Chapter 3. The General Musculoskeletal Examination

The general musculoskeletal examination (GMSE) is designed to build directly on the sequence and techniques taught in the screening musculoskeletal examination (SMSE). It is intended to provide a comprehensive assessment of joint inflammation through the use of palpation and will enable you to recognize the important physical finding of joint swelling, essential to diagnosing arthritis. While the skills involved are more complex than those of the SMSE, the proper techniques of joint palpation can be mastered on normal individuals.

With practice, a systematic and thorough GMSE can be performed in ∼6 to 8 minutes. Furthermore, the GMSE provides the foundation for learning more detailed, regional musculoskeletal examinations (RMSE) at a later point in your training.

The GMSE is clinically useful as the initial examination in individuals with generalized musculoskeletal complaints (possible arthritis or connective tissue disease) and in individuals with apparently local or regional musculoskeletal complaints found to have additional abnormalities on the SMSE.

This instructional program will enable you to identify the location of the joint line and expected areas of visible and palpable swelling of major peripheral small and large joints. It will develop your skill in joint palpation and permit you to identify the location of clinically important bursae as well as fibromyalgia tender points. Most importantly, it will prepare you to perform a fully integrated GMSE.

Categories of Abnormality

The six basic categories of abnormality you will assess with the general examination include

1. Deformity

2. Visible swelling

3. Muscle atrophy

4. Tenderness, warmth, and palpable swelling (bony enlargement or synovial swelling)

5. Abnormalities of range of motion

6. Abnormalities of gait

Symmetry

A central axial spine, paired peripheral joints, and symmetric 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 in the screening and general musculoskeletal examinations. The combined use of passive as well as active range of motion minimizes the need for patient instruction and this maximizes the speed and efficiency of the examination (Fig. 3–1A, B).

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 (examiner-initiated manipulation).

Importance of Objective Findings

An essential feature of the GMSE is the use of ...