Regional examination of the musculoskeletal system: introduction video

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Regional examination of the musculoskeletal system (REMS) refers to the more detailed examination that would be expected once an abnormality has been detected through either the history or screening examination.

Regional examination refers to a group of joints linked together by function, examination of which may require detailed neurological and vascular examination including examination of all joints within that region. For the purposes of this video the examination has been divided into the following areas:

  • hand and wrist
  • elbow
  • shoulder
  • hip
  • knee
  • foot and ankle
  • spine.

It should be remembered that this is an artificial divide and that the examination of the shoulder, for example, should often be taken into context with cervical spine examination.

The following general principles should be followed during the examination process:

Introduction

  • Firstly, introduce yourself to the patient.
  • Explain what you are going to do to the patient.
  • Gain verbal consent to examine.
  • Ask the patient to let you know if you cause them pain or discomfort during the examination.

Look

You should look for skin changes, muscle bulk and swellings in and around the joint. And look for deformity in terms of alignment and posture of the joint.

Feel

Feel for skin temperature across the joint line and other relevant sites. Assess swellings for fluctuance and mobility. Vascular and neurological assessment should also be made.

As a general principle students should be able to detect synovitis using the triad of warmth, swelling and tenderness.

Move

The full range of movement of the joint should be assessed both actively and passively. By doing this a loss of movement or degree of extra movement known as hypermobility may be detected.

Function

A functional assessment should be made particularly relating to how the patient uses that particular joint.