The complete musculoskeletal exam is complex and involves evaluation of every joint and muscle in the body.
In the Emergency Department the physician will be performing either a screening musculoskeletal exam to pick up any gross abnormalities in musculoskeletal function or they will be performing a system specific exam such as in the case of a patient that comes to the emergency department complaining of right ankle pain following an injury while playing basketball.
Every musculoskeletal exam, whether it be general or joint specific involves:
- Inspection of the musculature and joints to evaluate for swelling or deformity
- Range of Motion testing
- Palpation of any joints that appear to be abnormal
- Strength testing
- Sensory examination
The simplest form of musculoskeletal screening exam is simply recorded as “gait normal, no focal defects seen”.
A slightly more detailed examination might include: “No muscular asymmetry noted. No swelling or tenderness of joints. ROM upper and lower extremities normal. Strength is 5/5 and symmetric in the upper and lower extremities. Gait is normal.”
For a joint specific injury the physician will check to see if the circulation to the extremity is normal and they will also evaluate for deformity, swelling, redness, tenderness, and range of motion.
An example of a normal ankle exam might be something like this: “the ankle is nerovascularly intact. Strength and range of motion are normal. The malleoli (ankle bones) are non tender and the patient’s gait is normal.”
Abnormal findings might include:
- Lateral malleolus swollen and tender to palpation
- Diffuse swelling of the midfoot with tenderness at the base of the fifth metatarsal
- Obvious open (bone exposed) deformity of the lateral malleolus with loss of the dorsalis pedis and posterior tibialis pulses (the ankle is dislocated and without circulation and needs to be reduced [set] immediately.