Chapter 4: Musculoskeletal Examination

INTRODUCTION

The musculoskeletal system includes bones; muscles with their related tendons and synovial sheaths; bursa; and joint structures such as cartilage, menisci, capsules, and ligaments. Acute injuries or chronic conditions that disrupt the anatomy or physiology of musculoskeletal tissues can greatly affect a patient's function by causing direct impairments such as pain, inflammation, swelling, structural deformity, restricted joint movement, joint instability, and muscle weakness. Examples of diagnoses that result in direct impairment of the musculoskeletal system include fracture, rheumatoid arthritis (RA), osteoarthritis (OA), joint dislocation, tendinitis, bursitis, muscle strain/rupture, and ligament sprain/rupture.

Many pathological conditions that initially affect other body systems such as the neurological, cardiovascular, or pulmonary systems can result in secondary or indirect impairment of the musculoskeletal system. This often occurs when patients' activities are restricted by the condition—perhaps as a result of confinement for a period of time to a bed or wheelchair—or the patient moves the upper extremities (UEs) or lower extremities (LEs) in an inefficient or stress-causing pattern. Diagnoses that can cause indirect impairments of the musculoskeletal system include traumatic brain injury (TBI), cerebral vascular accident (CVA), cerebral palsy (CP), spinal and peripheral nerve injury, burns, and myocardial infarction (MI), just to name a few.

Both direct and indirect musculoskeletal impairments can contribute to activity limitations and participation restrictions and disability that affect a patient's ability to perform certain tasks and roles in society. By considering the few examples of diagnoses that cause direct and indirect musculoskeletal impairments provided in the previous paragraph, one can appreciate how often physical therapists and other health professionals encounter clinical problems affecting the musculoskeletal system. Administering specific tests and measures is almost always a major component of an initial patient examination.

This chapter discusses the purposes of, and provides a general framework for, conducting a musculoskeletal examination. The principles and components of a musculoskeletal examination, together with how to organize and integrate the data with those of other body systems, are emphasized. Other resources are available that provide detailed musculoskeletal testing procedures of specific body regions.^1,2,3,4,5

PURPOSES OF THE MUSCULOSKELETAL EXAMINATION

Evaluation of data from the musculoskeletal examination contributes to establishing a diagnosis and prognosis, setting anticipated goals and expected outcomes, and developing and implementing a plan of care (POC). A musculoskeletal examination is also an important component of evaluating treatment outcomes both periodically during the treatment process and at the conclusion of the episode of care. ...