Knee Examination

Inspection

 Examines both knee joints for SEADS (swelling, erythema, muscle atrophy, deformity,
skin changes)
 Comments on presence of valgus/varus deformity

 States that the hips and ankles should be examined as well

Palpation

 Palpates knees for crepitus, warmth, and effusion.

 Palpates along joint-line for tenderness
 Palpates for Baker’s cysts ( popliteal cyst..etc meniscus tear,arthritis )

 Tests passive range of motion for effected knee

Tests for Effusion

 Examines for Bulge Sign

 Uses fluctuation to assess for effusion ( patellar tap sign)

  Tests for ballottement

Range of Motion/Gait

 Assesses patient’s gait

 Assesses active range of motion for both knees

Stability

 Assesses for LCL and MCL damage

 Assesses for ACL damage using Anterior Drawer Sign

 Assesses for PCL damage using Posterior Drawer Sign

Special Tests

 Assesses for meniscal tears using McMurray Test

Hip Examination

Inspection

 Examines both hips joints for SEADS (swelling, erythema, muscle atrophy, deformity,
skin changes)
 Assesses all active range of motion for both hips (flexion/extension, abduction/adduction,
rotation)
 Assesses patient’s gait (patient refuses due to pain)
 States that the lower back and knees should be examined as well

Palpation

 Palpates hips, PSIS, and ASIS for tenderness

 Determines real and apparent leg lengths (notes that there is a significant difference)
 Assesses peripheral pulses
 Assesses neurologic status of effected limb
 Tests all passive range of motion for effected hip

Special Tests

 Performs Trendelenburg’s Test assessing for hip abductor strength

 Assesses for flexion contracture of effected hip while eliminating lumbar lordosis
Back/Lumbar Examination

History

 Onset of back pain

 Location, and if pain is unilateral/bilateral
 Quality of pain (dull)
 Radiation of pain (none)
 Alleviating and aggravating factors
 Medications/therapies that have been attempted/are successful to relieve the pain
 Associated trauma or overuse injury
 Sensory loss (none)
 Parasthesia (none)
 Motor deficits (none)
 Fever, weight loss, or other systemic symptoms (none)
 Bladder or bowel incontinence
 Past history of back pain
 Personal history of peripheral vascular disease
 Smoking history (quantity in pack-years)
 Dyslipidemia
 Personal history of malignancy
 Effect on daily activities

Physical Examination

Inspection

 Comments on shape of spine – kyphosis, scoliosis, as well as posture

  Comments on any asymmetry of the back, including swelling, scars, or bruising

Range of Motion/Gait

 Observes all active ranges of motion for the back

 Assesses patient’s gait

Palpation

 Palpates along spinous processes and paraspinal muscles of the back for tenderness
 Performs straight leg raise on both sides, with and without ankle dorsiflexion (negative)
 Palpates peripheral pulses (present)
 States that an abdominal exam should be performed to rule out an abdominal aortic
aneurysm

Neurological exam
 Tests foot sensation (L4, L5, S1)
 Tests for saddle anesthesia (S3, S4, S5)
 Tests knee (L4) and ankle reflex (S1)
 Tests Babinski response
 Tests power of big toe and foot dorsiflexion, as well as foot plantarflexion (S1)
 Assesses for hip abduction (L5); states that full hip examination should be performed
 States that rectal tone should be assessed
Shoulder pain

History

 Onset and duration of pain (began during softball)

 Progression
 Alleviating and aggravating factors (worse when bring arm above the shoulders)
 Quality and location of pain
 Radiation
 Presence of night time or morning symptoms (worsens at night)
 Sensory symptoms in the affected arm e.g. numbness, tingling
 Motor symptoms in affected arm e.g. weakness, decreased grip strength
 Associated stiffness
 Fever and other systemic symptoms
 Personal history of arthritis
 Associated trauma/overuse
 Past shoulder pain
 Pain in other joints
 Occupational history as it relates to the pain
 Family history of arthritis
 Effect on daily activities

Physical Examination

Inspection

 Examines both shoulders for SEADS

 Assesses all active ranges of motion of shoulder
 Examines the neck for range of motion
 States that the elbow should be examined as well

Palpation

 Palpates shoulder for crepitus, warmth, and effusion

 Palpates the sternoclavicular, acromioclavicular, and glenohumeral joints for
tenderness/deformity
 Palpates all bony aspects of the shoulder joint
 Tests passive range of motion for affected shoulder

Special Tests

 Assesses for rotator cuff pathology

 Assesses for impingement of muscle tendons
 Assesses for shoulder instability

 Hand Pain

History

 Identifies affected hand joints (MCPs, PIPs)

 Onset of pain
 Aggravating factors (activity)
 Alleviating factors (rest, Advil)
 Character
 Radiation
 Association with morning stiffness and duration of stiffness (lasts more than 1 hour)
 Other affected joints, elsewhere in the body
 Frequency (intermittent flare-ups)
 Nighttime pain
 Fever, night sweats, weight loss, or other systemic symptoms
 Associated rash
 Mouth ulcers, dry mouth
 GI symptoms
 Associated neurologic symptoms
 Ophthalmologic symptoms: dry eyes, irritation
 History of trauma
 Current medications
 Personal history of rheumatologic disease
 Family history of diabetes, thyroid disease, or Celiac disease (autoimmune diseases)
 Family history of rheumatologic conditions
 Effect on daily activities

Physical Examination

Inspection of Hand joints, including Wrist

 Comments on presence/absence of erythema and effusion

 Comments on deformities, muscle wasting, and deviations

Palpation of hand joints, including the wrist

 Warmth
 Tenderness
 Effusion
 Crepitus
 Instability
 Neurologic exam of hand for power and sensation

Range of Motion
  Assess active and passive range of motion of all joints in the hand

Extra-articular examination for autoimmune disease

 General: presence/absence of edema, muscle wasting, cachexia

 Oral examination: ulcers
 Respiratory examination: effusions, interstitial disease
 Musculoskeletal: other effused joints
 Dermatologic: rashes, ulcers, petechiae
 Ophthalmologic: iritis