Our ability to participate in functional activities is greatly dependent on the state of our body joints, from the knees and hips which bear weight and allow walking to the jaw joints which aid speaking and eating. Our joints are exceptionally well designed to allow us to move about and accomplish tasks and mostly they do their jobs quietly and very well. Illness, injury or disease can damage the joints, causing pain and stiffness and limiting functional activity. Physiotherapy examination of the joints is a core skill, demanding a logical approach, the finding of pathological signs and the formation of a treatment plan.

A joint is a junction between two bones and in the body our joints have different functions such as force transmission, weight bearing and movement. The symphysis pubis and acromioclavicular joints are examples of force transmission joints, the back is mostly a weight bearing series of joints and the shoulders and knees have to do with movement. The joints we are most familiar with are the synovial joints, the most common type and these have a cartilage lining over the bone ends, synovial fluid secreted by the joint lining and have ligamentous structures surrounding the joint to support its function.

After the visual examination the physiotherapist will palpate the joint and surrounding structures, which means exploring or stressing an area logically with the fingers or hand, an important physio skill to clarify the diagnosis. The physio will palpate around the joint margins, the joint line itself, the tendon insertions and the ligaments surrounding the joint. Effusion, which means the presence of synovial fluid in a joint, can be felt by the resistance it gives if it is tight, by its thickness and plasticity if it is sticky and by the way it can be moved around the joint if it watery.

Once the joint has been assessed visually, which takes a very short time, the physiotherapist will move on to palpation of the joint structures which will help identify which parts of the joint are affected. Palpation involves systematically feeling and stressing structures in an anatomical area to pin down faulty structures more closely. Palpation of the joint involves testing the joint line, the insertions of the tendons and ligaments, along the ligaments themselves and around the joint margins. Fluid in the joint is called an effusion and can be thick and sticky, very tight and firm if there is a lot, or movable if the fluid is thin

Normal joint function is dependent on normal ligaments and physiotherapy testing of them is routine by manual stressing. Major joint ligaments have great strength and normally should show no reaction to being stressed, however testing can reveal a stretched, painful or ruptured ligament. Muscle strength is charted on the Oxford scale of 0 to 5, although patients may not exert their strength if they are in pain or very anxious. Sensibility of the joint and joint position testing tells the physio that normal joint feedback is occurring which is vital for planning of normal movement.

Functional testing of the joint in normal activities and typical postures may be used by the physiotherapist particularly if the joint examination has not indicated clear problems. This way any deficiencies that may not have been obvious on less stressful testing can become evident.