Chapter 35 History taking and Clinical Examination in Musculoskeletal Disease

The components of the musculoskeletal (MSK) system include the bones, joints, ligaments, muscles and tendons as well as the neurological and vascular structures. A simple system allows a concise yet comprehensive history to be taken and a reliable examination to be performed. This will permit diagnosis of the common, the rare and the clinically urgent MSK problems that are likely to be encountered in clinical practice. The gait cycle is all of the activity between the initial contact of the foot with the ground and the succeeding initial contact of the same limb. There are two main stages: the stance phase and the swing phase. The aim of sensory testing is to establish a pattern of sensory loss. Increased movement and flexibility of a joint can often cause joint pain and symptoms of instability. A formal assessment of joint mobility can help document the degree of mobility.

Multiple Choice Questions
Weblinks

Journal articles

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3658379/ (free)

This article provides a detailed overview of the anatomy, aetiology and pathophysiology of tendon injury coupled with comprehensive evaluation and treatment information that clinicians require to optimally design treatment programmes for rehabilitation and prevention.

https://link.springer.com/article/10.1007%2Fs00590-017-1979-8 (paid)

This article provides a detailed description of tests for diagnosing shoulder impingement.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4094013/ (free)

This review provides the reader with a detailed overview of hip examination. It contains 21 steps, which compares well with the shoulder 20-step examination and the knee 33-step examination. Consideration should be given to the four layers that constitute the hip: the osseous, capsulolabral, musculotendinous and neurovascular.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3213012/ (free)

This review analyses the most commonly used tests and signs for knee examination, outlining the correct way to perform the test, the correct interpretation of a positive test and the best management for evaluating an injured knee in both the acute and delayed setting.

https://pubmed.ncbi.nlm.nih.gov/35476673/ (paid)

This review provides a detailed assessment and differential diagnosis of a stiff flat foot with particular reference to the adolescent age group.

Website

https://stanfordmedicine25.stanford.edu/the25/Ankleandfootexam.html (free)

This online resource provides a detailed overview of different aspects of the physical examination of painful conditions of the foot and ankle.

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