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Examination for musculoskeletal pain

Back to Widespread musculoskeletal pain

You'll need to give a physical examination – patients expect it, and it can provide important information about the problem.

The first aim of examination should be to establish whether the pain is coming from the joint or surrounding tissues. Articular problems are usually characterised by tenderness along the joint line and/or pain at the end of the range of movement, with any restriction in range of movement tending to be equal in both active and passive movement.

Suggested examination technique

Essential component Why do this?
Musculoskeletal screening examination, e.g. GALS screen To quickly and systematically screen for normal and abnormal joints
Examine joints reported as painful  To look for specific abnormalities such as swelling, redness, heat, bruising, deformity, loss of range of movement, pain on movement 
MTPJ/MCPJ squeeze test and ability to form a complete fist (ability to completely cover fingernails in fist position) to test for possible inflammatory arthritis To determine subtle synovitis from inflammatory arthritis
Examine for finger/toenail abnormalities, skin rashes, psoriasis, alopecia, petechiae To look for signs of inflammatory arthritis, connective tissue diseases or other systemic illness 
Possible component Why do this?
Examine any other systems identified in history To look for systemic illness or rheumatological presentations of systemic disease
Neurological examination, particularly looking for weakness or upper motor-neurone signs To look for rheumatological presentations of neurological disease
Palpate for lymphadenopathy, take temperature To look for systemic illness or rheumatological presentations of systemic disease

Read more about the GALs screen and examining for swelling.

Kim's examination findings

Kim's examination shows that she's unable to make a tight fist and her wrists are tender to palpation. The MCPJ squeeze test was painful for her.

Fahmida's examination findings

Fahmida's examination shows she has a normal range of movement, no swelling and a normal squeeze test.

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