Faculty of Health & Medical Sciences, Indus University 1
1
INDUS UNIVERSITY
Faculty of Health & Medical Sciences, Indus University 2
Course Name: Musculoskeletal Physical
Therapy
Course Code: MPT-607
Week 01
Faculty of Health & Medical Sciences, Indus 3
University
CONTENTS TO BE COVERED:
Principles & Concepts Of
Musculoskeletal Evaluation &
Assessment
• Patient history
• Observation
• Examination of movement
• Special tests
• Reflexes and cutaneous distribution
• Joint play movements
• Palpation
• Diagnostic imaging
Faculty of Health & Medical Sciences, Indus 4
University
PATIENT HISTORY
• Personal history
• Subjective Assessment
• Presenting complain
• History of presenting
complain
• Onset
• Character
• Radiation
• Associated symptoms
Faculty of Health & Medical Sciences, Indus 5
University
• Timings/ pain pattern
• Severity
• Location/ site
• Intensity according to
VAS
• Aggravating factors
• Reliving factors
• Socioeconomic history
• Past medical history
• Past surgical history
• Drug history
• Any sports history /
hobbies
• Family history
Faculty of Health & Medical Sciences, Indus 6
University
Pain and Its Relation to Severity of Repetitive Stress
Activity:
• Level 1: Pain after specific activity
• Level 2: Pain at start of activity resolving with warm-up
• Level 3: Pain during and after specific activity that does not
affect performance
• Level 4: Pain during and after specific activity that does affect
performance
• Level 5: Pain with activities of daily living (ADLs)
• Level 6: Constant dull aching pain at rest that does not
disturb sleep
• Level 7: Dull aching pain that does disturb sleep
Reactions to Stress:
• Aches and pains
• Anxiety
• Changed appetite
• Chronic fatigue
• Difficulty concentrating
• Difficulty sleeping
• Irritability and impatience
• Loss of interest and enjoyment in life
• Muscle tension (headaches)
• Sweaty hands
• Trembling
• Withdrawal
OBSERVATION
In an assessment, observation is the “looking” or inspection phase. Its
purpose is to gain information on visible defects, functional deficits,
and abnormalities of alignment.
The examiner should attempt to answer the following questions often
by comparing both sides:
• What is the normal body alignment?
• Is there any obvious deformity?
• Are the bony contours of the body normal and symmetric, or is there an obvious
deviation?
• Are the soft-tissue contours (e.g., muscle, skin, fat) normal and symmetric?
• Are the color and texture of the skin normal?
• Is there any heat, swelling, or redness in the area being observed?
EXAMINATION
Because the examination portion of the assessment involves touching
the patient and may, in some cases, cause the patient discomfort, the
examiner must obtain a valid consent to perform the examination
before it begins.
Principles of Examination:
Tell the patient what you are doing
• Test the normal (uninvolved) side first
• Do active movements first, then passive movements, and then
resisted isometric movements
• Do painful movements last
• Apply overpressure with care to test end feel
• Repeat movements or sustain certain postures or positions if
history indicates
• Do resisted isometric movements in a resting position
• Remember that with passive movements and ligamentous testing,
both the degree and quality (end feel) of opening are important
• With ligamentous testing, repeat with increasing stress
• With myotome testing, make sure that contractions are held for
5 seconds
• Warn the patient of possible exacerbations
• Maintain the patient’s dignity
• Refer if necessary
SPECIAL (DIAGNOSTIC) TESTS:
After the examiner has completed the history, observation, and evaluation of
movement, special tests may be performed for the involved joint. Many special tests
are available for each joint to determine whether a particular type of disease,
condition, or injury is present.
Special Test Considerations:
Any special test, regardless of its classification, can be positively or
negatively affected by the:
• Patient’s ability to relax
• Presence of pain and the patient’s perception of the pain
• Presence of patient apprehension
• Skill of the clinician
• Ability and confidence of the clinician
Special Test Uses:
• To confirm a tentative diagnosis
• To make a differential diagnosis
• To differentiate between structures
• To understand unusual signs
• To unravel difficult signs and symptoms
REFLEXES AND CUTANEOUS DISTRIBUTION
After the special tests, the examiner can test the superficial, deep tendon,
or pathological reflexes to obtain an indication of the state of the nerve
or nerve roots supplying the reflex. If the neurological system is thought
to be normal, there is no need to test the reflexes or cutaneous
distribution.
JOINT PLAY MOVEMENTS
All synovial and secondary cartilaginous joints, to some extent, are
capable of an active ROM, termed “voluntary movement” (also called
active physiological movement) through the action of muscles crossing
over the joint. In addition, there is a small ROM that can be obtained
only passively by the examiner; this movement is called joint play or
accessory movement.
Mennell’s Rules for Joint Play Testing:
• The patient should be relaxed and fully supported
• The examiner should be relaxed and should use a firm but
comfortable grasp
• One joint should be examined at a time
• One movement should be examined at a time
• The unaffected side should be tested first
• One articular surface is stabilized, while the other surface is moved
• Movements must be normal and not forced
• Movements should not cause undue discomfort
PALPATION
Palpation is an important assessment technique that must be practiced if
it is to be used effectively. Tenderness often does enable the
examiner to name the affected ligament or the specific section or exact
point of the tearing or bruising.
Examiner Observations When Palpating a Patient:
• Differences in tissue tension and texture
• Differences in tissue thickness
• Abnormalities
• Tenderness
• Temperature variation
• Pulses, tremors, and fasciculations
• Pathological state of tissues
• Dryness or excessive moisture
• Abnormal sensation
Grading Tenderness When Palpating:
• Grade I—Patient complains of pain
• Grade II—Patient complains of pain and winces
• Grade III—Patient winces and withdraws the joint
• Grade IV—Patient will not allow palpation of the joint
DIAGNOSTIC IMAGING
Reasons for Ordering Diagnostic Imaging:
• To confirm a diagnosis
• To establish a diagnosis
• To determine the severity of injury
• To determine the progression of a disease
• To determine the stage of healing
• To enhance patient treatment
• To determine anatomical alignment
Thank You
Faculty of Health & Medical Sciences, Indus University 10
