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HEAL100 Health Care — exam and revision material · Other

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Health Care study guide material, 86 pages. Originally published on StudyMerit.

Pages
86
Academic year
2025/2026
Language
English

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Physical examination: General musculoskeletal approach  Foundational Principles  Purpose of the Musculoskeletal Exam  Identify mechanical, inflammatory, traumatic, or systemic causes of joint and muscle complaints.  Differentiate between localized and systemic musculoskeletal diseases.  Evaluate patient-reported functional limitations and correlate them with clinical findings.  Clinical Context  Review the patients:  Baseline level of function and activities of daily living (ADLs)  Occupational and recreational activities  History of trauma, overuse, autoimmune disease, systemic illness, or surgery  Strategic Considerations  Determine whether a screening exam (asymptomatic patients) or focused exam (complaint-based) is indicated.  Always compare bilaterally and begin with the unaffected side.  Core Musculoskeletal Examination: IPROMS Framework  Inspection  General Observations  Observe patient movement while entering the room: Antalgic gait, guarding, use of assistive devices, note posture, ease of transitions from sit to stand, and body alignment.  Specific Observations  Assess for:  Joint symmetry: Is the process monoarticular, oligoarticular, or polyarticular?  Asymmetry: Assess muscle bulk and contour  Deformities: Valgus (knock-knees), varus (bowlegs), ulnar deviation or swan neck deformities (RA), fasciculations or tremors, examine joint above and below complaint  Hypertrophy: Assess for incidence of muscle spasms or of repetitive use  Atrophy: Assess for evidence of neurologic deficit or musculotendinous rupture  Skin changes: Scars, rashes (e.g., psoriasis), erythe0ma, ecchymosis, ulcers, temperature differences

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 Functional Posture and Use  Look for compensatory patterns (e.g., leaning, joint offloading)  Assess spinal curvature (kyphosis, lordosis, scoliosis)  Palpation  Technique and Purpose  Use fingertips and palms to palpate bone landmarks, joints, and soft tissue structures.  Compare sides systematically.  Warm your hands to reduce patient discomfort.  Findings to Assess  Tenderness:  Localized vs. diffuse  Along bone, joint lines, or tendinous insertions  Swelling:  Effusion within joints  Boggy synovial thickening (e.g., synovitis in RA)  Soft tissue edema (e.g., in tendinitis or trauma)  Crepitus:  Audible or palpable grinding during movement (OA, joint degeneration)  Nodules or Masses:  Rheumatoid nodules, ganglion cysts, tophi  Redness:  Least common sign of inflammation near the joint  Suggests acute inflammation of the joint or synovium: Septic, crystal-induced, or rheumatoid arthritis  Increased warmth:  Compare to contralateral joint using the dorsal hand surface  Range of motion  Active Range of Motion  Patient moves the joint independently.  Observe:  Smoothness  Range (full vs. restricted)  Pain or crepitus  Compensation from adjacent joints  Passive Range of Motion  Examiner supports and moves the joint.  Assess:  Resistance to movement

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 Pain reproduction  Mechanical vs. inflammatory limitations  Interpreting Limitations  Decreased ROM:  Intra-articular: Joint inflammation, synovitis, effusion, OA  Extra-articular: Tendinitis, bursitis, nerve entrapment, fibrosis  Neurologic: Muscle weakness, spasticity  Special maneuvers  Purpose  Identify ligament instability, joint capsule tears, impingements, or mechanical derangements  Reproduce symptoms (pain, instability, clicking) with movement targeting specific structures  General Examples  Shoulder:  Neer and Hawkins tests (impingement)  Empty can (supraspinatus tear)  Knee:  Lachman’s (ACL tear): Excessive laxity  Stabilize femur with one hand, pull anteriorly on tibia with other  McMurray’s (meniscal tear): Pain or palpable click with hand on joint line  With foot everted, knee in varus position, gently flex/extend knee while palpating the medial joint line  Invert foot, with knee in valgus position  Palpate lateral joint line while gently extending and flexing the knee  Hip:  FABER/Patrick’s test (SI joint)  Used to detect pathology in the hip as well as the sacroiliac joint  Flexion, abduction, external rotation  Stabilize opposite ASIS and push on crossed knee  Wrist:  Finkelstein’s (de Quervain’s tenosynovitis)  Spine:  Straight Leg Raise (lumbar radiculopathy)  Spurling’s test (cervical nerve root compression)

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