Musculoskeletal
• Examination of gait and station
• Inspection and/or palpation of digits and nails (eg, clubbing, cyanosis, inflammatory
conditions, petechiae, ischemia, infections, nodes)
HEAD AND NECK
• Inspection and/or palpation with notation of presence of any misalignment, asymmetry,
crepitation, defects, tenderness, masses, effusions
• Assessment of range of motion with notation of any pain, crepitation or contracture
• Assessment of stability with notation of any dislocation (luxation), subluxation or laxity
• Assessment of muscle strength and tone (eg, flaccid, cog wheel, spastic) with notation
of any atrophy or abnormal movements
SPINE, RIBS, AND PELVIS
• Inspection and/or palpation with notation of presence of any misalignment, asymmetry,
crepitation, defects, tenderness, masses, effusions
• Assessment of range of motion with notation of any pain, crepitation or contracture
• Assessment of stability with notation of any dislocation (luxation), subluxation or laxity
• Assessment of muscle strength and tone (eg, flaccid, cog wheel, spastic) with notation
of any atrophy or abnormal movements
RIGHT UPPER EXTREMITY
• Inspection and/or palpation with notation of presence of any misalignment, asymmetry,
crepitation, defects, tenderness, masses, effusions
• Assessment of range of motion with notation of any pain, crepitation or contracture
• Assessment of stability with notation of any dislocation (luxation), subluxation or laxity
• Assessment of muscle strength and tone (eg, flaccid, cog wheel, spastic) with notation
of any atrophy or abnormal movements
LEFT UPPER EXTREMITY
• Inspection and/or palpation with notation of presence of any misalignment, asymmetry,
crepitation, defects, tenderness, masses, effusions
• Assessment of range of motion with notation of any pain, crepitation or contracture
• Assessment of stability with notation of any dislocation (luxation), subluxation or laxity
• Assessment of muscle strength and tone (eg, flaccid, cog wheel, spastic) with notation
of any atrophy or abnormal movements
RIGHT LOWER EXTREMITY
• Inspection and/or palpation with notation of presence of any misalignment, asymmetry,
crepitation, defects, tenderness, masses, effusions
• Assessment of range of motion with notation of any pain, crepitation or contracture
• Assessment of stability with notation of any dislocation (luxation), subluxation or laxity
• Assessment of muscle strength and tone (eg, flaccid, cog wheel, spastic) with notation
of any atrophy or abnormal movements
LEFT LOWER EXTREMITY
• Inspection and/or palpation with notation of presence of any misalignment, asymmetry,
crepitation, defects, tenderness, masses, effusions
• Assessment of range of motion with notation of any pain, crepitation or contracture
• Assessment of stability with notation of any dislocation (luxation), subluxation or laxity
• Assessment of muscle strength and tone (eg, flaccid, cog wheel, spastic) with notation
of any atrophy or abnormal movements