Joint examination: inspection, palpation and range of motion !

Exam technique

Look at, feel and move each joint, always against the healthy side, to tell whether the problem is inside the joint or around it.

Updated 2026-11-01

See it in 3D: Joint capsule · Finger joint capsules · Wrist capsule

What it is

The joint exam follows a fixed order: inspection, palpation, active motion, passive motion, strength, neurovascular status and special tests. Its aim is to decide between arthritis (inflammation inside the joint), a periarticular lesion (tendon, bursa, ligament) and referred pain. Comparing with the healthy side is what makes a finding objective.

Landmark anatomy

Synovial joint: capsule, synovial membrane that makes the fluid, articular cartilage and ligaments; the capsule bulges when there is an effusion.
Periarticular structures: tendons, sheaths, bursae and entheses; they hurt at one exact spot and with the movement that stretches them.
Useful landmarks: joint lines, tendon insertions and bony prominences.

Technique, step by step

Explain the exam, ask permission and fully expose the joint and its partner; first ask where it hurts.
Inspection: swelling, redness, deformity, muscle wasting, scars and the position the joint is held in.
Palpation: warmth with the back of the hand, tender points (joint line, tendons, bursae), effusion, synovial thickening and crepitus.
Active motion: the patient moves the joint through all its planes; note the range, the pain and where in the arc it starts.
Passive motion: if active motion is limited, the examiner gently moves the supported joint; note the end feel and measure with a goniometer.
Strength: grade 0 to 5 (Medical Research Council scale) against gravity and against the examiner's hand.
Distal neurovascular exam: pulses, capillary refill, sensation and finger or toe movement.
Watch a functional task (walking, buttoning, combing) and finish with the region's special tests, never forcing into severe pain.

Abnormal findings

Warmth, redness, swelling and pain through the whole arc: arthritis.
Acute hot single joint: think septic arthritis first, then gout or pseudogout; the joint fluid must be examined.
Symmetric polyarthritis of the small joints of the hands and wrists with morning stiffness over an hour: the rheumatoid pattern.
Pain on active motion with full passive range: periarticular lesion (tendinopathy, bursitis).
Coarse crepitus, bony nodes and pain that worsens with use and eases with rest: osteoarthritis.
Soft fluctuant swelling: effusion; boggy: synovial thickening; hard: bony enlargement.

Common errors

Examining through clothing or without comparing with the healthy side.
Testing only active motion: it cannot separate joint from periarticular disease.
Forgetting the joint above and below: knee pain may come from the hip.

Test yourself

Think of the answer, then tap the question to see it.

What does it mean when active and passive motion are equally limited?

The lesion is probably inside the joint (arthritis, osteoarthritis, capsulitis). If passive motion is preserved, think of a tendon or bursa.

Which part of the hand best assesses joint temperature?

The back of the hand, comparing with the opposite joint and the nearby skin.

Which diagnosis must not be missed in an acute hot single joint?

Septic arthritis. Gout and pseudogout are also considered, and the joint fluid is examined.

Which hand joints does rheumatoid arthritis typically spare?

The distal interphalangeal joints.

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See it in 3D

The structures of Durgical's 3D anatomy where it is found.

← All of the clinical exam

Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: Musculo-Skeletal Exam – Practical Guide to Clinical Medicine (UC San Diego School of Medicine, 2026); Rheumatoid arthritis: MedlinePlus Medical Encyclopedia (MedlinePlus, U.S. National Library of Medicine, 2026); Rheumatoid arthritis (WikEM, 2026).

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Representative model, for educational purposes only.