discussion

A. Skeleton and extremities: compare sides for alignment, contour and symmetry, size, gross deformity

B. Skin and subcutaneous tissues over muscles and joints for color, number of skinfolds, swelling, masses

C. Inspect muscles and compare sides for size, symmetry, fasciculations, or spasms.

D. Palpate all bones, joints, and surrounding muscles for muscle tone, heat, tenderness, swelling, and crepitus.

E. Test each major joint for active and passive range of motion and compare sides.

F. Test major muscle groups for strength and compare sides.

G. Hands and wrists

1. Dorsum and palm of hands for contour, position, shape, number and completeness of digits

2. Palpate each joint in the hand and wrist.

3. Test range of motion: metacarpophalangeal flexion and hyperextension; thumb opposition; forming a fist; finger adduction and abduction; wrist extension, hyperextension and flexion; radial and ulnar motion

H. Elbows

1. Inspect the elbows in flexed and extended position for contour and carrying angle.

2. Palpate the extensor surface of the ulna, olecranon process, and the medial and lateral epicondyles of the humerus.

3. Test range of motion: flexion, extension, pronation, and supination.

I. Shoulders

1. Shoulders and shoulder girdle for contour.

2. Palpate the joint spaces and bones of the shoulders.

3. Test range of motion: shrugging, forward flexion and hyperextension, abduction and adduction, internal and external rotation.

4. Test muscle strength: shrugging, abduction with forward flexion, medial rotation, lateral rotation.

J. Temporomandibular joint

1. Palpate the joint space for clicking, popping, and pain.

2. Test range of motion: opening and closing mouth, moving jaw laterally to each side, protruding and retracting jaw.

3. Test strength of temporalis muscles.

K. Cervical spine

1. Neck for alignment, symmetry of skinfolds and muscles

2. Test range of motion: forward flexion, hyperextension, lateral bending, and rotation.

3. Test strength of sternocleidomastoid and trapezius muscles.

L. Thoracic and lumbar spine

1. Spine for alignment.

2. Palpate the spinal processes and paravertebral muscles.

3. Percuss for spinal tenderness.

4. Test range of motion: forward flexion, hyperextension, lateral bending, rotation.

M. Hips

1. Hips for symmetry and level of gluteal folds

2. Palpate hips and pelvis for instability, tenderness, and crepitus.

3. Test range of motion: flexion, extension, and hyperextension; adduction; abduction; internal and external rotation.

4. Test muscle strength: knee in flexion and extension, abduction and adduction.

N. Legs and knees

1. Knees for natural concavities

2. Palpate the popliteal space and joint space.

3. Test range of motion: flexion and extension.

4. Test the strength of muscles in flexion and extension.

O. Feet and ankles

1. Feet and ankles during weight bearing and non–weight bearing for contour, alignment with tibias, size, number of toes

2. Palpate the Achilles tendon and each metatarsal joint.

3. Test range of motion: dorsiflexion and plantar flexion, inversion and eversion, and flexion and extension of the toes.

4. Test strength of muscles in plantar flexion and dorsiflexion.