CLINICAL EXAMINATION OF MUSCLOSKELETAL SYSTEM

CLINICAL EXAMINATION OF MUSCLOSKELETAL SYSTEM

SEQ 01:

MUSCLOSKELETAL SYSTEM:

DEFINITION:

The system of muscles and tendons and ligaments and bones and joints and associated tissues that move the body and maintain its body form, organic structure, physical structure, is termed as musculoskeletal system.

CLINICAL EXAMINATION OF MUSCLOSKELETAL SYSTEM:

Clinical examination of musculoskeletal system can be done as:

GENERAL OBSERVATION:

• General appearance

 • Gait

 • Deformity

 • Swelling

• Redness

OBSERVATION:

Observe the hands, extensor surfaces, face, trunk, legs, feet etc and following things will be observed:

1.      HANDS:

§  Swelling

§  Deformity

§  Nail changes

§  Tophi

§  Reynaud’s

2.      EXTENSOR SURFACES:

§  Rheumatoid nodules

§  Swollen bursa

§  Psoriasis rash

3.      FACE:

§  Rash

§  Alopecia

§  Mouth ulcer

§  Eyes

4.      TRUNK:

§  Kyphosis

§  Scoliosis

§  Tender spots (fibromyalgia, enthesitis)

5.      LEGS:

§  Deformity

§  Swelling

§  Restricted movement

6.      FEET:

§  Deformity

§  Swelling (gout, dactylitis)

§  Redness

EXPLANATION:

Pain:

Pain is the most common symptom that brings a patient with musculoskeletal diseases to the physician. Pain is a subjective hurting sensation or experience described in various terms, often of actual or perceived physical damage. Pain is a complex sensation that is difficult to define, qualify, and measure. The patient’s pain may be modified by emotional factors and previous experiences.

Stiffness:

Stiffness is a common complaint among patients with arthritis. What is meant by stiffness varies from patient to patient, however. Some patients may use the term stiffness to refer to pain, soreness, weakness, fatigue, or limitation of motion.

Rheumatologists generally use the term stiffness to describe discomfort and limitation on attempted movement of joints after a period of inactivity.

 The duration of stiffness related to inactivity varies, with mild stiffness lasting minutes and severe stiffness lasting hours.

Morning stiffness is an early feature of inflammatory arthropathies and is particularly noted in rheumatoid arthritis and polymyalgia rheumatica, in which morning stiffness may last for several hours.

Limitation of Motion:

Limitation of motion is a common complaint among patients with articular disorders. This complaint must be differentiated from stiffness, which usually is transient and variable, whereas limitation of motion secondary to joint disease is generally fixed and varies less over time. The interviewer should determine the extent of disability resulting from the restriction in joint motion.

Swelling:

Joint swelling is an important symptom in patients with rheumatic diseases. The presence of true joint swelling narrows the differential diagnosis in a patient with arthralgia. To determine whether the swelling is related to joint synovitis as opposed to soft tissue conditions, clarifying the anatomic location and distribution of the swelling is key.

Weakness:

Weakness is another common complaint that can be associated with myriad different subjective meanings. True weakness is the loss of muscle power. When present, it is demonstrable on physical examination.

Fatigue:

Patients with musculoskeletal disorders frequently complain of fatigue. Fatigue can be defined as an inclination to rest even though pain and weakness are not limiting factors. Fatigue after varying degrees of activity that is relieved by rest is normal. Patients with rheumatic diseases experience fatigue even without activity. Fatigue generally improves as the systemic rheumatic disease improves.

Loss of Function:

The comprehensive history should include an assessment of the patient’s ability to perform activities of daily living, as loss of function is a common manifestation of musculoskeletal disease with serious impact on health and quality of life. The extent of disability may vary from loss of the ability to use one finger joint due to arthritis to complete physical incapacitation due to severe inflammatory polyarthritis.