Musculoskeletal history taking & Physical examination

Musculoskeletal history taking

— In addition to normal history taking, you will need to add for musculoskeletal disease risk factors and a system review.

— Risk factors:

- Occupation and sport

- Family history

- Infection

- Medication

- Overseas travel

- Past history of musculoskeletal injury or condition

Systemic review

— Assess pain use WWQQAA plus B

— Where – the location and radiation of a symptom

— When – when it began, fluctuation over time, duration

— Quality – what it feels like

— Quantity – intensity, degree of disability

— Aggravating and alleviating factors – what makes it worse, what makes it better

— Associated symptoms

— Beliefs – fractures, ligaments torn or sprains

Physical Examination

1.Look/Observe:

Swelling

Wasting of muscle

Erythema

Asymmetry

Traumatic bruises

Scar

2.Feel:

- Temperature

- Tenderness

- Synovitis

- Effusion

- Bony swelling (hard and immobile)

3.Move:

- Active

- Passive

- Stability(stress the joint in abnormal direction)

- Crepitus(feel or hear)

4.Measure:

- Range of motion (use goniometer, tape measure or ruler)

5.Special test:

- Straight leg raising

- Crossed straight leg raising

- Femoral stretch

- Trendelenburg test

- Apprehension test

- McMurray’s test

Herniated disc and Spinal stenosis

— Observe : Posture, gait

— Palpate : Spinous process and interspinous ligaments

— Move : Extension, Flexion, Lateral flexion, Rotation

— Special test:

1. Trendelenburg test

2. The straight-leg raising test

3. Crossed straight-leg raising test

4. Femoral stretch test

Piriformis syndrome

— Look : gait, posture

— Palpate: the piriformis muscle

— Internal rotation of the ipsilateral hip

— Move : Flexion, Rotation(internal & external), Abduction, Adduction, Extension

— Test :

1. Lasegue test

2. The beatty test