bone, joint, and muscle disorders
Medical History and Physical Examination in Musculoskeletal Disorders
Physical Examination
A doctor looks for certain things during a physical examination depending on what disorder or injury is suspected. When evaluating bones, if a Overview of Fractures is suspected, the doctor may notice that the affected part (such as an arm or a leg) is abnormally shaped, suggesting that the segments of bone are out of alignment. A doctor may feel (palpate) the surfaces of the bones and joints to detect any tenderness, warmth, fluid in the joints, or abnormal shape, particularly if a fracture, a tumor, or a bone infection ( Osteomyelitis ) is suspected. Compression fractures of the spine caused by the doctor feels muscles for bulk, tone (how relaxed the muscle is when it is not being used), strength, and tenderness. Muscles are also checked for twitches and involuntary movements, which may indicate a nerve disease rather than a muscle disease (see Motor Nerves ). Doctors look for wasting away of muscle (atrophy), which can result from damage to the muscle or its nerves or from lack of use (disuse atrophy), as sometimes occurs with prolonged bed rest. Doctors also look for muscle enlargement (hypertrophy), which normally results from activities or exercises that repeatedly stress the muscle, such as weight lifting. However, when a person is ill, hypertrophy may result from one muscle working harder to compensate for the weakness of another. Muscles can also enlarge when normal muscle tissue is replaced by abnormal tissue, which increases the size but not the strength of the muscle. Abnormal tissue can replace muscles in Amyloidosis and in certain inherited muscle disorders, such as Doctors try to establish which (if any) muscles are weak and how weak they are. The muscles can be tested systematically, usually beginning with the face and neck, then the arms, and finally the legs. Normally, a person should be able to hold the arms extended, palms up, for one minute without their sagging, turning, or shaking. Downward drift of the arm with palms turning inward is a sign of weakness. Strength is tested by pushing or pulling while the doctor pushes and pulls in the opposite direction. Strength is also tested by having the person perform certain maneuvers, such as walking on the heels and tiptoes or rising from a squatting position or getting up and down from a chair rapidly 10 times. The doctor tests a person'sactive range of motion.The active range of motion is the maximum range through which people can move a joint by themselves. Limited active range of motion may indicate weakness, pain, or stiffness as well as mechanical abnormalities (such as scarring and swelling). The doctor then tests a person'spassive range of motion.The passive range of motion is the maximum range through which the doctor can move the person's joint while the person is completely relaxed. The doctor also checksmuscle toneby moving the limb passively. Resistance to passive movement (called passive resistance) may be decreased when the nerve leading to the muscle is damaged. Resistance to such movement may be increased when the spinal cord or brain is damaged. If a person is weak, doctors also tap the person's muscle tendon with a rubber hammer to check Reflexes . Reflexes may be slower than expected when the nerve leading to the muscle is damaged. Reflexes may be more rapid than expected when the spinal cord or brain is damaged. Doctors note which joints or limbs are affected. Finding a pattern of affected joints and limbs can help doctors figure out the cause. Doctors also examine affected joints in more detail. For example, they examine the joints to determine whether fluid is in the joint (called a joint effusion). They may test specific active or passive motions. They may pull or apply force to see whether the joint is stable. 