Merck Manual

Please confirm that you are not located inside the Russian Federation

honeypot link

Medical History and Physical Examination in Musculoskeletal Disorders

By

Alexandra Villa-Forte

, MD, MPH, Cleveland Clinic

Last full review/revision Mar 2020| Content last modified Mar 2020
CLICK HERE FOR THE PROFESSONAL VERSION

Some disorders affect primarily the joints (such as osteoarthritis Osteoarthritis (OA) Osteoarthritis is a chronic disorder that causes damage to the cartilage and surrounding tissues and is characterized by pain, stiffness, and loss of function. Arthritis due to damage of joint... read more Osteoarthritis (OA) ), causing arthritis. Other disorders affect primarily the bones (such as fractures Overview of Fractures A fracture is a crack or break in a bone. Most fractures result from force applied to a bone. Fractures usually result from injuries or overuse. The injured part hurts (especially when it is... read more Overview of Fractures , Paget disease of bone Paget Disease of Bone Paget disease of bone is a chronic disorder of the skeleton in which areas of bone undergo abnormal turnover, resulting in areas of enlarged and softened bone. The breakdown and formation of... read more Paget Disease of Bone , and tumors Overview of Bone Tumors Bone tumors are growths of abnormal cells in bones. Bone tumors may be cancerous (malignant) or noncancerous (benign). Cancerous tumors may start in the bone (primary cancer) or start in other... read more ) or muscles or other soft tissues (such as fibromyalgia Fibromyalgia Fibromyalgia is characterized by poor sleep, fatigue, mental cloudiness, and widespread aching and stiffness in soft tissues, including muscles, tendons, and ligaments. Poor sleep, stress, strains... read more and tendinitis Tendinitis and Tenosynovitis Tendinitis is inflammation of a tendon. Tenosynovitis is tendinitis accompanied by inflammation of the protective covering around the tendon (tendon sheath). The cause is not always known. Tendons... read more ).

Medical History

During a musculoskeletal evaluation, doctors ask people about musculoskeletal symptoms but also look for other symptoms, such as fever, chills, weight loss, rash, eye pain or redness, and symptoms of heart, lung, and gastrointestinal disorders. These other symptoms may be caused by or associated with various musculoskeletal disorders.

Pain

Pain Musculoskeletal Pain Pain is the most common symptom of most musculoskeletal disorders. Pain ranges from mild to severe and from acute and short-lived to chronic and of long duration and may be local or widespread... read more is the most common symptom of musculoskeletal disorders. Doctors ask people to describe the character, location, and severity of the pain. They ask people to list factors that aggravate or relieve the pain and describe whether the pain is new or recurring. Doctors want to know whether the pain is worse when first moving a joint or after prolonged use and whether it is present upon waking or develops during the day. Doctors also ask people to describe what the pain feels like, for example, whether it is sharp or dull or whether it is aching or burning. They need to know whether people feel the pain deep in a joint or whether other musculoskeletal structures seem to be affected by it. Knowing the type and location of the pain can help doctors figure out the cause.

Stiffness

People who have musculoskeletal disorders often have stiffness Joint Stiffness Joint stiffness is the feeling that the motion of a joint is limited or difficult. The feeling is not caused by weakness or reluctance to move the joint due to pain. Some people with stiffness... read more of their joints (that is, people feel resistance when trying to move a joint). Doctors ask people to specifically describe their stiffness because people often use the word "stiffness" to describe weakness or extreme tiredness (fatigue), but, to doctors, "stiffness" means difficulty moving the joints. Doctors distinguish stiffness from a reluctance to move because of pain that occurs with movement.

Doctors also ask people to describe when they feel stiffness. In some joint disorders (such as rheumatoid arthritis Rheumatoid Arthritis (RA) Rheumatoid arthritis is an inflammatory arthritis in which joints, usually including those of the hands and feet, are inflamed, resulting in swelling, pain, and often destruction of joints.... read more Rheumatoid Arthritis (RA) and osteoarthritis Osteoarthritis (OA) Osteoarthritis is a chronic disorder that causes damage to the cartilage and surrounding tissues and is characterized by pain, stiffness, and loss of function. Arthritis due to damage of joint... read more Osteoarthritis (OA) ), stiffness occurs after people first start to move after a period of rest or when awakening in the morning. Doctors also need to know where people feel stiffness and how long stiffness lasts. For example, in disorders that cause inflammation (such as rheumatoid arthritis Rheumatoid Arthritis (RA) Rheumatoid arthritis is an inflammatory arthritis in which joints, usually including those of the hands and feet, are inflamed, resulting in swelling, pain, and often destruction of joints.... read more Rheumatoid Arthritis (RA) ), stiffness is prolonged (for example, longer than an hour), whereas in disorders that do not cause inflammation (such as osteoarthritis Osteoarthritis (OA) Osteoarthritis is a chronic disorder that causes damage to the cartilage and surrounding tissues and is characterized by pain, stiffness, and loss of function. Arthritis due to damage of joint... read more Osteoarthritis (OA) ), stiffness is short-lived (for example, about 10 minutes) even though it may be severe and pain may persist.

Fatigue

Fatigue Fatigue Fatigue is when a person feels a strong need to rest and has so little energy that starting and sustaining activity is difficult. Fatigue is normal after physical exertion, prolonged stress... read more is another symptom doctors ask about. Fatigue is when a person feels a strong need to rest and has so little energy that starting and sustaining activity is difficult. It differs from weakness or an inability to move, and doctors evaluate people to distinguish it from sleepiness. Fatigue may mean people have a disorder that affects more than one system in the body and causes inflammation, or that there is a disorder disrupting normal sleep Sleep disorders Sleep is necessary for survival and good health, but why sleep is needed and exactly how it benefits people are not fully understood. One of sleep's benefits is its restorative effect on people's... read more .

Joint instability

People may have joint instability (for example, wobbliness or buckling of a joint), which suggests weakness of the ligaments or other structures that stabilize the joint. Buckling occurs most often in the knee.

Physical Examination

A doctor looks for certain things during a physical examination depending on what disorder or injury is suspected.

When evaluating bones, if a fracture Overview of Fractures A fracture is a crack or break in a bone. Most fractures result from force applied to a bone. Fractures usually result from injuries or overuse. The injured part hurts (especially when it is... read more Overview of Fractures is suspected, the doctor may notice that the affected part (such as an arm or a leg) is abnormally shaped, suggesting that the segments of bone are out of alignment.

When a person complains of muscle weakness, the doctor feels muscles for bulk, tone (how relaxed the muscle is when it is not being used), strength, and tenderness. Muscles are also checked for twitches and involuntary movements, which may indicate a nerve disease rather than a muscle disease (see Motor Nerves Motor Nerves When a neurologic disorder is suspected, doctors usually evaluate all of the body systems during the physical examination, but they focus on the nervous system. Examination of the nervous system—the... read more ). Doctors look for wasting away of muscle (atrophy), which can result from damage to the muscle or its nerves or from lack of use (disuse atrophy), as sometimes occurs with prolonged bed rest.

Doctors also look for muscle enlargement (hypertrophy), which normally results from activities or exercises that repeatedly stress the muscle, such as weight lifting. However, when a person is ill, hypertrophy may result from one muscle working harder to compensate for the weakness of another. Muscles can also enlarge when normal muscle tissue is replaced by abnormal tissue, which increases the size but not the strength of the muscle. Abnormal tissue can replace muscles in amyloidosis Amyloidosis Amyloidosis is a rare disease in which abnormally folded proteins form amyloid fibrils that accumulate in various tissues and organs, sometimes leading to organ dysfunction, organ failure, and... read more Amyloidosis and in certain inherited muscle disorders, such as Duchenne muscular dystrophy Duchenne Muscular Dystrophy and Becker Muscular Dystrophy Muscular dystrophies are a group of inherited muscle disorders in which one or more genes needed for normal muscle structure and function are defective, leading to muscle weakness of varying... read more .

Doctors try to establish which (if any) muscles are weak and how weak they are. The muscles can be tested systematically, usually beginning with the face and neck, then the arms, and finally the legs. Normally, a person should be able to hold the arms extended, palms up, for one minute without their sagging, turning, or shaking. Downward drift of the arm with palms turning inward is a sign of weakness. Strength is tested by pushing or pulling while the doctor pushes and pulls in the opposite direction. Strength is also tested by having the person perform certain maneuvers, such as walking on the heels and tiptoes or rising from a squatting position or getting up and down from a chair rapidly 10 times. The person is asked to look in all directions; if double vision develops, one or more eye muscles may be weak.

The doctor tests a person's active range of motion. The active range of motion is the maximum range through which people can move a joint by themselves. Limited active range of motion may indicate weakness, pain, or stiffness as well as mechanical abnormalities (such as scarring and swelling). The doctor then tests a person's passive range of motion. The passive range of motion is the maximum range through which the doctor can move the person's joint while the person is completely relaxed. The doctor also checks muscle tone by moving the limb passively. Resistance to passive movement (called passive resistance) may be decreased when the nerve leading to the muscle is damaged. Resistance to such movement may be increased when the spinal cord or brain is damaged.

If a person is weak, doctors also tap the person's muscle tendon with a rubber hammer to check reflexes Reflexes When a neurologic disorder is suspected, doctors usually evaluate all of the body systems during the physical examination, but they focus on the nervous system. Examination of the nervous system—the... read more . Reflexes may be slower than expected when the nerve leading to the muscle is damaged. Reflexes may be more rapid than expected when the spinal cord or brain is damaged.

Doctors note which joints or limbs are affected. Finding a pattern of affected joints and limbs can help doctors figure out the cause.

Doctors also examine affected joints in more detail. For example, they examine the joints to determine whether fluid is in the joint (called a joint effusion). They may test specific active or passive motions. They may pull or apply force to see whether the joint is stable.

NOTE: This is the Consumer Version. DOCTORS: CLICK HERE FOR THE PROFESSONAL VERSION
CLICK HERE FOR THE PROFESSONAL VERSION
Others also read
Test your knowledge
Metastatic Bone Tumors
Metastatic bone tumors are cancers that originate elsewhere in the body and then spread (metastasize) to the bones. Any cancer can spread to the bones, although some types are more likely to do so than others. Which of the following types of cancer is most likely to spread to the bones?
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID

Also of Interest

Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
TOP