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LEARNING OBJECTIVES
Identify the purposes of performing a musculoskeletal examination.
Discuss the components of a musculoskeletal examination.
Identify questions that should be included in a patient interview.
Describe the procedures used to selectively test specific tissue types in a musculoskeletal examination.
Identify additional procedures that often complement a musculoskeletal examination.
Using the case study examples, apply clinical decision-making skills in evaluating musculoskeletal examination data.
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The musculoskeletal system includes bones; muscles with their related tendons and synovial sheaths; bursa; and joint structures such as cartilage, menisci, capsules, and ligaments. The musculoskeletal system works in concert with the nervous system to produce purposeful movement. Injury and disease can greatly affect function by causing impairments such as pain, inflammation, limited movement, instability, and weakness. Examples of diagnoses that result in direct impairment of the musculoskeletal system include fracture, rheumatoid arthritis, and other systemic diseases, osteoarthritis, joint dislocation, tendinosis, bursitis, muscle strain/rupture, and ligament sprain/rupture. Of note is that musculoskeletal disorders are the second most common cause of disability worldwide, measured by years lived with disability, with low back pain being the most frequent condition.1 In addition to primary musculoskeletal impairments, 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. Both direct and indirect musculoskeletal impairments can contribute to activity limitations and participation restrictions that affect a patient's ability to perform certain tasks and roles in society. Thus, performing a systematic, evidence-based, and thorough evaluation is an important skill for health-care professionals who encounter patients with musculoskeletal disorders, as it will form the foundation of an effective treatment plan. In addition to an understanding of the musculoskeletal system and the pathologies that affect it, the clinician must understand psychosocial aspects of care that affect outcome.
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This chapter discusses the purposes of, and provides a general framework for, conducting a musculoskeletal examination. Other resources are available that provide detailed musculoskeletal testing procedures of specific body regions.2
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PURPOSES OF THE MUSCULOSKELETAL EXAMINATION
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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 effectiveness throughout an episode of care. The purposes of performing a musculoskeletal examination include the following:
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To determine the presence and extent of impairments, activity limitations, and disability
To identify the specific tissues and pathology causing/contributing to the impairment, activity limitation, or disability when possible
To establish objective baseline status against which progress will be measured
To formulate appropriate goals, expected outcomes, and a POC in consultation with the patient
To determine the presence of red flags and yellow flags and determine if consultation with other health-care providers is ...