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REMS (regional examination of the musculoskeletal system)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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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:


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