[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical exam](https://durgical.com/en/clinical-exam/) › [Musculoskeletal system](https://durgical.com/en/clinical-exam/#a-musculoskeletal) › Joint examination: inspection, palpation and range of motion [Clinical exam](https://durgical.com/en/clinical-exam/) · [Musculoskeletal system](https://durgical.com/en/clinical-exam/#a-musculoskeletal) # 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](https://durgical.com/en/anatomy/articular-capsule-of-knee-joint/) · [Finger joint capsules](https://durgical.com/en/anatomy/finger-joint-capsules/) · [Wrist capsule](https://durgical.com/en/anatomy/wrist-joint-capsule/) ## Key points - Order: inspection, palpation, active motion, passive motion, strength, neurovascular exam and special tests, always compared with the other side. - If active and passive motion are equally limited, the lesion is usually inside the joint; if only active motion fails, it is outside. - An acute hot single joint is septic arthritis until proven otherwise. - Rheumatoid arthritis: symmetric polyarthritis of the MCP, PIP and wrist joints that spares the DIP joints. - Nursing: record pain, motion, strength and neurovascular status, and report any worsening at once. ## 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. ## Memory aid Look, feel, move, compare: four verbs and always two sides. ## 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. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/clinical-exam/joint-examination-inspection-palpation-and-range-of-motion/) ## See it in 3D The structures of Durgical's 3D anatomy where it is found. - [Joint capsule](https://durgical.com/en/anatomy/articular-capsule-of-knee-joint/) - [Finger joint capsules](https://durgical.com/en/anatomy/finger-joint-capsules/) - [Wrist capsule](https://durgical.com/en/anatomy/wrist-joint-capsule/) ## Related - [Hand deformities: Heberden, Bouchard, swan neck, boutonnière](https://durgical.com/en/clinical-exam/hand-deformities-heberden-bouchard-swan-neck-boutonniere/) - [Knee effusion: patellar tap and bulge sign](https://durgical.com/en/clinical-exam/knee-effusion-patellar-tap-and-bulge-sign/) - [Inspection of gait and posture (orthopedic)](https://durgical.com/en/clinical-exam/inspection-of-gait-and-posture/) - [Motor examination: bulk, tone and strength grading](https://durgical.com/en/clinical-exam/motor-examination-bulk-tone-and-strength-grading/) - [Pain assessment and pain scales](https://durgical.com/en/clinical-exam/pain-assessment-and-pain-scales/) - [Nursing assessment: head-to-toe and focused assessment](https://durgical.com/en/clinical-exam/nursing-assessment-head-to-toe-and-focused-assessment/) ## Related conditions - [Rheumatoid arthritis](https://durgical.com/en/conditions/rheumatoid-arthritis/) - [Gout](https://durgical.com/en/conditions/gout/) - [Knee Osteoarthritis](https://durgical.com/en/conditions/knee-osteoarthritis/) - [Septic Arthritis of the Knee](https://durgical.com/en/conditions/septic-arthritis-of-the-knee/) [← All of the clinical exam](https://durgical.com/en/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](https://sites.ucsd.edu/clinicalmedguide/musculo-skeletal-exam/) (UC San Diego School of Medicine, 2026); [Rheumatoid arthritis: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000431.htm) (MedlinePlus, U.S. National Library of Medicine, 2026); [Rheumatoid arthritis](https://wikem.org/wiki/Rheumatoid_arthritis) (WikEM, 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/clinical-exam/joint-examination-inspection-palpation-and-range-of-motion/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/joint-examination-inspection-palpation-and-range-of-motion/