MSK Physical Exams Checklist

Spine Lower Spine Inspect Special Tests • Side: (comment on Cervical Lordosis, Thorasic Kyphosis, ☐ Adam’s Forward Bend Test (scoliosis) Lumbar Lordosis) ☐ Schober’s Test (Lumbar spine flexibility) • Back: Is there scoliosis? • Look at gate (comfortable posture, position of spine, position Nerve Roots of (flex hip to guard?) ☐ Spinal nerve root exam o Stance phase on each side “Walk down the leg” (L2, L3, L4, L5, S1) o Swing phase on each side ☐ Reflex of knee and ankle o Watch head, trunk, arm, hip, knee and ankle movement Sciatic Nerve (L4-S3) Palpate ☐ (with Dorsi Flexion) + Crossover Sign • Find C7 (contralateral) • Hands on pelvis (L3) ☐ Bowstring • PSIS (L5) • Feel if pelvis is level Higher Nerve Roots • Feel the spinus processes ☐ Femoral Test (for femoral neuropathy/ L2-L4) • Feel paraspinus muscles both sides

ROM • Flexion: Bend Forward (Where is the bend coming from? Measure distance from ground. ) • Extension: Bend Back • Lateral Flexion (Side to Side with arms on side) • Rotation (Siting Position)

C-Spine ROM Special Tests • Bring head down to chest ☐ Nerve Root Exam (C5, C6, C7, C8) • ear down to shoulder ☐ Spurling (Foraminal compression test) • Rotate Side to Side ☐ Ociput to Wall

MedNotable.com Shoulder Inspect AC Joint: • Look for anterior fullness, square shoulder, holding onto arm, ☐ Scarf Test Popeye sign? • Look at Sulcus – should see a divot Glenohumoral Joint: (looking for dislocation) • AC joint fullness (dislocation)? ☐ Apprehension Test (or axial loading)

Palpation Biceps • Sternoclavicular joint ☐ Yergeron • Clavicle ☐ Speed’s Test • Acromioclavicular joint • Greater tuberosity of humerus : • Bicipital groove Impingement • Glenohumeral joint line ☐ Neer’s • Spine of scapula ☐ Hawkins-Kennedy Test (Extra) • Vertebral border of scapula • Rotator cuff SupraSpinatus (abduction) • Subacromial & subdeltoid bursa ☐ Drop Arm Test ☐ Empty Can Test/Jobe’s ROM • Abduction Subscapularis: (internal rotation) • Adduction ☐ Lift-Off Test • Flexion • Extension Infraspinatus/Teres Minor (external rotation) • Internal rotation ☐ Horn Blower’s Test • External rotation

Elbow Inspect Bruising, carrying angle Special Tests ☐ Medial Epicondylitis (+ve test: pain over medial epicondyle) Palpate § aka “Golfer’s ” • Medial epicondyle § Resisted wrist flexion • Olecranon § Resisted pronation • Lateral epicondyle ☐ Lateral Epicondylitis (+ve test: pain over Lat. epicondyle) Radial head § Aka “Tennis elbow” • rd • Biceps tendon § Resisted extension of 3 finger • Ulnar nerve § Resisted wrist extension § Resisted supination • Olecranon bursa ☐ Colateral Ligament Stability (MCL/LCL) ROM ☐ Tinel Sign (Ulnar Nerve) • Flexion • Extension • Forearm supination • Forearm pronation

Wrist and Hand Inspect Special Tests Palpate ☐ Allen’s Test (Vasculature of Hand) • Extensor tendons ☐ Finklestein’s Test (for Dequervain’s -for tendonitis of the thumb • Anatomic snuff box extensors & abductors) • Radial Styloid ☐ Phalens Test, Tinel’s Test (Carpel Tunnel) • ulnar syloid/Distal ulna ☐ Axial Load/Grind Scafoid • Look for dinner fork sign (radial fracture) • Hook of hamate • 1st CMC joint • Thenar/hypothenar muscles • DIPs and PIPs

ROM • Wrist: flexion, extension, ulnar deviation, radial deviation • Finger: flexion, extension, abduction, adduction • Thumb: flexion, extension, abduction, adduction, opposition

Hip Inspect Special Tests ☐ Log Roll (internal/external rotation) • ASIS ☐ Trendelenburg test (hip abductor/gluteus mediusweakness) • Greater trochanter ☐ OBER (Tight IT Band) • Ischial tuberosity ☐ FABER (SI Joint) ☐ (hip flexion ) ROM • Flexion • Extension • Abduction • Adduction • Internal rotation • External rotation

Knee Inspect Special Tests • with malleolus touching look if knees touch Joint Effusion: • Looks for genu valgum/varum ☐ /Tap Test Palpation ☐ Knee Milking • Patella ☐ Luminescence Test (Extra) • Prepatellar/infrapatellar/suprapatellar bursa • Medial joint line Stability: • Lateral joint line ACL/PCL • Pes anserine bursa ☐ Anterior/Posterior • Tibial tubercle ☐ • Popliteal fossa ☐ Pivot Shift (Extra) • Fibular head • MCL/LCL Meniscus • Patellar & quadriceps tendon ☐ McMurray (Medial = Valgus + Ex rot, Lateral = Varus +Int. Rot) ☐ Thessaly Test (Extra) ROM § Flexion (Measure heel to buttock) MCL/LCL • Extension ☐ Apply Valgus/ Varus force

Ankle Inspect Special Tests • Bruising over lateral and medial side, can you see the veins ☐ Talar Tilt/Inversion & eversion stress testing (calcaneofibular and and contours well? look for hair growth or loss deltoid stability) • Observe Gate: Heel Toe Strike, flexion contracture? ☐ Anterior Drawer (anterior talo-fibular ligament stability) • Look at Medial malleolus, Tibial posterior tendons, bumps ☐ Thompson Test (Achilles Tendon) around 1st MTP? Bunion/bunonettes? ☐ Tinel Sign (Tarsal tunnel) • Look at syndesmotic ligament, anterior talus fibular ligament ☐ Morton’s Neuroma Test (Extra) • Heel (sides of the heel for growth plates, plantar fasciitis, Achilles tendon)

Palpation • 1st MTP joint • medial malleolus • lateral malleolus • deltoid ligament • lateral ankle ligaments • Achilles tendon • Plantar fascia • Heel pad ROM • Plantar flexion • Dorsiflexion • Inversion • Eversion • Supination (combination of heel inversion, adduction & plantar flexion of forefoot) • Pronation (heel eversion, abduction & dorsiflexion of forefoot) • Flexion & extension of toes

Nerve Roots (See ASIA International Standards for Neurological Classification of Spinal Cord Injury) C-Spine Motor Sensory C5 Elbow Flexion Lateral Deltoid C6 Wrist Extension Thumb (dorsum) C7 Elbow Extension Middle Finger (dorsum) C8 Finger Flexion (Distal Phalanx of Middle Finger) Pinky (dorsum) T1 Finger Abduction Medial Lower Arm

Lumbar Spine Motor Sensory L2 Hip Flexion Anterior Thigh (Midway up) L3 Knee Extension Medial Knee L4 Ankle Dorsiflexion Over the medial malleolus L5 Big Toe Extensor Dorsum of Foot S1 Ankle Plantar Flexion Lateral Foot (near heal)

Peripheral Nerves (Exam of the most distal extent of the nerve is the best approach. It will assume that the whole nerve is intact to that point) Upper Limb Motor Sensory Axillary Abduct shoulder Lateral deltoid Musculocutaneus Flex elbow Volar-lateral forearm Radial Extension MCP 1st dorsal web space Extension thumb Median Opposition thumb / pinky Volar index finger tip Ulnar Adduct fingers (pinch paper) Volar pinky finger tip

Lower Limb Motor Sensor Obturator Adduct hip Medial thigh Femoral Extend knee Medial calf Fibial Superficial Eversion foot Dorsum foot Fibial Deep Dorsiflex foot / toes Dorsal 1st web space Tibial Plantar flex foot / toes Plantar foot