS

FOR INERT STRUCTURES

• Pain• Range• End-feel

PASSIVE MOVEMENTS

• Capsular pattern

• Non-capsular pattern

NORMAL END-FEEL

• Hard

• Soft

• Elastic

ABNORMAL END- FEEL

• ‘Hard’• Spasm• Springy• Empty

CAPSULAR PATTERN

• Arthritis• Varies from joint to joint• Limitation in a fixed proportion

which varies according to the joint

• Same whatever the cause of the arthritis

NON-CAPSULAR PATTERN

• Intra-articular displacement• Ligamentous lesion• Extra-articular lesion

RESISTED TESTS

FOR CONTRACTILE STRUCTURES

• Muscle• Tendon• Attachments to bone

RESISTED TESTS

• Pain• Power• Relaxed contractile unit may

produce pain on passive stretching

RESISTED TESTS

• Joint in mid position• No joint movement• Eliminate muscles not tested• Test muscles strongly• Patient and examiner positioned

to advantage

RESISTED TESTS

• Strong and painless• Strong and painful• Weak and painless• Weak and painful• Painful on repetition• All painful/juddering

NEUROLOGICAL EXAMINATION

• Reflexes• Power• Sensation• Plantar response

OTHER TESTS

• Mechanical/neural tests• Blood tests• X-ray• EMG• Scans

PALPATION

Once the structure at fault has been identified