# 1997 Musculoskeletal Exam Bullets



## AR2728 (Jul 29, 2010)

Will someone please review the following and let me know how many bullets you would apply per the 1997 guidelines for the Musculoskeletal exam portion?

_MUSCULOSKELETAL: Left knee range of motion 0-120 degrees. There is positive effusion. Positive tenderness to palpation along the MCL. Stable to varus and valgus stress at 0 and 30 degrees. Lachman's difficult to ascertain due to guarding and knee effusion. Unable to perform pivot shift secondary to guarding. Positive pain with hyperflexion of the left knee. Negative McMurray. Positive pain along the medial patellofemoral ligament. Patella glide to the second quadrant medially and laterally. Negative J sign. _

I'm having a difference of opinion with my office manager, she is counting Patella glide, Lachman's, McMurray, Negative J sign all as a separate bullet (4)plus the range of motion, palpation, stability all as their own separate bullet as well-for a total of 7.  That's not even possible in terms of examing the same joint, right?


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## lindsey.motter (Jul 29, 2010)

AMRader said:


> Will someone please review the following and let me know how many bullets you would apply per the 1997 guidelines for the Musculoskeletal exam portion?
> 
> _MUSCULOSKELETAL: Left knee range of motion 0-120 degrees. There is positive effusion. Positive tenderness to palpation along the MCL. Stable to varus and valgus stress at 0 and 30 degrees. Lachman's difficult to ascertain due to guarding and knee effusion. Unable to perform pivot shift secondary to guarding. Positive pain with hyperflexion of the left knee. Negative McMurray. Positive pain along the medial patellofemoral ligament. Patella glide to the second quadrant medially and laterally. Negative J sign. _
> 
> I'm having a difference of opinion with my office manager, she is counting Patella glide, Lachman's, McMurray, Negative J sign all as a separate bullet (4)plus the range of motion, palpation, stability all as their own separate bullet as well-for a total of 7.  That's not even possible in terms of examing the same joint, right?



I pulled out the MSK form here and have 3.  Left knee is considered "(6) Left lower extremity.  If you look at the bullets, it does not have each and every test separate from the other.  There are 4 total bullets and each are comprehensive.  With the palpation/tenderness/effusion, that is 1 ....  ROM/pain is 2 ....stability/is 3.  I don't see anything about gait or muscle strength.  So I have 3 bullets.

HTH


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## trose45116 (Sep 27, 2015)

*exam using 1997*

how many bullets do you count here. I count... my question is on the RT can you count for the bullets as well.  

vital signs
general appearance

LT HAND

gait
skin
rom
sensation
strength
CV

RT HAND

palpation
sensation
CV
ROM
strength
skin




Vitals: Wt 150 lbs, BMI 22.80 Index, Ht 5 ft 8 in

 Examination: 
   General Examination: 
    Alert and oriented, no acute distress with normal affect. Presents today with a normal gait.
       Examination of the left hand reveals no erythema or ecchymosis. No visible swelling over the medial hand. He still has some mild tenderness over the distal fifth metacarpal. We does clench his fist she does have a mild dropped medical at the fifth MCP joint. His range of motion with flexion of the fifth ray is improving. It is near normal. He does have a mild sensation of tightness with this. The remainder of the extrinsic and intrinsic function of the hand is intact. Strength is improving with grip strength. Cascade reveals only a very slight lateral deviation with flexion of the fifth digit. Sensation intact, distal pulse 2+. Skin exam is normal.
       Examination of the right hand reveals no tenderness to palpation. Full active range of motion and strength of the hand and wrist. Extrinsic and intrinsic function is intact. Sensation intact, distal pulse 2+. Skin exam is normal.


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