- Does the problem arise from the joint, tendon, or muscle?
- Is the condition acute or chronic?
- Is the condition inflammatory or non-inflammatory?
- What pattern do affected areas/joints follow?
- How does it impact the patient's life?
Definitions
Musculoskeletal System
The system in the body composed of muscles, bones, tendons and ligaments that support the body, allow movement, and protect vital organs.
Joint
A structure in a body where two or more bones are joined together, facilitating movement.
Tendon
A flexible but inelastic cord of strong fibrous collagen tissue attaching a muscle to a bone.
Ligament
A short band of tough, flexible fibrous connective tissue which connects two bones or cartilages or holds together a joint.
Socrates Method for History Taking
In musculoskeletal assessment, the Socrates method involves a systematic approach to understanding the patient's history and the specifics of their condition. The following questions are crucial in this method:
Detail of Injury Questions
For a comprehensive understanding, ask:
- Onset - When did the injury occur?
- Mechanism of injury - How did the injury occur?
- Ability to weight bear immediately after injury?
- Effect on daily activities?
- Pain on movement?
- Presence of swelling? How quickly did it occur?
- Any clicking, locking, or giving way of the joint?
- Previous injuries to the joint?
- Patient's concerns/ideas?
Symptoms
Identifying symptoms is fundamental, including:
- Heat
- Pain
- Redness
- Swelling
- Weakness/Loss of function
- Locking/Triggering
- Deformity
- Extra-articular manifestations
- Bruising
Examination Techniques
Observe (LOOK):
Examine exposed areas and compare with unaffected sides looking for swelling, deformity, or abnormalities.
Palpate (FEEL):
Touch joints or muscles to find tenderness, swelling, or abnormalities. Know surface anatomy for accurate palpation.
Assess:
Evaluate range of motion (ROM), strength, joint instability, coordination, and balance.
Special Tests:
Tests for peripheral nerve damage and assess pulses can be necessary.
Common Musculoskeletal Problems
Understanding common conditions aids diagnosis:
- Soft tissue injury (muscle, tendon, ligament)
- Fracture
- Dislocation/Subluxation
- Compartment syndrome
- Infection
- Overuse conditions
- Degenerative conditions
REMS: Regional Examination of Musculoskeletal System
A structured approach:
- Look at the joint/s
- Feel the joint/s
- Move the joint/s
- Assess joint/s function
Terminology for Positional Orientation
Understanding directional terminology is crucial:
- Superior - above
- Inferior - below
- Anterior - to the front
- Posterior - to the back
- Ventral – front
- Dorsal - back
- Distal - furthest away
- Proximal - closest
- Lateral - outside
- Medial - towards the middle
- Superficial - surface
- Deep - deep
Anatomy and Function: The Shoulder
Examination: LOOK, FEEL, MOVE (flexion, extension, abduction, adduction, rotation), and assess FUNCTION (power, resistance). Special Tests: Conduct tests such as the painful arc and cross arm test for comprehensive evaluation.
Painful arc (Supraspinatus tendonitis/impingement?)
Pain between 70-120o of active abduction
+ve? test if worsens with resistance
Cross-arm test (AC joint pathology)
Pain over AC joint in flexion to 90o with active adduction
Additional Assessments and Tests
Consider performing:
- C-spine examinations
- Neurological tests
- X-rays in cases of trauma, prolonged symptoms, suspected arthritis, or severe pain
Elbow Examination
Methodical approach:
- LOOK
- FEEL
- MOVE: Flexion, Extension, Hyperextension, Pronation, Supination
- FUNCTION: Grip test
- SPECIAL TESTS: Maudsley's test, Tinel’s Sign
Maudsley’s test: (lateral epicondylitis)
For lateral epicondylitis
- • Pain on resisted middle finger extension
Tinel’s sign
• For Carpal tunnel or other neurological conditions
• Tapping median nerve produces paraesthesia (numbness/pin needle)
Wrist and Hand Injury Examination
- LOOK for asymmetry or deformity.
- FEEL for warmth or tenderness.
- MOVE: Test wrist and hand movements including flexion, extension, and opposition.
- FUNCTION: Assess grip power and resistance.
• Pain or tenderness over scaphoid bone
To remember :
In understanding musculoskeletal assessment, use the Socrates method for thorough history taking, identifying key symptoms, and conducting a meticulous examination through observation, palpation, and assessment. Recognize common issues such as soft tissue injuries and degenerative conditions. Adequately examine specific regions like shoulder, elbow, and wrist using appropriate special tests to diagnose underlying musculoskeletal problems efficiently.