27. Musculoskeletal examination

When examining the musculoskeletal system, it is important for the patient to be sufficiently unclothed, so that the connections between the joints and any left-right differences can be observed. There is no need to remove underwear. The examination should be carried out in the following order: inspection (including palpation), gait, passive movement assessment, isometric muscle tests, clinical palpation and any other tests indicated. The patient should be observed throughout the examination to determine the ranges of motion and any movement limitations. Make sure that you can always see the patient’s face while doing the physical examination. Any abnormalities found from physical examination should always be interpreted in light of the patient’s context (from history-taking). Physical examination findings will be more reliable if the findings from history-taking, inspection, movement assessment, specific tests and palpation combined are consistent with the diagnosis.