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PWF2b – MSK PE – Physician Workflow Part 2b
Nov 8, 2019
•
Mark Morgan
categories:
Objective/Exam
PHYSICAL EXAM
Brief non-MSK Exam
-General -
-HEENT -
-Neck -
-Abd -
-Ext -
-Neuro -
-Psych -
-Neurovascular:
*
no sign of compromised blood/nerve supply to affected/ipsilateral limb with testing of sensation/motor/reflexes
REDUCED SENSATION
MOTOR WEAKNESS
ABNORMAL REFLEXES
.
speech input
description of deficits
-Gait:
*
No gait abnormalities
GAIT ABNORMALITIES-
ANTALGIC GAIT
TRENDELENBURG GAIT
VARUS THRUST GAIT
LATERAL PATELLAR TRACKING WITH GAIT
FLEXED KNEE GAIT
speech input
description of deficits
-MSK:
Select for location specific exam(s)
*Neck
--Inspection:
*
Neck supple, no gross thyromegaly
normal curvature
CURVATURE ABNORMALLY STRAIGHT
CURVATURE KYPHOTIC
--Palpation:
*
No tenderness to palpation of
midline/spinous processes
R paraspinals
R suboccipal area
R trapezial ridge
R levator scapula
R rhomboids
R 1st rib
L paraspinals
L suboccipital area
L trapezial ridge
L levator scapula
L rhomboids
L 1st rib
**TTP of
R paraspinals
midline/spinous processes
R suboccipal area
R trapezial ridge
R levator scapula
R rhomboids
R 1st rib
L paraspinals
L suboccipital area
L trapezial ridge
L levator scapula
L rhomboids
L 1st rib
**
---
No step-offs noted
ABNORMAL STEP-OFF NOTED
--ROM:
*
Not limited & not painful in
flexion
extension
R side-bend
R rotation
L side-bend
L rotation
**LIMITED
**PAINFUL
in
flexion
extension
R side-bend
R rotation
L side-bend
L rotation
**
--Special Tests:
*
---Spurlings -
negative
R POSITIVE
L POSITIVE
---Axial Compression -
negative
POSITIVE
*R/L Shoulder
--Inspection:
*
no deformity
normal fairly developed musculature without atrophy
R SIDED MUSCLE ATROPHY
R SHOULDER SAGGING
R SHOULDER EFFUSION
R SHOULDER GROSS DEFORMITY
R SCAPULAR WINGING
L SIDED MUSCLE ATROPHY
L SHOULDER SAGGING
L SHOULDER EFFUSION
L SHOULDER GROSS DEFORMITY
L SCAPULAR WINGING
--Palpation:
*
No tenderness to palpation of
R AC joint
R subacromial area
R bicipital groove
R pectoralis tendon
R coracoid process
L AC joint
L subacromial area
L bicipital groove
L pectoralis tendon
L coracoid process
**TTP of
R AC joint
R subacromial area
R bicipital groove
R pectoralis tendon
R coracoid process
L AC joint
L subacromial area
L bicipital groove
L pectoralis tendon
L coracoid process
**
--ROM:
*
Not limited & not painful in
R scarf test
R internal rotation
R external rotation
R abduction
R forward flexion
R extension
L scarf test
L internal rotation
L external rotation
L abduction
L forward flexion
L extension
**LIMITED
**PAINFUL
in
R scarf test
R internal rotation
R external rotation
R abduction
R forward flexion
R extension
L scarf test
L internal rotation
L external rotation
L abduction
L forward flexion
L extension
**
--Special Tests:
*
---Spurlings -
negative
R POSITIVE
L POSITIVE
---Neers -
R negative
R POSITIVE
L negative
L POSITIVE
---Hawkins-Kennedy -
R negative
R POSITIVE
L negative
L POSITIVE
---Modified Yergasons -
R negative
R POSITIVE
L negative
L POSITIVE
---Empty Can test -
R negative for pain/weakness
R POSITIVE for pain
R POSITIVE for weakness
L negative for pain/weakness
L POSITIVE for pain
L POSITIVE for weakness
---Resisted Internal Rotation -
R did not elicit pain
R ELICITED PAIN
L did not elicit pain
L ELICITED PAIN
---Resisted External Rotation -
R did not elicit pain
R ELICITED PAIN
L did not elicit pain
L ELICITED PAIN
---Instability/labral tests -
(Apprehension/Sulcus sign/Mayo Sheer/O'Brien/Crank)
R negative
R POSITIVE
L negative
L POSITIVE
*R/L Elbow
--Inspection:
*
no gross deformity
no edema/effusion
no ecchymosis
R ELBOW EDEMA
R ELBOW EFFUSION
R ELBOW ECCHYMOSIS
L ELBOW EDEMA
L ELBOW EFFUSION
L ELBOW ECCHYMOSIS
--Palpation:
*
No tenderness to palpation of
R olecranon
R antecubital fossa
R medial epicondyle
R lateral epicondyle
L lateral epicondyle
L olecranon
L antecubital fossa
L medial epicondyle
.
**TTP of
R olecranon
R antecubital fossa
R medial epicondyle
R lateral epicondyle
L lateral epicondyle
L olecranon
L antecubital fossa
L medial epicondyle
**
--ROM:
*
Not limited & not painful in
R flexion
R extension
R abduction
R adduction
L flexion
L extension
L abduction
L adduction
**LIMITED
**PAINFUL
in
R flexion
R extension
R abduction
R adduction
L flexion
L extension
L abduction
L adduction
**
*R/L Wrist
--Inspection:
*
no gross deformity
EDEMA
EFFUSION
ECCHYMOSIS
--Palpation:
*
No tenderness to palpation of
R dorsal aspect
R volar aspect
R medial aspect
R lateral aspect
R snuffbox
L dorsal aspect
L volar aspect
L medial aspect
L lateral aspect
L snuffbox
.
**TTP of
R dorsal aspect
R volar aspect
R medial aspect
R lateral aspect
R snuffbox
L dorsal aspect
L volar aspect
L medial aspect
L lateral aspect
L snuffbox
**
--ROM:
*
Not limited & not painful in
R flexion
R extension
R abduction
R adduction
L flexion
L extension
L abduction
L adduction
**LIMITED
**PAINFUL
in
R flexion
R extension
R abduction
R adduction
L flexion
L extension
L abduction
L adduction
**
--Special Tests:
*
---Tinels test -
R negative
R POSITIVE
L negative
L POSITIVE
---Phalens test -
R negative
R POSITIVE
L negative
L POSITIVE
---Reverse Phalens test -
R negative
R POSITIVE
L negative
L POSITIVE
---Finklesteins test -
R negative
R POSITIVE
L negative
L POSITIVE
*Upper Back
--Inspection:
*
no gross deformity
R PARASPINAL MUSCLE SPASM
L PARASPINAL MUSCLE SPASM
GROSS/EXCESS LATERAL SPINAL CURVATURE
KYPHOSIS
ABNORMAL STRAIGHTENING OF T-SPINE
R SCAPULAR WINGING
L SCAPULAR WINGING
--Palpation:
*
No tenderness to palpation of
midline/spinous processes
R 1st rib
R paraspinals
R upper trapezius
R lower trapezius
R levator scapula
R rhomboids
L 1st rib
L paraspinals
L upper trapezius
L lower trapezius
L levator scapula
L rhomboids
.
**TTP of
midline/spinous processes
R 1st rib
R paraspinals
R upper trapezius
R lower trapezius
R levator scapula
R rhomboids
L 1st rib
L paraspinals
L upper trapezius
L lower trapezius
L levator scapula
L rhomboids
**
---
No step-offs noted
ABNORMAL STEP-OFF NOTED
--ROM:
*
Not limited & not painful in
flexion
extension
R side-bend
R rotation
L side-bend
L rotation
**LIMITED
**PAINFUL
in
flexion
extension
R side-bend
R rotation
L side-bend
L rotation
**
--Special Tests:
*
---Spurlings -
negative
R POSITIVE
L POSITIVE
---Axial Compression -
negative
POSITIVE
*Low Back
--Inspection:
*
no gross deformity
R PARASPINAL MUSCLE SPASM
L PARASPINAL MUSCLE SPASM
GROSS/EXCESS LATERAL SPINAL CURVATURE
KYPHOSIS
ABNORMAL STRAIGHTENING OF L-SPINE
--Palpation:
*
No tenderness to palpation of
midline/spinous processes
R paraspinals
R quadratus lumborum
R sacral sulcus
R piriformis
L paraspinals
L quadratus lumborum
L sacral sulcus
L piriformis
.
**TTP of
midline/spinous processes
R paraspinals
R quadratus lumborum
R sacral sulcus
R piriformis
L paraspinals
L quadratus lumborum
L sacral sulcus
L piriformis
**
---
No step-offs noted
ABNORMAL STEP-OFF NOTED
--ROM:
*
Not limited & not painful in
flexion
extension
R side-bend
R rotation
L side-bend
L rotation
.
**LIMITED
**PAINFUL
in
flexion
extension
R side-bend
R rotation
L side-bend
L rotation
**
--Special Tests:
*
---Axial Compression -
negative
POSITIVE
---Straight Leg Raise -
R negative
R POSITIVE
L negative
L POSITIVE
---Duncan Ely test -
R negative
R POSITIVE
L negative
L POSITIVE
(for quad tightness)
---Thomas test -
R negative
R POSITIVE for hip flexor tightness
R POSITIVE for quad tightness
L negative
L POSITIVE for hip flexor tightness
L POSITIVE for quad tightness
---Popliteal angle with passive knee extension -
R normal
R ABNORMAL for hamstring tightness
L normal
L ABNORMAL for hamstring tightness
---Obers test -
R normal
R ABNORMAL for IT band tightness
L normal
L ABNORMAL for IT band tightness
*R/L Hip
--Inspection:
*
no gross deformity
GROSS DEFORMITY
--Palpation:
*
No tenderness to palpation of
R greater trochanter/bursa
R anterior superior iliac spine
R ischial tuberosity
R Iliac crest
R IT band
R anterior aspect of hip/acetabulum
L greater trochanter/bursa
L anterior superior iliac spine
L ischial tuberosity
L Iliac crest
L IT band
L anterior aspect of hip/acetabulum
.
**TTP of
R greater trochanter/bursa
R anterior superior iliac spine
R ischial tuberosity
R Iliac crest
R IT band
R anterior aspect of hip/acetabulum
L greater trochanter/bursa
L anterior superior iliac spine
L ischial tuberosity
L Iliac crest
L IT band
L anterior aspect of hip/acetabulum
**
--ROM:
*
Not limited & not painful in
R flexion
R extension
R internal rotation
R external rotation
R abduction
L flexion
L extension
L internal rotation
L external rotation
L abduction
**LIMITED
**PAINFUL
in
R flexion
R extension
R internal rotation
R external rotation
R abduction
L flexion
L extension
L internal rotation
L external rotation
L abduction
**
--Special Tests:
*
---Log Roll -
R negative
R POSITIVE
L negative
L POSITIVE
---Straight Leg Raise -
R negative
R POSITIVE
L negative
L POSITIVE
---FABERE test -
R negative
R POSITIVE
L negative
L POSITIVE
---FADIR test -
R negative
R POSITIVE
L negative
L POSITIVE
---Thomas test -
R negative
R POSITIVE for hip flexor tightness
R POSITIVE for quad tightness
L negative
L POSITIVE for hip flexor tightness
L POSITIVE for quad tightness
---Obers test -
R normal
R ABNORMAL for IT band tightness
L normal
L ABNORMAL for IT band tightness
*R/L Knee
--Inspection:
*
no gross deformity
no gross dislocation
R GROSS EFFUSION
R ECCHYMOSIS
R LATERALLY DISPLACED PATELLA
L GROSS EFFUSION
L ECCHYMOSIS
L LATERALLY DISPLACED PATELLA
--Palpation:
*
No tenderness to palpation of
R Quad tendon
R Patella
R lateral patellar facet
R medial patellar facet
R Patellar tendon
R Medial Joint Line
R Lateral Joint Line
R Pes Anserine Bursa
R IT Band
R LCL Ligament
R MCL Ligament
R Popliteal Fossa
L Quad tendon
L Patella
L lateral patellar facet
L medial patellar facet
L Patellar tendon
L Medial Joint Line
L Lateral Joint Line
L Pes Anserine Bursa
L IT Band
L LCL Ligament
L MCL Ligament
L Popliteal Fossa
.
**TTP of
R Quad tendon
R Patella
R lateral patellar facet
R medial patellar facet
R Patellar tendon
R Medial Joint Line
R Lateral Joint Line
R Pes Anserine Bursa
R IT Band
R LCL Ligament
R MCL Ligament
R Popliteal Fossa
L Quad tendon
L Patella
L lateral patellar facet
L medial patellar facet
L Patellar tendon
L Medial Joint Line
L Lateral Joint Line
L Pes Anserine Bursa
L IT Band
L LCL Ligament
L MCL Ligament
L Popliteal Fossa
**
.
No palpable baker's cyst
PALPABLE BAKER'S CYST
--ROM:
*
Not limited & not painful in
R flexion
R extension
R internal rotation
R external rotation
L flexion
L extension
L internal rotation
L external rotation
**LIMITED
**PAINFUL
in
R flexion
R extension
R internal rotation
R external rotation
L flexion
L extension
L internal rotation
L external rotation
**
--Special Tests:
*
---Patellar Apprehension test-
R negative
R POSITIVE
L negative
L POSITIVE
---Varus test -
R negative
R POSITIVE
L negative
L POSITIVE
---Valgus test -
R negative
R POSITIVE
L negative
L POSITIVE
---Lachman -
R negative
R POSITIVE
L negative
L POSITIVE
---Anterior Drawer -
R negative
R POSITIVE
L negative
L POSITIVE
---Posterior Drawer -
R negative
R POSITIVE
L negative
L POSITIVE
---McMurrays -
R negative
R POSITIVE
L negative
L POSITIVE
---Thessaly test -
R negative
R POSITIVE
L negative
L POSITIVE
---Duncan Ely test -
R negative
R POSITIVE
L negative
L POSITIVE
(for quad tightness)
---Thomas test -
R negative
R POSITIVE for hip flexor tightness
R POSITIVE for quad tightness
L negative
L POSITIVE for hip flexor tightness
L POSITIVE for quad tightness
---Popliteal angle with passive knee extension -
R normal
R ABNORMAL for hamstring tightness
L normal
L ABNORMAL for hamstring tightness
---Obers test -
R normal
R ABNORMAL for IT band tightness
L normal
L ABNORMAL for IT band tightness
*R/L Ankle/Foot
--Inspection:
*
no gross deformity/dislocation of ankles
no gross deformity/dislocation of feet
Normal height of plantar arches with weight bearing
HIGH plantar arches with weight bearing
LOW/REDUCED plantar arches with weight bearing
COMPLETE COLLAPSE of plantar arches with weight bearing
R ANKLE GROSS EFFUSION
R ANKLE ECCHYMOSIS
R FOOT GROSS EDEMA
R FOOT ECCHYMOSIS
R HALLUX VALGUS
L ANKLE GROSS EFFUSION
L ANKLE ECCHYMOSIS
L FOOT GROSS EDEMA
L FOOT ECCHYMOSIS
L HALLUX VALGUS
--Palpation:
*
No tenderness to palpation of
R proximal fibula
R distal fibula
R distal tibia/lateral malleolus
R medial malleolus
R anterior talofibular ligament (ATFL)
R posterior talofibular ligament (PTFL)
R calcaneal fibular ligament (CFL)
R deltoid ligament complex
R achilles tendon
R posterior calcaneus
R plantar fascia
R base of 5th metatarsal
R dorsal aspect of navicular bone
L proximal fibula
L distal fibula
L distal tibia/lateral malleolus
L medial malleolus
L anterior talofibular ligament (ATFL)
L posterior talofibular ligament (PTFL)
L calcaneal fibular ligament (CFL)
L deltoid ligament complex
L achilles tendon
L posterior calcaneus
L plantar fascia
L base of 5th metatarsal
L dorsal aspect of navicular bone
.
**TTP of
R proximal fibula
R distal fibula
R distal tibia/lateral malleolus
R medial malleolus
R anterior talofibular ligament (ATFL)
R posterior talofibular ligament (PTFL)
R calcaneal fibular ligament (CFL)
R deltoid ligament complex
R achilles tendon
R posterior calcaneus
R plantar fascia
R base of 5th metatarsal
R dorsal aspect of navicular bone
L proximal fibula
L distal fibula
L distal tibia/lateral malleolus
L medial malleolus
L anterior talofibular ligament (ATFL)
L posterior talofibular ligament (PTFL)
L calcaneal fibular ligament (CFL)
L deltoid ligament complex
L achilles tendon
L posterior calcaneus
L plantar fascia
L base of 5th metatarsal
L dorsal aspect of navicular bone
**
--ROM:
*
Not limited & not painful in
R ankle dorsiflexion
R ankle plantarflexion
R ankle inversion
R ankle eversion
R foot inversion
R foot eversion
R hallux flexion
R hallux extension
R flexion of lesser toes
R extension of lesser toes
L ankle dorsiflexion
L ankle plantarflexion
L ankle inversion
L ankle eversion
L foot inversion
L foot eversion
L hallux flexion
L hallux extension
L flexion of lesser toes
L extension of lesser toes
**LIMITED
**PAINFUL
in
R ankle flexion
R ankle extension
R ankle inversion
R ankle eversion
R foot inversion
R foot eversion
R hallux flexion
R hallux extension
R flexion of lesser toes
R extension of lesser toes
L ankle flexion
L ankle extension
L ankle inversion
L ankle eversion
L foot inversion
L foot eversion
L hallux flexion
L hallux extension
L flexion of lesser toes
L extension of lesser toes
**
--Special Tests:
*
---Talar Tilt-
R negative
R POSITIVE
L negative
L POSITIVE
---Anterior Drawer -
R negative
R POSITIVE
L negative
L POSITIVE
---Posterior Drawer -
R normal
R POSITIVE
L normal
L POSITIVE
---Tib/Fib Squeeze test -
R normal
R POSITIVE
L normal
L POSITIVE
---Ankle External Rotation Test (Syndesmotic Stress Test) -
R normal
R POSITIVE
L normal
L POSITIVE
---Thompson Test (Achilles integrity) -
R normal
R POSITIVE
L normal
L POSITIVE
--Add'l comments-
none
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