MSK Exam

Question 1

What are the components of the MSK exam for the TMJ?

Answer 1

• Inspection*: for swelling, redness, deformities, symmetry
• Palpation*: for tenderness, fluid range of motion, “clicking” sensation, crepitus; also examine masseter and temporalis muscles
• ROM (active)*: Ask pt to open & close jaw slowly & demonstrate protrusion, retraction, & lateral motion of the jaw. Oral aperture should be ≥3-finger breadths.

Question 2

What are the components of the MSK exam for the neck?

Answer 2

• Inspection*: for symmetry, swelling, redness, deformities. Inspect from front, back & sides. Identify the C2 & C7 spinous processes.
• Palpation*: spinous processes & paravertebral muscles for tenderness/spasm
• ROM*: flexion (45°), extension (55°), rotation (70°), lateral flexion (40°).

Question 3

What are the components of the MSK exam for the spine & posterior pelvis?

Answer 3

• Inspection* (posterior & lateral): Observe posture. Assess for normal/abnormal curvatures of spine, symmetry, muscle mass, & bony abnormalities.
• Palpation*: Identify thoracic+lumbar spinous processes, sacroiliac joints, PSIS’s, & iliac crests. Palpate spinous processes & paravertebral muscles for tenderness/spasm.
• Percussion*: With ulnar surface of fist, tap on spinous processes to test for tenderness.
• ROM (active)*: Flexion, extension (30°, place hands on the PSIS), rotation (30°, place hands on hips), lateral flexion (35°).

Question 4

What are the components of the MSK exam for the shoulder?

Answer 4

• Inspection*: for deformity, swelling, atrophy, or asymmetry
• Palpation*: Identify acromion, AC joint, long head of biceps tendon (can have externally rotate arm a bit), clavicle, SC joint, & spine of the scapula. Palpate landmarks for areas of tenderness/crepitus.
• ROM* (active): flexion (180°), extension (50°), abduction (180°), adduction (50°), internal rotation (90°), & external rotation (90°) (high five = external, bring arms down = internal)
• Strength*: Abduction (deltoid) & adduction

Question 5

What are the components of the MSK exam for the elbow?

Answer 5

• Inspection*: for deformity, swelling, atrophy, or asymmetry
• Palpation*: Identify medial+lateral epicondyles, radial head (lateral), ulnar groove (ulnar nerve’s location, by medial epicondyle), anterior cubital fossa, distal biceps & triceps tendons, olecranon process & bursa. Palpate for swelling, masses, tenderness or nodules.
• ROM* (passive & active): Flexion (160°) (pt make T then touch hand to shoulder, extension (0°), pronation & supination (90°)
• Strength*: Biceps & triceps

Question 6

What are the components of the MSK exam for the wrist?

Answer 6

• Inspection*: for deformity, swelling, atrophy, asymmetry, radial/ulnar deviation of wrist
• Palpation*: Identify distal radius & ulnar styloid, scaphoid (anatomic snuff box), carpal tunnel. Note any tenderness, swelling, nodules or redness.
• ROM*: Extension (70°), palmar flexion (90°), radial (20°) & ulnar (55°) deviation
• Strength*: Wrist flexors & extensors

Question 7

What are the components of the MSK exam for the hand?

Answer 7

• Inspection*: Inspect the hands in motion to see if the motions are smooth & natural.
• Palpation*: Identify MCP, PIP, & DIP joints. Palpate with thumb & index finger, the medial & lateral aspects of the joints.
• ROM*: Flexion & extension (make fist then spread fingers), abduction & adduction (spread fingers apart & together), thumb opposition (touch the thumb to each finger)
• Strength*: Grip, finger abduction, thumb opposition checked against max resistance

Question 8

What are the components of the MSK exam for the hip?

Answer 8

• Inspection*: Observe gait, limb length (distance between ASIS & medial malleolus), symmetry of iliac crests, bruising, muscle swelling, or atrophy.
• Palpation*: Identify iliac crest, ASIS, greater trochanter, ischial tuberosity, & proximal hamstring tendon (inserts on ischial tuberosity). Palpate for tenderness.
• ROM* (passive & active): Flexion (130°, knee to chest), extension (15°, prone), abduction (45°) & adduction (30°) (passive, stabilize pelvis, grasp ankle), internal (40°) & external (45°) rotation (passive, flex knee, grasp ankle)
• Strength*: Hip flexors, hip extensors, abduction, adduction. Test one hip at time.

Question 9

What are the components of the MSK exam for the knee?

Answer 9

• Inspection*: for muscle mass, swelling, effusion, bony abnormalities, varus/valgus
• Palpation*: medial & lateral epicondyles, iliotibial band, medial & lateral joint lines, patella, patellar tendon, tibial tuberosity, pes anserine bursae, fibular head, hamstring tendons. Palpate for tenderness, swelling, joint effusion, smooth motion, & crepitus
• ROM* (passive & active): Flexion (135°), extension (supine/seated/squat)
• Strength*: Quadriceps (extension), hamstrings (flexion)

Question 10

What are the components of the MSK exam for the ankle?

Answer 10

• Inspection*: for deformities, swelling, or nodules
• Palpation*: Identify anterior ankle joint, medial malleolus, lateral malleolus, anterior talofibular ligament, calcaneofibular ligament, tendon of anterior tibialis, Achilles tendon. Palpate landmarks & assess for tenderness, swelling & warmth.
• ROM* (passive & active): dorsiflexion (20°), plantar flexion (45°), inversion (30°), & eversion (20°)
• Strength*: dorsiflexion, plantar flexion

Question 11

What are the components of the MSK exam for the feet?

Answer 11

• Inspection*: for deformities, swelling, nodules, calluses or corns, number & position of toes, abnormalities of the longitudinal arch of the foot
• Palpation*: Palpate calcaneus, metatarsal bones, base of the 5th metatarsal, peroneal tendon, MTP & IP. Compress forefoot between thumb & fingers & evaluate for pain.
• ROM* (passive & active): flex & extend the toes in relation to the feet
• Strength*: Great toe dorsiflexion, great toe plantar flexion