●​ Nodules​ ●​ Pronation: Palm

downward​
I. General Overview
●​ Crepitus​
●​ Supination: Palm upward​
This section of the nursing health ●​ Stability​
assessment material focuses on the
evaluation of the
Lower Limb and Trunk Movements:
motor-musculoskeletal system,
Range of Motion:
particularly assessing joints,
muscles, and the range of motion ●​ Inversion: Turning foot
(ROM). The image and text provide 1.​ Active ROM – Patient inward​
foundational knowledge necessary moves the joint
for conducting a comprehensive independently​ ●​ Eversion: Turning foot
musculoskeletal exam. outward​
2.​ Passive ROM – Examiner
moves the joint​ ●​ External Rotation: Away
from midline​

II. Circumference Measurement Limitations in ROM may be due to: ●​ Internal Rotation: Toward
and Interpretation midline​
●​ Joint capsule damage​ ●​ Abduction: Away from
Normal Finding:
midline​
●​ Articular cartilage changes​
●​ Arm and leg ●​ Adduction: Toward midline​
circumference differences ●​ Muscle contractures​
of ≤ 1 cm between the left
and right sides are ●​ Scar formation​
considered normal.​
​
Abnormal V. Clinical Application
Finding/Rationale:​

IV. Illustrated Body Movements Understanding these movements is

●​ A difference of > 1 cm may
and Definitions critical in:
indicate muscular atrophy
(muscle wasting) or
hypertrophy (muscle Neck and Shoulder Movements: ●​ Neurological exams​
enlargement), which can
result from disuse, ●​ Orthopedic evaluations​
●​ Depression: Lowering a
neurological damage, body part​
overuse, or compensatory ●​ Rehabilitation therapy​
activity.​ ●​ Elevation: Raising a body ●​ Documenting functional
part​ limitations or
improvements​
●​ Retraction: Moving a body
part backward​ ●​ Assessing post-operative
III. Assessment of Joints and or post-injury recovery​
Muscles ●​ Protraction: Moving a body
part forward​
Visual and tactile inspection of:
Upper Limb Movements:
●​ Size, color, and symmetry​ VI. Types of Body Movements

●​ Deformities​ ●​ Flexion: Decreasing joint

angle​
Movement Description
●​ Muscle atrophy​
●​ Extension: Increasing joint
angle​
Palpation for: ●​ Circumduction: Circular
movement​ Flexion Decreasing
●​ Edema​ joint angle
●​ Opposition: Thumb
●​ Heat​ touches other fingertips​

●​ Tenderness​ ●​ Reposition: Thumb returns Extension Increasing joint

to anatomical position​ angle
●​ Pain​
 resistanc
Hyperextensio Extension Elevation Raising a body e
n beyond normal part
range

3 Active Average
Depression Lowering a motion weaknes
Abduction Limb away body part against s
from midline gravity
only

Opposition Thumb
Adduction Limb toward touches fingers
midline 2 Passive Poor
ROM ROM
only
(gravity
Reposition Thumb to eliminate
Internal Rotating anatomical d)
Rotation inward position

1 Slight Severe
External Rotating Radial Wrist toward flicker of weaknes
Rotation outward Deviation thumb side contracti s
on

Circumduction Circular Ulnar Deviation Wrist toward

movement little finger side 0 No Paralysi
muscula s
r
contracti
on
Pronation Palm/sole
downward VII. Muscle Strength Testing

Ask the patient to perform each

movement against resistance and
rate strength using: VIII. Special Tests for Wrist
Supination Palm/sole Problems
upward
Rating Scale for Muscle Strength
1. Phalen’s Test

●​ Press backs of hands

Inversion Sole inward Rating Explana Classifi together at 90° for 1
tion cation minute.​

●​ Positive:
Tingling/numbness in
Eversion Sole outward thumb to ring finger =
5 Active Normal carpal tunnel syndrome​
motion
against
full 2. Tinel’s Sign
Protraction Body part resistanc
forward e
●​ Percuss median nerve on
wrist.​

●​ Positive: Tingling in
Retraction Body part 4 Active Slight thumb/first few fingers.​
backward motion weaknes
against s
some
IX. Muscle Assessment ●​ Cervical Flexion: 45°​ ●​ External Rotation: 90°​

Normal Muscle Characteristics: ●​ Cervical Extension: 55°​

●​ Lateral bending: 40°​

●​ Symmetry in size and
strength​ Musculoskeletal Assessment Report:
Upper Arm, Elbow, Wrist, and Hand
●​ Non-tender​

●​ No involuntary movements​ XI. Clinical Relevance

I. Introduction
Helps detect:
Abnormal Findings:
Assessment of ROM in upper
●​ TMJ disorders​ extremities helps identify joint,
●​ Atrophy​ muscle, or nerve issues. This report
●​ Cervical spondylosis​ covers elbow, forearm, wrist, and
●​ Hypertrophy​ fingers based on textbook visuals.
●​ Arthritis​
●​ Flaccidity (Atony)​
●​ Scoliosis​
●​ Weakness (Hypotonicity)​
●​ Neuromuscular issues​ II. Elbow & Forearm Assessment
●​ Fasciculations​
Movements & Normal ROM:
●​ Tremors​
●​ Flexion: Forearm to upper
arm – 160°​
XII. Cervical & Lumbar Spine ROM
●​ Extension: Straightening
Cervical: arm – 180° (or 0°)​
X. Joint Assessment

●​ Flexion: 45°​ ●​ Supination: Palm up – 90°​

General Techniques:
●​ Extension: 55°​ ●​ Pronation: Palm down –
●​ Assess active and passive 90°​
ROM​ ●​ Lateral: 40°​

●​ Inspect for redness, ●​ Rotation: 70°​ Technique:

swelling, deformity​

●​ Palpate for tenderness, ●​ Patient seated/standing.​

Lumbar/Thoracic:
crepitus​
●​ Elbow stabilized.​
●​ Flexion: 75–90°​
●​ ROM observed actively;
Specific Joint Assessments: use goniometer for angles.​
●​ Extension: 30°​

1. Temporomandibular Joint (TMJ) ●​ Lateral: 35°​ ●​ Test muscle strength after

ROM by applying
●​ Flexion, Extension, ●​ Rotation: 30°​ resistance (5 = normal).​
Lateral, Protraction,
Retraction​ ●​ Elbow flexed at 90° for
forearm rotation testing.​
●​ Normal: 1–2 cm lateral,
2–4 cm vertical mouth
opening​ XIII. Shoulder ROM Normal Findings:

●​ Flexion: 180°​ ●​ Symmetry, no

2. Sternoclavicular Joint redness/swelling​
●​ Extension: 50–60°​
●​ Inspect for symmetry, ●​ No tenderness/nodules on
●​ Abduction: 180°​ palpation​
color, swelling​
●​ Adduction: 45–50°​ ●​ Smooth, fluid motion​
3. Cervical, Thoracic, Lumbar Spine ●​ Internal Rotation: 90°​ ●​ No abnormal sounds​
 ●​ Strength grade: 5/5 in all ●​ Flexion/Extension​ management like PT, meds, or
movements​ surgery.
●​ Abduction/Adduction​

Abnormal Signs: ●​ Opposition: Thumb

touches fingers​
Report on Assessing Joints and
●​ Limited ROM, pain, ●​ Reposition: Thumb returns​ Muscles: Wrist and Hand/Fingers
weakness​ Range of Motion

●​ Swelling, tenderness,
asymmetry​ Technique:
I. Introduction
●​ Observe active ROM​
Conditions Identified by Exam: The wrist is a complex condyloid
●​ Palpate joints and tendons​ joint that allows for flexion,
●​ Arthritis: Pain/stiffness, extension, radial deviation, and ulnar
●​ Assess muscle strength deviation. The hands and fingers are
↓ROM​ against resistance​ composed of multiple joints (hinge,
●​ Bursitis: Swelling behind saddle, and condyloid) enabling fine
●​ Compare bilaterally​ motor movements crucial for
elbow​
everyday activities. Assessing the
●​ Epicondylitis: range of motion (ROM) in these
Lateral/medial pain with Normal Findings: areas helps identify musculoskeletal
use​ problems, injuries, or neurological
●​ Symmetrical shape​ issues affecting the distal upper
●​ Fracture/Dislocation: extremities. This report outlines the
Severe pain, loss of ●​ No redness, swelling, techniques for evaluating these
function​ tenderness​ movements and the expected
normal ranges.
●​ Ulnar nerve entrapment: ●​ Smooth movement​
Weakness/numbness​
●​ Strength grade: 5/5​
●​ Muscle strain/sprain: Pain II. Wrist Assessment
after use/injury​
Abnormal Signs: Wrist Joint Movements & Normal
ROM:
●​ Swelling, deformities​
●​ Flexion: Bending the hand
III. Wrist, Hand, & Fingers ●​ Limited ROM or crepitus​ downward at the wrist.​
Assessment
●​ Pain during motion​ ○​ Normal ROM:
Joint Type: 70°​
●​ Weak grip or opposition​
●​ Wrist: Condyloid (flexion, ●​ Extension
extension, deviation)​ (Hyperextension): Bending
Conditions Detected: the hand backward at the
●​ Fingers: Hinge & saddle wrist.​
joints (varied motion)​ ●​ Carpal Tunnel Syndrome
(test with Phalen’s & ○​ Normal ROM:
Tinel’s)​ 90°​
ROM Movements (Wrist): ●​ Radial Deviation: Moving
●​ Arthritis (stiffness,
nodules)​ the hand sideways toward
●​ Flexion: Bend down​ the thumb.​
●​ Tendonitis or injury​
●​ Extension: Raise up​ ○​ Normal ROM:
●​ Fracture/dislocation​ 20°​
●​ Radial deviation: Move
wrist toward thumb​ ●​ Ulnar Deviation: Moving
the hand sideways toward
●​ Ulnar deviation: Move the little finger.​
wrist toward little finger​
IV. Clinical Relevance ○​ Normal ROM:
55°​
ROM Movements (Fingers): Accurate upper extremity
assessment supports diagnosis and
treatment of orthopedic, neurologic, Assessment Technique:
and systemic diseases. Guides
 ●​ The examiner typically movements.​ reveal tenderness,
stands in front or beside swelling, or bony
the seated patient.​ overgrowth.​

●​ The patient is instructed to

actively perform each Normal Variations:
movement while the III. Hands and Fingers
examiner observes for Assessment
smoothness, symmetry, ●​ Symmetry: Hands and
and range.​ The assessment of the hands and fingers should be
fingers involves multiple movements symmetrical without
●​ The forearm should be that assess the functionality of the deformities.​
stabilized to isolate wrist joints within the hand. Key
movement.​ movements include: ●​ Absence of Nodules and
Tenderness: Palpation
●​ Goniometer use is should be smooth and
●​ Finger Abduction: non-tender.​
recommended for Spreading fingers apart.​
accurate measurement of
angles.​ ●​ Full Range of Motion: The
●​ Finger Adduction: Bringing patient should be able to
fingers together.​ perform all movements
●​ Muscle strength is
assessed by having the smoothly.​
●​ Finger Flexion: Bending
patient repeat each the fingers into a fist.​
movement against ●​ Adequate Grip Strength:
resistance to evaluate While not always
●​ Finger Extension: assessed with ROM, grip
strength during flexion, Straightening the fingers.​
extension, radial, and strength is typically
ulnar deviations.​ evaluated simultaneously.​
●​ Thumb Flexion: Bending
the thumb across the
palm.​
Normal Variations: Abnormal Findings:
●​ Thumb Extension:
●​ Symmetry: Both wrists Straightening the thumb ●​ Swelling, pain,
should appear away from the palm.​ tenderness, deformities, or
symmetrical, with no limitations in ROM.​
redness or swelling.​ ●​ Thumb Abduction: Moving
the thumb away from the ●​ Weakness or limited grip
●​ Absence of Tenderness palm.​ strength.​
and Swelling: Palpation
should reveal no ●​ Thumb Adduction: Moving
tenderness or swelling.​ the thumb toward the
palm.​
●​ Smooth Movement: IV. Clinical Significance
Movements should be fluid ●​ Thumb Opposition:
with no pain or abnormal Touching the thumb to
each fingertip.​ Assessing the wrist and hand/fingers
sounds such as crepitus.​
ROM is vital for identifying
●​ Finger Opposition & musculoskeletal and neurological
●​ Full ROM: The patient
Reposition: Ability to move conditions such as:
should be able to achieve
the normal ROM values.​ each finger to touch the
thumb and return to the ●​ Arthritis
●​ Muscle Strength: Normal starting position.​ (Osteoarthritis/Rheumatoi
muscle strength is d Arthritis): Pain, stiffness,
denoted by “Full ROM and swelling in the wrist
against resistance” or “5 Assessment Technique: and fingers, often with
muscle strength,” nodules (e.g., Heberden’s
indicating the ability to ●​ The examiner observes and Bouchard’s nodes).​
move through the full the patient actively
range without fatigue.​ performing these ●​ Carpal Tunnel Syndrome:
movements.​ Numbness, tingling, and
weakness in the hand,
●​ Finer movements, such as impairing fine motor skills
Abnormal Findings:
opposition, are assessed and grip strength.​

●​ Asymmetry, redness, for coordination and

dexterity.​ ●​ De Quervain’s
swelling, tenderness, or Tenosynovitis: Pain and
nodules.​ tenderness at the base of
●​ Palpation of the joints
(interphalangeal and the thumb, limiting
●​ Limited ROM, pain, or movement.​
weakness during metacarpophalangeal) can
 ●​ Dupuytren’s Contracture: ●​ Assessment Technique:​ suggest
Thickening of the palmar conditions such
fascia causing finger ○​ Grip Strength: as rheumatoid
flexion deformities.​ The image arthritis.​
illustrates the
●​ Fractures or Dislocations: use of a ○​ Muscle
Pain, swelling, and loss of dynamometer to Strength: The
wrist or finger function.​ measure grip patient should
strength. The exhibit strong
●​ Nerve Injuries patient is grip strength
(Median/Ulnar Nerve instructed to and be able to
Damage): Weakness or squeeze the resist the
paralysis of specific hand device as hard examiner’s
muscles, affecting as they can. attempt to open
movements like opposition Grip strength is their fist.​
and grip.​ assessed
bilaterally, with ○​ Normal Grip
the average Strength: Grip
Accurate documentation of ROM, from several strength can
pain, discomfort, swelling, and trials recorded.​ vary based on
deformities is critical for diagnosis age, sex, and
and treatment planning, which may ○​ Functional Test: physical
include physical therapy, pain The patient is condition, and it
management, or surgery. asked to make a should be
fist, and the compared to
examiner normative data
applies to assess any
resistance to deficits.​
test the ability to
Report on Assessing Joints and open the fist. ●​ Abnormal Findings:​
Muscles: Hands and Fingers This measures
(Grip) and Hip Range of Motion muscle strength ○​ Weak grip
(ROM) in the hands and strength or the
fingers.​ inability to resist
the examiner’s
This report provides a thorough
○​ Helpful Hint: To force should be
understanding of assessment
ensure documented.​
techniques and normal variations for
consistent
evaluating grip strength of the hands
resistance, the ○​ Any pain,
and fingers, as well as the range of
examiner can swelling, or
motion (ROM) of the hip joint, as
cross their index deformities in
illustrated in the provided images
and middle the hand and
from a nursing health assessment
fingers and have fingers should
textbook.
the patient also be noted as
squeeze these abnormal.​
I. Introduction fingers. This
method helps
●​ Grip Strength: Grip provide a
strength reflects the reliable
strength of the muscles in resistance point
during testing.​ III. Hip ROM Assessment
the hand and forearm,
providing important
information on upper ●​ Normal Variations:​ ●​ Key Movements and
extremity function.​ Normal ROM:​
○​ Symmetry: The
●​ Hip ROM: The hip joint, a fingers should ○​ Flexion:
ball-and-socket joint, appear straight Bending the
allows a wide range of and aligned, knee towards
movements essential for with no swelling the chest:​
daily activities, such as or deformities.​
walking, sitting, and ■​ Norm
standing.​ ○​ Tenderness and al
Nodules: ROM:
Palpation of 90°
finger joints (knee
should reveal no flexed
tenderness or ) to
II. Hands and Fingers (Grip) nodules. The 120°
Assessment presence of (with
nodules may leg
 straig assessed in a limitation.​
ht).​ prone position).​
○​ Normal Muscle
○​ Hyperextension ○​ The examiner Strength: The
(Extension): stabilizes the patient should
Moving the leg pelvis to isolate exhibit strong
behind the body:​ the hip joint muscle strength,
during ROM.​ achieving full
■​ Norm ROM against
al ○​ The patient resistance.​
ROM: actively
30°.​ performs the ●​ Abnormal Findings:​
movements, and
○​ Abduction: the examiner ○​ Limitations in
Moving the leg observes for ROM, pain, or
away from the smoothness, instability should
midline of the symmetry, and be documented.​
body:​ the extent of the
movement.​ ○​ Crepitus,
■​ Norm tenderness, or
al ○​ Goniometers muscle
ROM: can be used to weakness
40°–4 measure ROM should also be
5°.​ more precisely.​ considered
abnormal
○​ Adduction: ○​ Muscle strength findings.​
Moving the leg is tested by
towards the having the
midline (across patient perform
the body):​ movements
against
■​ Norm resistance IV. Alert Box: Important
al applied by the Considerations for Hip
ROM: examiner.​ Replacements
20°–3
0°.​ ●​ Normal Variations:​ ●​ Movement Restrictions:
For patients with hip
○​ Internal ○​ Symmetry: The replacements, specific
Rotation: hips should movements, such as
Rotating the leg appear adduction and internal
inward, turning symmetrical with rotation, must be avoided
the toes toward no signs of to prevent displacement of
the midline:​ swelling or the prosthetic hip joint.​
deformities.​
■​ Norm ○​ Examiners
al ○​ Stability: The hip should be
ROM: joint should feel cautious when
40°.​ stable during performing
movement with assessments on
○​ External no signs of these patients
Rotation: dislocation or and modify their
Rotating the leg subluxation.​ techniques
outward, turning accordingly.​
the toes away ○​ Absence of
from the midline:​ Tenderness and
Crepitus: The
■​ Norm hip joint should
al not produce any
ROM: grating or V. Clinical Significance
45°.​ clicking during
movement.​ ●​ Grip Strength and Hand
●​ Assessment Technique:​ Function:​
○​ Full ROM: The
○​ The patient patient should ○​ Conditions such
should lie be able to as rheumatoid
supine for most perform each arthritis and
movements movement with carpal tunnel
(except for the expected syndrome can
hyperextension, ROM without reduce grip
which is
 strength.​ ●​ Knee Joint: A hinge joint ○​ Nodules or
that allows for flexion and unusual bumps.​
○​ Weak grip extension. It plays a
strength may critical role in walking, ○​ The examiner
also be linked to running, and overall begins palpation
neurological mobility.​ about 10 cm
impairments, above the knee
such as nerve ●​ Ankle/Foot Joints: and works
injuries.​ Complex structures with down, including
multiple types of joints, the patella, joint
●​ Hip ROM and Disorders:​ such as hinge, gliding, and line, and
condyloid joints. These surrounding soft
○​ Conditions like joints are responsible for tissues.​
hip movements like
osteoarthritis, dorsiflexion, plantarflexion, ●​ Range of Motion Testing:​
hip fractures, inversion, eversion, and
and bursitis can toe movements, which are ○​ Flexion: The
limit hip ROM essential for maintaining patient bends
and cause pain balance and gait.​ the knee,
during bringing the heel
movement.​ towards the
Assessing ROM in these joints is buttocks.
○​ Post-hip crucial for diagnosing Flexion is
replacement musculoskeletal issues, injuries, and measured in
patients must neurological conditions that may supine, sitting,
have their ROM affect mobility. or standing
closely positions.​
monitored to
avoid ○​ Extension:
complications, Straightening
especially in the II. Knee Assessment the leg, with the
case of normal position
movement being 0
The upper portion of the image
restrictions degrees. Some
illustrates the assessment of the
mentioned in the individuals may
knee joint.
alert box.​ experience
slight
●​ Documentation: Recording Assessment Technique hyperextension.​
the grip strength and ROM
measurements, as well as : ●​ Muscle Strength Testing:
noting any pain, After assessing ROM, the
tenderness, or limitations, ●​ Inspection: The examiner examiner tests muscle
is crucial for accurate inspects both knees for:​ strength by having the
diagnosis and the patient flex and extend the
development of an ○​ Symmetry in knee against resistance.​
effective treatment plan.​ size and shape.​

○​ Deformities, Normal Variations

misalignment, or
swelling.​ :
Report on Assessing Joints and
○​ Any redness or
Muscles: Knee and Ankle/Foot ●​ Symmetry: Knees should
changes in skin
Range of Motion be symmetrical without
color.​
deformities or swelling.​
This report offers a comprehensive ○​ The popliteal
explanation of the assessment ●​ Smooth Movement:
space is
techniques for evaluating the range Flexion and extension
inspected for
of motion (ROM) of the knee and should be smooth, without
any swelling or
ankle/foot joints. It highlights the pain or creaking.​
bulging.​
normal variations and clinical
significance, providing a complete ●​ Normal ROM:​
●​ Palpation: The examiner
overview for healthcare palpates the knee for:​
professionals assessing lower ○​ Flexion:
extremity joint health. Approximately
○​ Temperature,
120–130
tenderness, and
degrees.​
consistency.​
○​ Extension: 0
I. Introduction degrees (slight
 hyperextension ○​ Tenderness, ●​ Pain, swelling, or
up to 15 swelling, and deformities in the ankle or
degrees can be nodules.​ foot.​
normal in some
individuals).​ ○​ Bony ●​ Limited ROM in any
prominences, direction.​
●​ Normal Muscle Strength: joint lines, and
A normal result is “5 soft tissues.​ ●​ Muscle weakness or
muscle strength”, where inability to resist
the patient can move ●​ Range of Motion Testing:​ movements against
through the full range of pressure.​
motion against maximal ○​ Dorsiflexion:
resistance.​ Pointing the
toes toward the
nose.​
Abnormal Findings
○​ Plantarflexion: IV. Clinical Significance
Pointing the
: toes downward.​ Assessing the ROM of the knee and
ankle/foot is critical in identifying
●​ Asymmetry in size, shape, ○​ Inversion: various musculoskeletal and
or swelling.​ Turning the neurological conditions:
soles of the feet
●​ Tenderness or nodules felt inward.​
●​ Knee Arthritis
during palpation.​
(Osteoarthritis,
○​ Eversion:
Rheumatoid Arthritis):
●​ Limited ROM or difficulty Turning the
Characterized by pain,
with flexion or extension.​ soles of the feet
stiffness, swelling, and
outward.​
limited ROM in both
●​ Muscle weakness or
flexion and extension.​
inability to perform ●​ Muscle Strength Testing:
movements against After assessing ROM, the
●​ Ligamentous Injuries (e.g.,
resistance.​ examiner applies
ACL, MCL tears): Pain,
resistance during
instability, and limited
dorsiflexion, plantarflexion,
ROM, often with swelling.​
inversion, and eversion.​
●​ Meniscal Tears: Pain,
III. Ankle and Foot Assessment clicking, and locking
Normal Variations sensations that limit ROM.​
The lower portion of the image ●​ Ankle Sprains: Pain,
:
shows the assessment of the ankle swelling, and restricted
and foot. ROM, especially in
●​ Symmetry: Ankles and
inversion or eversion.​
feet should be symmetrical
Assessment Technique
in size and shape.​
●​ Achilles
: Tendinitis/Rupture: Pain
●​ Smooth Movement:
and limited plantarflexion.​
Movements should be
●​ Inspection: The examiner pain-free and fluid.​
●​ Plantar Fasciitis: Heel pain
inspects the ankles and
that may limit ROM in the
feet for:​ ●​ Normal ROM: The patient
foot and ankle.​
should achieve a
○​ Size, shape, functional range of motion
●​ Gout: Pain, redness,
symmetry, and in all directions, though
swelling, and restricted
alignment.​ specific angular
ROM, often starting in the
measurements may not
big toe.​
○​ Deformities, skin always be provided.​
changes (color,
●​ Neurological Conditions
swelling, ●​ Normal Muscle Strength:
(e.g., Stroke, Peripheral
lesions), and the The patient should be able
Neuropathy): Muscle
patient’s stance to resist the examiner’s
weakness or paralysis
while standing pressure during ROM
leading to altered ROM
or walking (if testing.​
and gait abnormalities.​
appropriate).​

●​ Palpation: The examiner Abnormal Findings

palpates for:​ Accurate documentation of ROM,
pain, swelling, tenderness, and
: muscle strength is crucial for
diagnosis and creating an effective accurate diagnoses and create swelling, redness,
treatment plan. appropriate treatment plans. deformities, or signs of
distress, all of which can
guide further examination
and inform potential
diagnoses.​
traction while rotating the tibia
Report on Assessing Joints and internally and externally. Pain or
Muscles: Foot and Ankle discomfort suggests ligamentous
Alignment and Range of Motion injury or instability. 2. Palpation
(Continued)
●​ Normal Findings:​
●​ Rationale: Palpating joints,
This continuation provides further muscles, and bones
details on the assessment of foot ○​ No pain,
allows the examiner to
and ankle alignment and specific clicking, or
assess for warmth,
angular ROM measurements, further discomfort
tenderness, swelling, or
highlighting potential abnormal during the
any abnormal masses.
findings and their implications for maneuver.​
These signs can indicate
joint health. inflammation (e.g.,
●​ Abnormal Findings:​
synovitis), infection (e.g.,
abscesses), or
○​ Pain, clicking, or
musculoskeletal injuries
grinding during
(e.g., fractures). Palpation
I. Introduction the meniscus
can also help detect
grind test
muscle spasms or
Building upon the previous section, suggests a
tenderness that can guide
this report expands on the alignment meniscal tear.​
the diagnosis of conditions
of the foot and ankle. It includes like arthritis or muscle
specific angular measurements and ○​ Pain during the
strains.​
clarifies the key points for assessing distraction test
potential misalignments or suggests
deformities. ligamentous
injury.​
3. Range of Motion
(ROM)
IV. Clinical Significance:
II. Foot and Ankle Alignment
●​ Rationale: Assessing both
Understanding how to properly active and passive range
●​ Toes: The toes should perform the McMurray and Apley’s of motion (ROM) of joints
point forward and lie flat. tests and interpret the results is helps to identify limitations
Deviations like hallux essential for diagnosing knee caused by pain,
valgus (bunion) or claw injuries, including meniscal tears and inflammation, stiffness, or
toes may indicate ligamentous damage. These tests mechanical obstructions
underlying deformities.​ help clinicians confirm or rule out such as tendon damage or
potential diagnoses and guide the joint degeneration.
●​ Feet: The longitudinal arch management plan, whether through Deviations from the
should be visible, and conservative measures, normal range can suggest
weight distribution should rehabilitation, or surgery. conditions such as
be even across the foot. arthritis, muscle
Issues like flat feet (pes weakness, or joint
planus) or high arches instability.​
(pes cavus) can indicate
abnormalities.​ Certainly! Below is a breakdown of
the rationale for the principles of
●​ Absence of Deformities: physical examination based on the
musculoskeletal assessments and
4. Muscle Strength
No presence of corns,
calluses, bunions, or other tests discussed in the reports: Testing
structural abnormalities
should be observed.​ ●​ Rationale: Testing muscle
1. Inspection strength provides insight
into neuromuscular
●​ Rationale: Visual function. A reduced
observation of the muscle strength score
This detailed assessment ensures patient’s posture, gait, joint (such as “4” or below on a
healthcare professionals can identify alignment, and overall scale of 0 to 5) could
any musculoskeletal or neurological appearance provides initial indicate nerve impairment,
issues affecting the lower insights into potential muscle atrophy, or central
extremities, enabling them to make abnormalities. This helps nervous system lesions.
identify asymmetry, Normal muscle strength
 (“5” on a scale of 5) is Leg Raising (Lasègue’s) condition and guiding the
essential for proper motor Test is used to evaluate for choice of treatment or
function, and abnormal nerve root irritation, rehabilitation.​
findings can help identify particularly sciatica or
conditions such as lumbar disc herniation.
neuropathy, motor neuron Abnormal reflex responses
disease, or orthopedic help narrow down the 11. Joint Effusion
problems affecting specific diagnosis and guide
muscle groups.​ further testing such as Tests
MRI for nerve or spinal
issues.​ ●​ Rationale: Tests such as
the Ballottement Test and
5. Special Tests Bulge Sign are used to
detect the presence of
●​ Rationale: Special tests 8. Pain Assessment fluid within the joint, which
like the McMurray Test, often indicates
Lachman Test, and Bulge ●​ Rationale: Evaluating pain inflammation or injury.
Sign are used to detect is crucial in determining Fluid accumulation could
specific musculoskeletal the cause of be due to conditions like
pathologies. These tests musculoskeletal gout, arthritis, or joint
are designed to stress symptoms. Pain during trauma. Detecting and
particular tissues (such as movement or palpation documenting joint effusion
ligaments, menisci, or joint can indicate inflammation, is crucial for diagnosing
capsules) to reproduce mechanical damage, or the underlying cause and
symptoms or detect signs nerve compression. guiding further
of injury or disease. The Specific pain patterns intervention.​
results of these tests help (e.g., sharp, dull, or
confirm or exclude specific radiating pain) are vital
diagnoses such as clues for diagnosing
ligament tears, meniscal conditions like tendonitis, 12. Neurological
injuries, or joint effusions.​ arthritis, or nerve Signs
impingement.​
●​ Rationale: Neurological
6. Gait and Posture testing, such as assessing

Analysis 9. Symmetry pronator drift or sensory

responses, helps identify
signs of neurological
●​ Rationale: Assessing the impairment, which can be
●​ Rationale: Analyzing gait symmetry of the joints,
and posture helps identify caused by conditions like
limbs, and muscles helps a stroke, multiple
abnormal movements or to identify any signs of
postures that could sclerosis, or spinal cord
asymmetry, which may be injuries. For example,
indicate musculoskeletal indicative of deformities
or neurological disorders. pronator drift suggests a
(e.g., scoliosis or joint contralateral upper motor
For example, the dislocations), or atrophy
Trendelenburg Test neuron lesion, providing
(e.g., from nerve damage critical diagnostic
assesses the strength of or muscle diseases).
the gluteus medius and information for
Asymmetry can also be a neurological disorders.​
hip stability. A positive key sign of developmental
result, where the pelvis disorders or injuries.​
drops on the
non-weight-bearing side,
suggests weakness or 13. Bony Deformities
dysfunction in the hip 10. Functional and Alignment
muscles, commonly seen
in conditions like hip Testing ●​ Rationale: Observing for
osteoarthritis or gluteus
medius weakness.​ bony deformities, such as
●​ Rationale: Functional hallux valgus or hammer
testing, such as assessing toes, and joint alignment
a patient’s ability to helps identify structural
perform weight-bearing
7. Reflex Testing tasks or specific
abnormalities in the
musculoskeletal system.
movements (like squatting These deformities can
●​ Rationale: Reflexes or walking), helps result from congenital
assess the integrity of the determine how conditions, injuries, or
nervous system and can musculoskeletal disorders diseases like
indicate nerve affect a patient’s daily osteoarthritis, and they
compression or damage. activities. It also assists in may require intervention
For instance, the Straight evaluating the severity of a such as corrective surgery
 or orthotics to manage
symptoms and improve
functionality.​

14. Swelling and

Inflammation
●​ Rationale: Swelling and
signs of inflammation
(warmth, redness) suggest
an ongoing inflammatory
process. In conditions like
rheumatoid arthritis, gout,
or synovitis, joint
inflammation can impair
function, causing pain and
reduced range of motion.
Early detection of these
signs can help initiate
appropriate treatments,
including anti-inflammatory
medications or joint
aspiration.​

Conclusion:
The rationale for the physical
examination principles is to gather
comprehensive and accurate data to
assess the patient’s musculoskeletal
and neurological health. Each
technique provides valuable
information that helps healthcare
providers formulate a differential
diagnosis, monitor disease
progression, guide treatment
decisions, and ultimately improve
patient outcomes. Recognizing
normal findings helps identify
abnormalities and ensures the
patient receives the most
appropriate care for their condition.