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Editor's Notes

• #6: General resting posture and/or gait: general attitude of the limb (limb positioning) - this provides clues to tendon injury, disc prolapse, fracture, muscle weakness. •• Skin: scars, sinuses, swellings, contractures, erythema/colour change, atrophy, loss of hair or nail, ulceration. •• Subcutaneous tissue: oedema, contractures, haematoma, swellings. •• Muscle and tendons: atrophy, hypertrophy, contractures, bulge (Popeye sign of biceps rupture), tendon ruptures, muscle haematoma. •• Bone: deformity, swelling, shortening. •• Joint: deformity, shortening, contractures, effusion.
• #10: Active movements: the patient should be systematically directed to move the joint themselves. The range of movement can be compared to the normal side to measure the extent of any limitation. Checking active movements first also helps to localise any areas of concern which the clinician can then focus on while checking movements passively. •• Assisted movements: this is where the patient moves the limb but some assistance may be provided by the examiner to take the joint through its full range of motion. This is especially relevant in shoulder examination when demonstrating a painful arc or a ruptured rotator cuff. •• Passive movements: after checking active movements, passive movements can then be checked by the examiner moving the limb/joint in question. This is useful as sometimes the patient may not be able to move a limb due to muscle/tendon injury or paralysis. However, the presence of a full passive range of movement indicates the absence of any injury to the joint itself. With passive movement, one should also be able to feel for any crepitus by resting a hand on the joint during movement. •• Power: finally the power of muscle groups should be tested and graded as per the medical research council scale (see page 134). It should be clear as to whether power is reduced because of true neurological weakness or due to pain.