Wednesday, 19 Jun 2024

Basic Principles of Assessing Musculoskeletal Minor Injuries

In primary care settings, healthcare professionals often encounter patients with musculoskeletal minor injuries. These injuries can affect any major joint in the body and can significantly impact a patient’s quality of life. This guide provides an overview of the basic principles for assessing these injuries in each major joint.

A fundamental approach to the assessment of musculoskeletal injuries is the ‘Look, Feel, Move’ examination:

  1. Look: Begin by visually inspecting the joint for any signs of swelling, redness, or deformity. Look for any skin changes, muscle wasting, or asymmetry.
  2. Feel: Palpate the joint to assess for warmth (which might indicate inflammation), tenderness (which might indicate a specific area of damage), or effusion (swelling within the joint).
  3. Move: Assess both active (patient-initiated) and passive (examiner-initiated) range of motion. This includes movements in all planes applicable to the specific joint.

Following this initial assessment, perform special tests to assess the integrity and function of specific structures within each joint:

Neck

Neck assessment involves observing for any visible abnormalities (like asymmetry or muscle wasting), palpating for tenderness or deformity, assessing active range of motion (flexion, extension, rotation), and conducting special tests if needed (like Spurling’s test for cervical radiculopathy). It is also important to note any red flags that may indicate serious pathology.

Shoulder

The shoulder is a complex joint with a wide range of motion. Special tests like the Neer’s sign, Hawkins-Kennedy test, and the apprehension test can help identify specific injuries such as rotator cuff tears or impingement syndromes.

Elbow

For the elbow joint, manoeuvres like the valgus stress test, varus stress test, and the Tinel’s sign can be used to assess the stability of the joint and the integrity of the ulnar nerve.

Wrist and Hand

Check the range of motion and grip strength. Special tests like the Finkelstein’s test can help diagnose conditions like De Quervain’s tenosynovitis.

Hip

The hip joint can be assessed using manoeuvres like the Thomas test, Trendelenburg test, and Patrick’s (FABER) test. These tests help evaluate hip flexor tightness, gluteal muscle function, and hip joint integrity respectively.

Knee

For the knee joint, tests like McMurray’s test, Lachman’s test, and valgus/varus stress tests are commonly used. These tests help identify meniscal tears and assess the integrity of the anterior/posterior cruciate ligaments and collateral ligaments.

Ankle and Foot

In the ankle and foot joints, manoeuvres like the anterior drawer test for the ankle, Thompson’s test, and windlass test can be used. These tests help assess conditions like ankle instability, Achilles tendon rupture, and plantar fasciitis respectively.

Remember, these assessments are part of a comprehensive examination of each joint. Clinical decision making should be based on findings from the entire history and physical examination. Always compare with the contralateral side when possible. If there’s any doubt about a diagnosis, further imaging or referral may be necessary.

For further understanding of the physical examination specialty manoeuvres of the knee, consider referring to the article Physical Examination Specialty Manoeuvres of the Knee on the PDUK website. This resource is a valuable tool for healthcare professionals seeking to enhance their knowledge in this area. Don’t miss out on this opportunity to expand your expertise!

References

Stanford Medicine 25 (2023) ‘Knee Exam’, Stanford Medicine 25, available at Stanford Medicine 25.

NPS MedicineWise (2023) ‘Physical examination of acute ankle and knee injuries’, NPS MedicineWise, available at NPS MedicineWise.

Physiopedia (2023) ‘Knee Examination’, Physiopedia, available at Physiopedia.

Geeky Medics (2023) ‘Knee Examination – OSCE Guide’, Geeky Medics, available at Geeky Medics.

Debette, C., Neyret, P., Magnussen, R.A., Servien, E., Lustig, S. (2023) ‘Degenerative Knee Assessment: Physical Examination and Outcome’, SpringerLink Sports Injuries,