Advanced Physical Diagnosis Online Companion

Dr. Oliver and Mr. Peirce, the First Physician and Surgeon Examining Patients Afflicted with Paralysis, Rheumatism, and Leprosy
Painted by William Hoare, 1761

The musculoskeletal exam is a broad part of the comprehensive physical exam, but in most cases will be focused by patient complaint.  For the majority of musculoskeletal problems, we recommend beginning with observing the anatomical area in question, and assessing for warmth, discoloration, symmetry, deformity, and other visible pathology.  

This is followed by palpating the concerning region, noting any abnormalities or unusual features.  Examiners should then move to evaluating range of motion - both passive (the examiner provides the force needed to move a joint) and active (the examinee provides the force needed to move a joint) - of the affected area, including the proximal and distal joints.  

Finally, depending upon the anatomical area or pathology in question, examiners may implement a variety of special tests or maneuvers to help narrow the diagnosis.  Of note, all aspects of the musculoskeletal exam should be applied bilaterally, so as to differentiate variants of normal anatomy from true pathology.

Included on this page are articles (organized by pathophysiology) and instructional videos for refining the musculoskeletal exam.

Click to Access the Following PDFs:

1: Digital clubbing

2: Modified Phalen's test as an aid in diagnosing carpal tunnel syndrome

Bates' Visual Guide to Physical Examination,  Volume 16:

Musculoskeletal System