Orthopedic Physical Examination Techniques Course

Lesson 1 • Principles of Clinical Reasoning

Hypothesis-driven examination logic and pattern recognition are introduced. Students apply diagnostic reasoning to differentiate structural from functional pathology.

Lesson 2 • Observation and Postural Analysis

Static and dynamic postural deviations are observed and documented before hands-on testing begins. Observation findings generate initial hypotheses refined by subsequent examination steps.

Lesson 3 • Musculoskeletal Anatomy Review

Key bony landmarks, joint structures, and soft tissues relevant to orthopaedic testing are identified. This anatomical grounding supports accurate palpation and test interpretation throughout the course.

Lesson 4 • Documentation and Baseline Measurement

Standardised outcome measures and baseline recording methods are established for objective tracking. Consistent documentation enables valid reassessment and progress monitoring.

Lesson 1 • Spinal Range of Motion Measurement

Cervical, thoracic, and lumbar mobility are quantified using inclinometry and tape-measure methods. Segmental vs. global motion distinctions guide clinical interpretation.

Lesson 2 • Reliability and Error Reduction

Sources of intra- and inter-rater measurement error are identified and minimised through standardised protocols. Students apply reliability strategies to produce clinically meaningful data.

Lesson 3 • Lower Extremity Range of Motion

Hip, knee, ankle, and foot joint mobility are measured with proper patient positioning and stabilisation. Compensatory movements are identified and controlled during measurement.

Lesson 4 • Upper Extremity Range of Motion

Shoulder, elbow, forearm, wrist, and hand joint mobility are measured using standardised goniometric protocols. Findings are compared to normative values for clinical interpretation.

Lesson 1 • Instrumented Dynamometry

Handheld and isokinetic dynamometers are used to quantify force production objectively. Students interpret peak torque, limb symmetry index, and torque-to-body-weight ratios.

Lesson 2 • Manual Muscle Testing Grading Systems

The Medical Research Council grading scale and its clinical application are explained. Students distinguish between gravity-eliminated and against-gravity testing positions.

Lesson 3 • Upper Extremity Muscle Testing

Rotator cuff, elbow, wrist, and hand muscle groups are tested with correct stabilisation and resistance application. Isolation techniques minimise substitution patterns.

Lesson 4 • Lower Extremity Muscle Testing

Hip, knee, and ankle muscle groups are assessed with standardised positioning and force application. Bilateral comparison reveals asymmetries guiding rehabilitation planning.

Lesson 1 • Swelling, Temperature, and Skin Assessment

Joint effusion, localised oedema, skin temperature changes, and trophic changes are assessed by palpation and observation. These findings indicate inflammatory or vascular involvement.

Lesson 2 • Palpation Technique Fundamentals

Hand position, pressure grading, and tissue-layer differentiation are established as core palpation skills. Systematic regional sequencing prevents missed findings.

Lesson 3 • Soft-Tissue Palpation and Tenderness Mapping

Muscle bellies, tendons, bursae, and ligaments are palpated and tenderness is mapped to anatomical structures. Tenderness localisation narrows the differential diagnosis.

Lesson 4 • Bony Landmark Palpation

Precise identification of bony prominences, joint lines, and anatomical reference points is practiced. Landmark accuracy anchors all subsequent special test positioning.

Lesson 1 • Neural Tension and Radiculopathy Testing

Straight leg raise, slump, and femoral nerve tension tests are performed with sensitising manoeuvres. Positive findings are interpreted against dermatomal and myotomal patterns.

Lesson 2 • Lumbar Spine Examination

Lumbar active motion, passive segmental mobility, and provocative loading tests are applied systematically. Mechanical vs. non-mechanical pain patterns are distinguished.

Lesson 3 • Thoracic Spine Examination

Thoracic mobility, rib cage mechanics, and postural deformity are assessed using passive and active techniques. Thoracic dysfunction contributing to shoulder and cervical symptoms is identified.

Lesson 4 • Cervical Spine Examination

Cervical active motion, passive intervertebral motion, and neural tension tests are performed in sequence. Findings differentiate discogenic, facet, and radicular cervical pathology.

Lesson 1 • Shoulder Complex Examination

Rotator cuff integrity, impingement, instability, and acromioclavicular pathology are assessed with targeted special tests. Test clustering improves diagnostic specificity for shoulder conditions.

Lesson 2 • Wrist and Hand Examination

Carpal tunnel, de Quervain tenosynovitis, triangular fibrocartilage complex, and ligament injuries are assessed with validated clinical tests. Functional grip and pinch strength are measured.

Lesson 3 • Thoracic Outlet Syndrome Assessment

Vascular and neurogenic thoracic outlet syndrome are differentiated using provocative positioning and pulse assessment. Findings are integrated with cervical and shoulder examination data.

Lesson 4 • Peripheral Nerve Examination of the Upper Limb

Median, ulnar, and radial nerve function is assessed through motor, sensory, and reflex testing. Localization of nerve lesions guides referral and management decisions.

Lesson 1 • Functional Movement Screening of the Lower Limb

Single-leg squat, step-down, and hop tests reveal dynamic alignment deficits and neuromuscular control impairments. Functional test results are linked to injury risk and rehabilitation targets.

Lesson 2 • Ankle and Foot Examination

Lateral ligament integrity, Achilles tendon pathology, and plantar fascia involvement are assessed with validated tests. Foot posture index and arch assessment guide orthotic recommendations.

Lesson 3 • Hip and Pelvis Examination

Intra-articular hip pathology, femoroacetabular impingement, and labral tears are assessed with provocation tests. Hip examination findings are differentiated from lumbar and sacroiliac referral.

Lesson 4 • Peripheral Nerve Examination of the Lower Limb

Sciatic, femoral, peroneal, and tibial nerve function is assessed through motor, sensory, and reflex testing. Nerve lesion localization differentiates radiculopathy from peripheral entrapment.

Lesson 1 • Differential Diagnosis Formulation

A prioritized differential diagnosis list is constructed from integrated examination findings. Students distinguish primary musculoskeletal pathology from referred pain and systemic conditions.

Lesson 2 • Building a Structured Examination Sequence

Efficient examination flow is constructed by sequencing observation, active motion, passive motion, and special tests. Logical ordering minimises patient repositioning and maximises diagnostic yield.

Lesson 3 • Interpreting Clusters of Clinical Tests

Likelihood ratios and post-test probability are applied to clusters of positive and negative findings. Students move beyond single-test interpretation to probabilistic clinical reasoning.

Lesson 4 • Reassessment and Outcome Monitoring

Systematic reassessment protocols track change in impairment and function over time. Students apply minimal clinically important difference values to determine meaningful treatment response.