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Home | Blog | Musculoskeletal Examination Techniques: Enhancing Diagnostic Accuracy in Primary Care

Musculoskeletal Examination Techniques: Enhancing Diagnostic Accuracy in Primary Care

Musculoskeletal Examination Techniques: Enhancing Diagnostic Accuracy in Primary Care

A clear, structured MSK examination is one of the most valuable tools in primary care. With time pressures and increasingly complex presentations, a repeatable, efficient approach helps GPs and physiotherapists differentiate simple from serious pathology and identify when early orthopaedic input is required.

A Simple, Time-Efficient Framework – Look, Feel, Move, Test

1. Look

  • Observe posture, swelling, deformity, bruising, muscle wasting or asymmetry.
  • Assess gait, weight-bearing and functional tasks (sit-to-stand, step-up, hand grip).

2. Feel

  • Palpate for warmth, tenderness, effusion, crepitus, and focal trigger points.
  • Compare bilaterally and identify structures in a logical order: bone → joint line → tendon → muscle → neurovascular structures.

3. Move

Active ROM

  • Ask the patient to move fully through flexion, extension, abduction/adduction, and rotational movements. Note pain, restriction or compensatory patterns.

Passive ROM

  • Helps differentiate capsular/joint restriction from muscular/soft-tissue restriction.
  • Pain on passive movement often suggests intra-articular pathology.

Resisted Movements

  • Quick screening for muscle strength, tendon integrity, and pain provocation.

4 Test: Key Special Tests for Primary Care

Shoulder

  • Jobe (Empty Can): supraspinatus dysfunction.
  • Hawkins–Kennedy / Neer: impingement signs.
  • External rotation lag: infraspinatus tears (useful in older patients).

Knee

  • Lachman: most sensitive test for ACL rupture.
  • Joint line tenderness + McMurray: meniscal involvement.
  • Patellar grind: patellofemoral pain.

Hip

  • FABER: intra-articular hip pathology/SIJ discomfort.
  • FADIR: femoroacetabular impingement.
  • Trendelenburg: gluteal weakness or abductor tendon pathology.

Back

  • SLR: L5/S1 radicular symptoms.
  • Femoral nerve stretch: L2–L4 nerve root irritation.
  • Red-flag screening (cauda equina, systemic symptoms, trauma).

Neurovascular Screening (Always Include)

  • Dermatomes, myotomes and reflexes.
  • Peripheral pulses and capillary refill where relevant.
  • Assess distal function after trauma or suspected fracture/dislocation.

When to Refer for surgical review or second opinion

  • Acute ligament or tendon ruptures (e.g., Achilles, biceps, ACL).
  • Fractures or suspected occult fracture.
  • Persistent mechanical symptoms.
  • Progressive weakness, neuro deficit or red flags.
  • Poor response to conservative management → review at 4–6 weeks.

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