Screening Musculoskeletal Exam

Upper Extremities

With the patient seated comfortably and appropriately undressed, begin the examination
of the upper extremities.

Inspect for deformity, visible swelling, muscle atrophy or abnormal joint range of
motion.

HANDS

Instruct the patient to open both hands.

Observe the dorsal and palmar surfaces and the intrinsic muscles.

Assess finger extension by asking the patient to spread the fingers.

Next, assess finger flexion by having the patient make a fist.

Inspect both fists during supination and pronation of the forearms.

WRISTS

Inspect the wrists. Extend and flex the wrists.

ELBOWS

Inspect, then flex and extend the elbows.

SHOULDERS

Inspect the deltoid muscles.

Observe shoulder flexion by asking the patient to bring the arms forward and raise them
overhead.

Observe shoulder internal rotation by having the patient place both hands behind the
back. Then assess shoulder external rotation by asking the patient to place both hands
behind the head.

Lower Extremities

Now begin the examination of the lower extremities.

Inspect for deformity, visible swelling, muscle atrophy or abnormal joint range of
motion.
HIPS

Ask the patient to lie down.

Assess hip flexion by grasping the ankle and moving the thigh up toward the chest.

Return the thigh to a position perpendicular to the exam table while holding the shin
parallel to the exam table.

Now, move the ankle medially to assess hip external rotation. Move the ankle laterally to
assess hip internal rotation.

Return the leg to the table.

KNEES

Observe the quadriceps muscles.

Inspect the knees.

Flex and extend each knee.

ANKLES

Inspect the ankles.

Dorsiflex and plantar flex the ankles.

FEET

Inspect the midfoot and toes.

Inspect the plantar surface of both feet.

ALIGNMENT

Now ask the patient to stand.

Observe the patient from behind while weight bearing.

Note the alignment of the knees. Inspect the calf muscles.

Now with the patient standing, begin the examination of the spine.

Inspect for deformity or abnormal range of motion.

CERVICAL SPINE

Inspect the cervical spine.

Assess neck flexion by instructing the patient to place his chin on the chest.

Assess neck extension by asking the patient to look up at the ceiling.

Observe right and left rotation by asking the patient to place his chin on each shoulder.

Assess lateral flexion (or lateral bending) by asking the patient to incline his ear toward
each shoulder.

Note the alignment of the heels and feet.

THORACIC AND LUMBAR SPINE

Now, while observing the patient from behind, inspect the thoracic and lumbar spine.

Observe lumbar flexion by instructing the patient to bend forward at the waist.

Assess lumbar extension by having the patient bend backward.

Assess thoracolumbar lateral flexion (or lateral bending) by asking the patient to bend to
the right and to the left.

Gait

Finally, observe the patient's gait.

Check for any limp, uneven rhythm or asymmetry.

Observe the swing and stance phases.

This completes the examination.