# Neuromusculoskeletal Assessment
## Observation

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.?
Local observations 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'.

## Joint tests
### Physiological movements

Physiological movements are divided into Active and Passive physiological movements (APM's and PPM's). All physiological movements can be performed by the person themselves and include the movements of flexion, abduction, rotation, etc. APM's occur when they actually perform these movements themselves, PPM's occur when the therapist performs the movements for the patient. The point is that during an APM, the muscle as well as the joint is being stressed, whereas during a PPM, (in theory) only the joint is moving. However, on some people it's almost impossible to convey the concept of relaxing completely. The following phrases may be helpful, although in my experience they almost never are:
* “Let your ... become heavy in my hands”
* “Relax your ... as you breathe out”
* “Let me move your ...”
If you are able to reproduce a symptom during a PPM, then you'll usually be inclined to investigate the joint further, as the muscle should have been relaxed during the movement and so may not have contributed to the symptom. However, even though the muscle shouldn't have been active, it will still have been either stretched or compressed and so a muscular component to the symptom cannot be entirely ruled out. This is the joy of assessment. Assume nothing.
L joint test for male n V joint test for female== Muscle tests ==

## Neurological tests

* See http://medimages.hostzi.com/album/Mappe%20e%20dermatomeri/dermatomes-netter2.jpg

### Reflexes

L joint test for male n V joint test for female

## Special Test

Neer Impingment Test:-The patient's arm is passively and forcibly fully elevated in the scapular plane with the arm medially rotated by the examiner.This passive stress causes= the greater tuberosity to jam against the antero-inferior border of the acromion. The patient's face shows pain, reflecting a passive test result. The test indicates an overuse injury to the supraspinatous muscle and some times to the bicepstendon. If the test is positive when done with the arm laterally rotated, the examiner should cheek the acromioclavicular joint.

## Palpation

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).

## Accessory movements

* ↑ David J. Magee,Othopedic Physical Assessment, 4e,neer impingement test,page no. 263