Contents
Introduction
This stands for:
- Gait
- Arms
- Legs
- Spine
The exam is a quick way of screening for musculoskeletal dysfunction. Most of the exam can be done without actually having to touch the patient, just ask them to copy your movements.
It is not a diagnostic examination, but basically a screening technique to asses if there may be underlying pathology that needs further investigation.
None of the movements should be painful, if pain is elicited, this is a sign for further investigation.
Questions
- What is your occupation?
- Do you have any pain or stiffness in your joints, muscles or back?
- Can you walk up and down stairs without difficulty?
Gait
- Does the patient need a walking aid?
- Check symmetry
- How easily is the patient able to stand up and sit down in a chair?
- Is there varus or valgus deformity?
- Are the feet abnormally inverted / everted?
- Are they generally unsteady (especially when turning)
- Look at posture –look at the normal spinal curvature and see if there are any abnormalities
- Is the patient able to turn quickly
Arms
Hands
- Quick inspection for any obvious abnormalities
- Ask the patient to make the prayer sign. This tests more than you would think!
- MCP, PIP and DIP extension
- Extension of the wrist
- Ask them to make the inverted prayer sign
- Ask the patient to make a fist
- Are they able to cover their nails?
- Also asses grip
- Assess pinch – check all fingers can oppose, and then test pinch strength
- Briefly look at the hands for signs of deformity
- Squeeze the MCP joints
- Check the tendon sheaths for thickening and trigger finger
- Squeeze the MCP joints as a crude test for inflammatory arthritis
Elbow
- Quick inspection for any obvious abnormalities
- Check extension – should go to 180’, but not beyond 190’
- Test if the patient can touch their ipsilateral shoulders
- Test pronation and supination
- Ask the patient to tuck their arms into their sides, with the elbow flexed at 90’, then ask them to pronate and supinate the hands
Shoulder
- Quick inspection for any obvious abnormalities
- Check abduction and elevation
- Internal rotation is important for getting dressed
- External rotation can be useful for checking lesions of the shoulder capsule – as it is often badly affected in these
- Adduction and external rotation can be examined together by asking the patient to put their hands on the back of their head
Spine
First observe, and check for any gross abnormalities, normal spinal curvature, and shoulder height
- Examine from the side and the back!
- Feel down the length of the spine feeling the: Spinous processes & Paraspinous muscles
Cervical spine
- Squeeze the levator scapulae – Tender in cervical pathology and fibromyalgia
- Test lateral flexion – but bear in mind that the range of movement tends to decrease with age – Ask the patient to ‘touch their ear to their shoulder’
- Test flexion and extension
Thoracic spine
Ask the patient to sit down (to eliminate involvement of the hips), and then rotate
Lumbar spine
- Ask the patient to touch their toes, and look for particularly restricted movement
- You can do a very crude estimation of lumbar flexion, by placing two fingers about 5cm apart (or as far as you can) on the lumbar spine as the patient bends over
- Do further tests (i.e. Schober’s Test) if you are suspicious
Hip
- With the patient lied flat on their back, check hip flexion
- Also quickly check internal rotation whilst the hip is still flxed
Knee
- Look for swelling and, and check for effusions (patella tap is sufficient)
- Look at quadriceps bulk
- Look for varus and valgus deformity (if you didn’t get a chance when assessing gait!)
Foot and ankle
- Inspect the sole of the foot for callouses
- Look for abnormal separation of the toes
- Squeeze the MTP joints – screening for inflammatory arthritis
- Check the foot arches
Any abnormal findings or pain require further assessment!