M1 H&P: Musculoskeletal

Devin Nickol, M.D.

 

I. General Exam Points

- Inspect

- Palpate

- Test range of motion

- Test strength

- Perform special maneuvers (e.g. Trendelenburg test)

 

II. Shoulder

- Abduction/adduction

- Flexion/extension

- Internal/external rotation

- Strength testing (shrug)

 

Muscle Function Level
Score
No evidence of contractility
0
Slight contractility, no movement
1
Full range of motion, gravity eliminated
2
Full range of motion, against gravity
3
Full range of motion, against gravity, some resistance
4
Full range of motion, against gravity, full resistance
5

 

III. Elbow

- Flexion/extension

- Pronation/supination

- Presence of effusion

 

IV. Wrist

- Palpation

- Flexion/extension

- Abduction/adduction

 

V. Hand and Fingers

- Inspection

- Heberden's nodes

- Bouchard's nodes

- Range of motion

- Tinel's sign

- Phelan's sign

- Asterixis

 

VI. Hip

- Flexion/extension

- Abduction/adduction

- Internal/external rotation

- Trendelenburg test

 

VII. Knee

- Check for pretibial edema

 

Physical Finding
Score
No detectable edema
0
Slight pitting, disappears rapidly
1+
Deeper than 1+, disappears in 10-15 seconds
2+
1 cm deep and may last more than one minute
3+
2 cm deep and lasts 2-5 minutes
4+

 

- Flexion/extension

- Check for joint effusion

- Patellar tap

- Bulge sign

- Drawer test for cruciate ligament stability

 

VIII. Ankle and Foot

- Dorsi/plantar flexion

- Inversion/eversion/rotation

- Flexion/extension of toes

 

IX. Spine

- Range of motion

- Cervical spine

- Thoracic spine

- Lumbar spine