Expansion
Look, feel, move, then special tests and function
Expansion
Look
- Scars, swelling, deformity, muscle wasting, erythema
- Compare with the other side
- Look from the front, side and behind, and while weight bearing for lower limb joints
Feel
- Temperature with the back of the hand
- Tenderness, localising it precisely
- Effusion: patellar tap or bulge sign at the knee
- Crepitus
Move
- Active first (the patient’s own movement), then passive
- Record range, pain and crepitus
- Resisted movement to test power and localise tendon pathology
Special tests appropriate to the joint, then function (grip, gait, activities of daily living) and neurovascular status distally.
Two disciplines matter throughout. Examine the joint above and below, since hip pathology presents as knee pain and shoulder pathology as arm pain. And watch the patient’s face, not the joint, while palpating.
A joint that is hot, red, swollen and exquisitely painful with pain on the slightest passive movement is a septic joint until proven otherwise, and requires urgent aspiration.