General observations This begins from the moment you lay eyes on the patient. what type of gait they are acquiring while entering to the cubicle? what posture they are acquiring while standing or sitting on the chair? whether they are using any devices or not? Do they walk with a limp, how pronounced is it? Do they lean to one side? Once you're in the cubicle you're still observing their movements. Are they guarded, wincing, nervous, etc.?
Once you've asked them to remove any relevant clothing in an appropriate manner (wolf whistles are almost never called for), you can take a closer look at the area in question. Do you see any bruising (haematoma), swelling, inflammation, cuts (lacerations), stitches, bony abnormalities, etc. Sometimes the clues will be more apparent than others. One lady I saw had a ruptured head of biceps (she came in with 'shoulder pain'), which meant that her biceps muscle ended up being bunched up near her elbow. She complained more of discomfort than pain and couldn't remember any traumatic injury to the area. Needless to say, it wasn't difficult to find the source of her 'shoulder pain'.
The therapist must carefully select the structures to palpate from the clinical findings they acquired from the subjective interview and physical examination. Targeted palpation detects variation in temperature, pain, tissue structure and tenderness over certain anatomical features (such as tendons, ligaments and muscle).
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