200 Words Series: How I Perform A Mechanical Exam

A mechanical examination begins with a methodical verbal history, typically producing one or two diagnoses to prove or disprove during the examination. Key information I elicit includes location of all/any symptoms, mechanism of injury, injury duration and trend, and activities that worsen/improve symptoms.

In the mechanical exam, I care precisely about tests’ effects. I examine the effect of upright posture. I check active and passive movement at the affected joint(s). If the patient has an extremity complaint, I always look at spine motion too. I often check nerve tension (arm or leg). The patient performs something that generates symptoms, such as squatting or lifting a bag - a “functional baseline.” Strength is also tested: for all upper body complaints I test roughly 8 arm muscles. With all lower body complaints, I test 6 leg muscles. With distinct extremity problems, I additionally strength test the specific muscles at those joints.

Next, most importantly, the patient performs repeated movements in the direction I have determined and we reassess relevant findings (symptom behavior, motion, nerve tension, strength, and/or functional baseline). Based on cause/effect, other directions may be tested. Before leaving, one specific movement is chosen for the patient to perform frequently at home.