REMS (regional examination of the musculoskeletal system)

REMS (regional examination of the musculoskeletal system) - general principles

• Introduce yourself
  • introduce yourself
  • explain to the patient what you are going to do
  • gain verbal consent to examine
  • ask the patient to let you know if you cause them any pain or discomfort at any time
    
    
• Look at joints for:
  • scars
  • swellings
  • rashes
  • muscle wasting
    
    
• Feel joints for:
  • temperature - using the back of your hand, feel for skin temperature across the joint line and at relevant neighbouring sites
  • swellings - should be assessed for fluctuance and mobility. The hard bony swellings of osteoarthritis should be distinguished from the soft, rubbery swellings of inflammatory joint disease
  • tenderness - in and around the joint
  • identifying inflammation of a joint (synovitis) relies on detecting the triad of warmth, swelling and tenderness
    
    
• Move
  • assess full range of movement - active and passive
    • full range of movement of the joint should be assessed. Compare one side with the other. As a general rule both active movements (where the patient moves the joint themselves) and passive movements (where the examiner moves the joint) should be performed
    • If there is a loss of active movement, but passive movement is unaffected, this may suggest a problem with the muscles, tendons or nerves rather than in the joints, or it may be an effect of pain in the joints
    • in certain instances joints may move further than expected - this is called hypermobility
    • important to elicit a loss of full flexion or a loss of full extension as either may affect function
      • should be recorded as mild, moderate or severe
    • quality of movement should be recorded, with reference to abnormalities such as increased muscle tone or the presence of crepitus
      
      
• Function
  • Functional assessment of joint - important to make a functional assessment of the joint
    • for example
      • in the case of limited elbow flexion, does this make it difficult for the patient to bring their hands to their mouth?
      • in the case of the lower limbs, function mainly involves gait and the patient's ability to get out of a chair

Reference:

• Arthritis Research Campaign - Clinical assessment of the musculoskeletal system - a guide for medical students and healthcare professionals