Muscle tendon injury

First-degree, mild

Tender without swelling, mild spasm

No ecchymosis

No palpable defect

Active contraction and passive stretch are painful

Second-degree, moderate

Tender with swelling

Mild to moderate ecchymosis

Moderate spasm

Possibly palpable discontinuity

Extremely painful with passive stretching and attempted contraction

Joint motion limited

Third-degree, complete

Extreme tenderness with swelling

May be severe bleeding and possible compartment syndrome with loss of sensation and

pulse distally

Palpable defect with bunching up of muscle tissue

Complete loss of muscle function

No change in pain with passive stretch

Ligament injury

First-degree, mild

Minimal or no swelling

Local tenderness

Increase in pain with passive and active range of motion

Minimal bruising

No instability or functional loss expected

Second-degree, moderate

Moderate swelling with ecchymosis

Very tender, more diffusely tender

Range of motion very painful and restricted due to swelling

Instability may be recognized

Functional loss may result

Third-degree, complete

Severe swelling and ecchymosis or hemarthrosis

Structural instability with abnormal increase in range of motion

Possibly less painful than second-degree tear

Bone injury

Contusion

Localized tenderness

With or without ecchymosis

Subcutaneous swelling

No palpable discontinuity

Fracture

Localized to diffuse tenderness

Deformity and/or instability

Palpable discontinuity in accessible areas

Ecchymosis

Possible neurovascular compromise

Stress fracture

Localized tenderness with overlying swelling and redness

Increased pain with vibration or ultrasound applied to bone

Certain locations are very common (i.e., tibia, fibula, metatarsals, femur)

Inflammatory joint disease

Swelling, redness of joint, frequently symmetric

Synovitis, systemic disease common

May see subcutaneous nodules on extensor surface

Severe joint deformities are common

Valgus deformities are common

Extensor tendon ruptures may be noted

Compression neuropathy with loss of sensation and muscle strength may be noted

Muscle weakness and restricted range of motion

Pain worsens with activity

Noninflammatory joint disease

Acute swelling and redness, asymmetrical involvement

Hypertrophic joint without destruction

Common pattern “capsular,” which is painful on range of motion

Weakness and tightness of muscles crossing involved joints

Pain lessens with activity

Stiffness in the morning; fusion of joint may eventually occur

Varus deformity may occur

Metabolic joint disease

Abnormal crystals in the joint fluid

Very painful, red and swollen joints

Loss of range of motion

Systemic disease common

Joint destruction may be severe

Nerve compression or radiculopathy

Pain, weakness, sensory loss, reflex loss and parasthesias in the dermatomal and/or

myotomal distribution of the affected nerve; degree of loss of function may be mild

or complete

Stretching the nerve may increase pain

Tapping over the nerve may result in distal tingling (Tinel’s sign), especially if regeneration

is occurring

Myofascial pain (trigger points)

Tenderness in a characteristic location of certain muscles

Palpation of this location causes referred pain to a distant site

A taut band, or sausage-like piece of muscle can often be palpated and may cause a twitch

of the muscle when plucked like a guitar string

The affected muscle is usually unable to relax fully and therefore passive stretch is limited

and painful

Neoplasm

Unremitting pain, often awakens patient from sleep, no comfortable position to relieve pain

Palpable mass if accessible and advanced

Fracture (pathological) if bone involved

Fever, weight loss, and fatigue

Possible neurovascular compromise

Infection

Swelling, redness, warmth, and tenderness

Fever and fatigue

Loss of joint range or motion with characteristic fluid findings in affected joint

Painful compression, active and passive range of motion of involved muscle

Reflex sympathetic dystrophy

Acute: Less than

Pain, warmth, swelling, redness

3 months after injury

Light touch is very painful

Increased hair growth

Mild stiffness of joints

Subacute: 4–12 months

Pain is extremely severe

after injury

Increased joint stiffness with loss of range of motion

Passive range of motion is very painful

Cool and pale or cyanotic discoloration

Less swelling

Chronic: More than

Less pain (usually)

1 year after injury

Periarticular fibrosis

Marked limitation in range of motion

No swelling

Pale, dry, and shiny skin

JOINT

MOTION

Shoulder

Flexion

0

–180

Extension

0

–60

Abduction

0

–180

Internal (medial) rotation

0

–70

External (lateral) rotation

0

–90

Elbow

Flexion

0

–150

Extension

0

Forearm

Pronation

0

–80/90

Supination

0

–80/90

Wrist

Extension

0

–70

Flexion

0

–80

Radial deviation

0

–20

Ulnar deviation

0

–30

Thumb

Carpometacarpal

Abduction

0

–70

Adduction

0

Opposition

Metacarpophalangeal

Flexion

0

–50

Extension

0

Interphalangeal

Flexion

0

–90

Extension

0

–20

Digits 2–5

Metacarpophalangeal

Flexion

0

–80

Extension

0

–45

Abduction/Adduction

0

–20

Proximal interphalangeal

Flexion

0

–110

Extension

0

Distal interphalangeal

Flexion

0

–90

Extension

0

–20

Hip

Flexion

0

–120

Extension

0

–30

Abduction

0

–45

Adduction

0

–30

External (lateral) rotation

0

–45

Internal (medial) rotation

0

–45

Knee

Flexion

0

–135

Extension

0

Ankle

Dorsiflexion

0

–20

Plantar flexion

0

–50

Inversion

0

–35

Eversion

0

–15

Subtalar

Inversion

0

–5

Eversion

0

–5

Forefoot

Inversion

0

–35

Eversion

0

–15

Toes

First metatarsophalangeal

Flexion

0

–45

Extension

0

–70

First interphalangeal

Flexion

0

–40

Second to fifth

Flexion

0

–40

metatarsophalangeal

Extension

0

–40

Page numbers in italics refer to figures;

adduction

those in bold refer to tables.

carpometacarpal joint—256, 258, 258

fingers—270, 271, 279

abdominal muscles—105, 106

active—250

abduction

hip—325

carpometacarpal joint—256, 258, 258

active—304, 306

fingers—270, 271, 279

passive—308, 310, 310

active—250

resistive—319, 320, 321

hip—317–19, 318, 319, 325

metacarpophalangeal joint—254–5, 256

active—304, 306

shoulder—182

passive—308, 309

active—162, 163, 163

metacarpophalangeal joint—254–5, 256

resistive—173–5, 175

shoulder—182

thumb—251, 275–6, 277, 279

active—162, 162, 163

toes—401, 402

passive—165, 165

adductor brevis—319, 320

resistive—172–3, 173, 174

adductor longus—300, 300, 319, 320

thumb—251, 274–5, 275, 276, 279

adductor magnus—319, 320

toes—401, 402

adductor pollicis—275, 277

great toe—419

adductor tubercle—345, 346

abductor pollicis brevis—274, 275

adductors of hip—319, 320

abductor pollicis longus—248, 274, 275

Adson’s maneuver—191, 193

abductors of hip—317, 318

agonists—11

accessory movement testing—31

alignment tests

ankle and foot—407–11

ankle and foot—426–7

cervical and thoracic spine—62–5, 63,

hip—331–3

64

Allen’s test—288, 289

elbow—211–15

anatomical snuff-box—242, 244, 248

hip—312

anconeus—217

knee—356–9

angle of femoral anteversion—332, 332

lumbosacral spine—113–15, 114

angle of Louis (sternal angle)—51, 53

shoulder—167–70, 168

ankle—380–432, 434

wrist and hand—259–61

abnormal gait—440–2

Achilles tendon (tendocalcaneus)

active movement testing—400, 401

palpation—396, 397

alignment tests—426–7

Thompson test for rupture—423, 424

dermatomes—418, 419

acromioclavicular joint—143, 144, 144

extension—419

cross-flexion test—189, 189

flexibility test—421, 422

mobility testing—169, 169

flexion—419

palpation—148, 148

functional anatomy—380–1

shear test—189, 189

mobility testing—407–11

acromion

mortise structure/function—380, 434,

abduction of humerus—144, 144

434

palpation—148, 148

neurological examination—417–21

actin—11

neurological tests—421–3

active movement testing—29

observation—384

ankle and foot—400, 401

overuse syndrome—385

cervical and thoracic spine—57, 59–62

palpatory examination—385–401

elbow—208

dorsal aspects—390–2

hip—303–5

lateral aspect—393–5

knee—354

medial aspect—385–90

lumbosacral spine—106, 110, 110–11

plantar surface—397–9

shoulder—156, 162, 162, 163, 163

posterior aspect—395–7

temporomandibular joint—88–93

passive movement testing—401, 403–11

wrist and hand—250–1

posture examination—19, 20

acute single supratolerance load—2, 3

radiological views—427, 431, 432

Adam’s apple—51

referred pain patterns—421, 421

biceps brachii—215, 216, 219, 220

bullfrog eyes—341, 342

cervical spine—34–5, 35, 37, 37–81

palpation—151, 152, 201, 201

bunion—435, 436

active movement testing—57, 59–62

resistive testing—216

Bunnell-Littler test—286, 287

distraction test—79

Speed’s test—189, 190

bursa—13–14

extension—67

trigger points and referred pain

calcaneal—397, 397

flexion—65, 66, 67

patterns—208

gastrocnemius-semimembranosus—353,

herniated disc—39

Yergason’s test—189, 190

353

Lhermitte’s sign—79, 79

biceps femoris—351, 351, 362, 363,

knee—344–5, 346

mobility testing—62–5

364

olecranon—13, 196, 199, 206, 207

neurological examination—68–78

trigger points—353

retrocalcaneal—396, 397

brachial plexus—68–9

biceps reflex (jerk)—73, 221, 221

bursitis—14

root level determination—70, 72–8

biceps tendon

buttock sign—306

upper limb tension test—68–9, 70, 71

long head—143, 144

observation—37–8

palpation—201, 201

C1 see atlas

palpatory examination—39–45

rupture—145

C2 see axis

anterior bony structures—49–54

bicipital groove—148–9, 149

C3-C6 spinous processes—45–6, 46

anterior soft-tissue structures—54–6

biological system—2

C5 nerve root level—68

posterior bony strucutres—41–6

body chart—16–17, 17, 19

biceps reflex—221

posterior soft-tissue structures—47–9

Boley gauge—91

evaluation—70, 72, 73

passive movement testing—62–5, 63, 64

bone—6–7, 7

C6 nerve root level—68

radiological views—80, 81, 81

injury—446–7

brachioradialis reflex—221

referred pain patterns—79, 80

bony structures palpation

evaluation—73, 74

resistive testing—65–8

ankle and foot

C7 nerve root level—68

Spurling test—78, 78–9

dorsal—390–1

evaluation—73, 75

subjective examination—38–9

lateral—393

triceps reflex—223

trigger points—56, 56–7, 57, 58, 59

medial—385–6

C7 spinous process—43, 43

vertebral artery test—79, 80

plantar surface—397–8

C8 nerve root level—68

cervical traction—64, 64

posterior—395–7

evaluation—73, 76

Charcot–Marie–Tooth disease—351

cervical and thoracic spine

café au lait spot—39, 98

chest observation—25, 26

anterior—49–54

calcaneal bursa—397, 397

Childress’ sign (duck walk test)—373

posterior—41–7

calcaneal valgus—19, 20

chondroblast—7

elbow

calcaneal varus—19

chondrocyte—7

lateral—202, 204

calcaneofibular ligament—394, 395

chondromalacia patellae—339, 343

medial—201

calcaneonavicular (spring) ligament—381,

chronic repetitive submaximal tolerance

posterior—205–6

383, 435

load—2, 3

hip—296–8, 300–1

calcaneus—381, 382, 435

clavicle—53, 54, 141, 147, 147

knee

medial tubercle—397–8, 398

claw finger—240

anterior—341–4

palpation—395, 396

claw hand—283, 284

lateral—347–50

calcium hydroxyapatite—6

claw toe—23, 399, 400

medial—345

cancellous (trabecular) bone—6, 7

clunk test—188, 188

lumbosacral spine

cane, hip abductor assistance—440, 440

coccydynia—101

anterior—104

capitate—244, 245

coccyx—35, 101, 101

posterior—98–101

capsular ligaments—144

collagen—5, 6

shoulder

capsular pattern—109, 112

bone—6

anterior—146–9

elbow—209

cartilage—7

posterior—151–3

fingers—251

ligament—8–9

temporomandibular joint—85, 86

foot and ankle—401

tendon—13

wrist and hand

forearm—209, 251

type I/type II—5, 6

dorsal—244–7

hip—306

common peroneal nerve—351, 351

palmar—236

knee—355

compartments of hand

radial—242–4

capsular Y ligament—293

I—248, 248

ulnar—241–2

carotid artery palpation (carotid pulse)—

II—248, 248

Bouchard’s nodes—240

51, 55–6, 56

III—248–9, 249

bounce home test—373, 375

carotid tubercle—51, 52

IV—249, 249

boutonnière deformity—240

carpal tunnel—234–5, 239, 240, 281

V—249, 249

brachial artery

carpal tunnel syndrome—236, 239, 275,

VI—250, 250

palpation—200, 201

280, 282

compensated Trendelenburg (lurch) gait—

traumatic compression—200

carpals—234, 234

443, 444

brachial plexus—68, 69, 181

carpenter’s knee—345

compression and distraction—32

postfixed—68

carpometacarpal joint, first

conditioning—2, 3, 4

prefixed—68

abduction and adduction—256, 258,

congenital hip dysplasia—295

brachial plexus tension test (upper limb

258

coracoacromial ligament—144, 144

tension test; Elvey’s test)—68–9, 70,

traction—261, 262

coracobrachialis—170, 171

71

cartilage—7–8, 8

coracoid process—148, 149

brachialis—215, 216

caudal glide (longitudinal distraction) of

cortical bone—6

brachioradialis—215, 216

shoulder—167, 168

Craig test—332–3, 333

palpation—204

center of gravity—434

cremasteric reflex—127, 130–1, 131

resistive testing—216

normal gait—437, 437, 439

cross-flexion test—189, 189

brachioradialis reflex—73, 221, 222

cervical muscles—65, 67, 67

crossover test—371