Chapter 2. The Screening Musculoskeletal Examination

The screening musculoskeletal examination (SMSE) is designed to provide an introduction to the physical assessment of musculoskeletal structures and will enable you to recognize normal joint appearance and alignment, the spectrum of normal joint range of motion and will help you recognize basic abnormalities of musculoskeletal structure and function. As a screening examination, it is brief yet systematic, is easily performed, and increases examiner confidence that no important musculoskeletal findings have been overlooked. With practice, the SMSE can be performed in ∼ 3 to 4 minutes. Furthermore, the screening examination provides the foundation for learning a more complete examination, the GMSE, at a later point in your training.

The SMSE is clinically useful as the musculoskeletal component of an athletic preparticipation physical examination, as part of a complete physical examination, or as the initial examination in an individual with a local or regional musculoskeletal complaint with possible musculoskeletal symptoms in other sites.

This instructional program will emphasize five categories of abnormality and will define the important role of symmetry in assessing the musculoskeletal system. It will outline the principles of active and passive range of motion and illustrate the neutral position and the principal direction of motion for most peripheral joints and the axial spine. Most importantly, it will prepare you to perform a fully integrated SMSE.

Categories of Abnormality

The five basic categories of abnormality you will assess with the screening examination include

1. Deformity

2. Visible swelling

3. Muscle atrophy

4. Abnormalities of range of motion

5. Abnormalities of gait

Symmetry

A central axial spine, paired peripheral joints, and symmetrical musculature provide the basis for essential side-to-side comparison during the musculoskeletal examination. Recognizing asymmetry is extremely important and may provide your first clue in diagnosing an abnormality.

Active and Passive Range of Motion

Both active and passive range of motion are used to assess joint function. Active range of motion is patient-initiated movement of the joint. Active range of motion tests integrated function and requires intact innervation, muscle and tendon function, as well as joint mobility (Fig. 2–1A).

Passive range of motion is examiner-initiated movement of the joint, and tests only joint mobility. The combined use of passive as well as active range of motion minimizes the need for patient instruction and thus maximizes the speed and efficiency of the examination (Fig. 2–1B).

Whenever joint movement is anticipated to be painful, it is best to first observe active range of motion (patient-initiated movement) to appreciate the degree of pain and dysfunction before gently attempting passive range of motion ...