I PASS
I PASS stands for Inspection, Palpation, Active ROM (& Passive ROM), Strength, Special Tests. This is a good mnemonic for doing Musculoskeletal exams e.g. shoulder, knee, etc.
- Inspection
- Palpation
- Active ROM
- Strength
- Special tests
Inspection – key things to look for.
- Surface anatomy
- Alignment. Evaluate the overall alignment of the limb or spine before focusing on the specific area of the complaint.
- Gait
- Deformities etc.
- During the inspection, carefully compare one side to the other to detect subtle deformities.
“Start the exam with the normal side (or non-injured side) and assume that is how the injured side is expected to be at baseline.
In lower extremity problems, always assess the effect of the condition on the patient’s gait.
Quantitate measurable parameters such as ROM, muscle strength, and the size of masses for comparison with past and future examinations.”
Look, Move, Feel, and do Special Tests
Other people remember the elements of a physical examination of a joint as Look, move, feel and do special tests.
- Look – This is the same thing as inspection above.
- Move -Assess for range of motion (both active and passive)
- Feel – Palpate relevant structures of the joint.
- Special tests – Special tests can be categorized into three groups:
- 1) Stress tests – These tests stress structures for instability (checks ligaments)
- 2) Provocative tests – These try to reproduce the patient’s pain
- 3) Functional tests – These tests assess the function of the join with movements (e.g. weight-bearing activity)