MSK PE Checklist/Guide for the PE of each Joint
These checklists are just a guide – they are to assist with watching the normal PE videos
– although they do not perfectly follow the videos. Some of the videos go a little more in
depth just to show you a complete exam - but – as medical students – you are primarily
responsible for what is in your small group sessions, which is amplified in the below
checklists. This information is also in your MSK textbook as well, under the PE section.
Thus – you have multiple sources to assist you in learning the basics of the MSK PE.
Remember - the videos and this checklist are a guide – to supplement the small group
sessions and ultimately to teach you how to perform and understand an effective MSK
PE.
Shoulder:
Inspection: disrobe patient – always compare to opposite side – look for
atrophy/deformity and skin changes
a) bony anatomy – sternoclavicular joint/clavicle/acromioclavicular
joint/acromion/scapular spine
b) check for scapular winging
c) muscle – deltoid/pectoralis/biceps contours
d) check for atrophy of muscles/RTC – primarily supraspinatus and infraspintus
e) recognize normal contours of a located HH
Palpation:
a) sternoclavicular joint
b) clavicle
c) acromioclavicular joint
d) acromion
e) scapular spine
f) greater tuberosity
g) bicipital groove
h) glenohumeral joint line – anterior and posterior
ROM: check active first – then passive (always compare ROM to opposite side to see
what motion is normal for that patient -as some are stiffer than others)
a) forward elevation (FE) – perform in scapular plane (0 – 165/170 is normal)
b) external rotation (ER) – elbow by side at 90 degrees (0 – 70 is normal)
c) internal rotation (IR) – hand behind back (check what vertebral level hand
goes to and compare to opposite side – typically about T7 is normal)
Strength
a) resisted FE – arm at 90 degrees of elevation and resist downward pressure
b) resisted ER – elbow at side at 90 degrees – and push out against resistance
c) resisted IR – elbow at side – same as above and push in
Special Testing
a) Rotator cuff:
a. Impingement tests (Hawkins and Neer) (tests RTC tendonitis/bursitis)
b. Empty can – resisted FE with arm in IR (isolates supraspinatus and
positive test may indicate pathology in supraspinatus)
c. Drop arm test – if positive indicates possible large supraspinatus tear
d. ER Lag – if positive – indicates infraspinatus tear
e. Subscapularis tests – belly press and lift off – if +, indicates
subscapularis tear
b) Instability testing
a. Check generalized ligamentous laxity
b. Apprehension test: with patient supine – place arm in 90 of ABD/ER:
if patient reports fear/pain, the test is +, indicates anterior instability
c. Sulcus sign – indicative of multidirectional instability – “loose
shoulder”
c) AC joint painful
a. Tender at AC joint
b. Pain at AC joint with cross chest adduction
c. Pain at AC joint with internal rotation behind back
d) Biceps signs
a. Speeds test – pain in bicipital groove with resisted palms up indicates biceps tendonitis
Neurovascular exam – always check the neck!
a) check peripheral nerves (axillary, musculocutaneous, ulnar, radial, median)
Knee/leg
Inspection:
a) atrophy/deformity/skin changes – note knee is a superficial joint – see these
things well – versus hip – deep joint
b) normal knee contours –
a. quadriceps
b. patella
c. patella tendon
d. tibial tubercle
e. medial and lateral joint line
f. effusion versus no effusion – look to the supra-patellar pouch – which
will be full if there is a big effusion
c) evaluate alignment of knee
d) resting position of knee – (contractures/flexion)
Palpation:
a)
b)
c)
d)
e)
f)
g)
h)
i)
quadriceps insertion
patella
patella tendon
tibial tubercle
medial and lateral joint line
medial and lateral epicondyle
MCL/LCL origin/insertion
Pes anserinus insertion
Fibular head
ROM: always check active first – then passive
a) knee flexion – normal is about 0 to 135
b) knee extension – normal is 0 degrees of extension – check if there is a
contracture – or loss of extension
c) check for hyperextension of the knee – which ligamentously lax patients may
have
Strength: can check supine or seated
a) resisted knee extension (testing quadriceps)
b) resisted knee flexion (testing hamstrings)
Special Testing:
a) ligamentous exam: check integrity of ligaments
a. MCL – valgus stress test
b. LCL – varus stress test
c. ACL – Lachmans/anterior drawer
d. PCL – posterior drawer
b) meniscus testing
a. joint line tenderness
b. McMurray’s – pain or click is a positive test if in location of presumed
meniscus tear – ie – medial joint line clicks or hurts with this
maneuver if you suspect a medial meniscus tear
c) patella ballottement to check for effusion - most times you will see this
effusion on inspection and if not – will check on the palpation part of the
exam.
d) Straight leg raise – to check for integrity of extension mechanism: this is
really part of your active knee extension test – patient should be able to fully
actively extend knee to full extension – which is 0 degrees.
e) Patella apprehension – if the patient has a history of patella dislocations – they
always occur laterally because the MPFL is torn. Lateral pressure on the
patella will cause apprehension – or fear – in the patient that you will dislocate
the patella.
f) Check quick hip exam as sometimes hip pain refers to the knee and the
hip is the issue!
g)
Always check a neurovascular exam
Back Exam
Palpated costovertebral angles for tenderness
Palpated spinous processes of thoracic and lumbar spine
Palpated paraspinal muscles of lumbar spine
Assessed ROM of back (flexion, extension, lateral bending)