Moving a painful limb
If a patient presented with pain in the knee for example. What should I do in the physical examination?
According to the books, we should not move that limb at all!
Tackling a painful joint
It's not that you should not move it at all. You won't know that it's tender unless you move it!
The trick is that you should be as gentle as possible and always tell the SP that you are going to examine that joint and ask him/her to tell you when they feel the pain.
Once they say Ahhh you say I am sorry that must be really painful for you and say I will not move it again.
In the rare instance when the SP tells you right way "don't move that joint it hurts a lot" then there are two strategies to tackle this;
First, explain to the SP that it's totally necessary for you to move that joint to reach an accurate diagnosis. SP said OK and then you do it gently.
Second, you listen to the SP and don't move the joint and in the patient note you mention that "range of movement was not elicited as per the request of the patient".
v.good answer, rasheed
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