This begins from the moment you lay eyes on the patient. How are they sitting in the chair? Are they sitting, or standing? Do they walk with a limp, how pronounced is it? Follow them into the cubicle so you can see them from behind, what is their posture like? Do they lean to one side? Once you're in the cubicle you're still observing their movements. Are they guarded, wincing, nervous, etc.?
Once you've asked them to remove any relevant clothing in an appropriate manner (wolf whistles are almost never called for), you can take a closer look at the area in question. Do you see any bruising (haematoma), swelling, inflammation, cuts (lacerations), stitches, bony abnormalities, etc. Sometimes the clues will be more apparent than others. One lady I saw had a ruptured head of biceps (she came in with 'shoulder pain'), which meant that her biceps muscle ended up being bunched up near her elbow. She complained more of discomfort than pain and couldn't remember any traumatic injury to the area. Needless to say, it wasn't difficult to find the source of her 'shoulder pain'.
Physiological movements are divided into Active and Passive physiological movements (APM's and PPM's). All physiological movements can be performed by the person themselves and include the movements of flexion, abduction, rotation, etc. APM's occur when they actually perform these movements themselves, PPM's occur when the therapist performs the movements for the patient. The point is that during an APM, the muscle as well as the joint is being stressed, whereas during a PPM, (in theory) only the joint is moving. However, on some people it's almost impossible to convey the concept of relaxing completely. The following phrases may be helpful, although in my experience they almost never are:
- “Let your ... become heavy in my hands”
- “Relax your ... as you breathe out”
- “Let me move your ...”
If you are able to reproduce a symptom during a PPM, then you'll usually be inclined to investigate the joint further, as the muscle should have been relaxed during the movement and so may not have contributed to the symptom. However, even though the muscle shouldn't have been active, it will still have been either stretched or compressed and so a muscular component to the symptom cannot be entirely ruled out. This is the joy of assessment. Assume nothing.
L joint test for male n V joint test for female== Muscle tests ==
L joint test for male n V joint test for female
The therapist must carefully select the structures to palpate from the clinical findings they acquired from the subjective interview and physical examination. Targeted palpation detects variation in temperature, pain, tissue structure and tenderness over certain anatomical features (such as tendons, ligaments and muscle).