Physical examination Examination includes Vascular and neurologic assessment Inspection for deformity, swelling, ecchymoses, open wounds, and decreased or abnormal motion Palpation for tenderness, crepitus, and gross defects in bone or tendon Examination of the joints above and below the injured area After fracture and dislocation are excluded (clinically or by imaging), stress testing of the affected joints for pain and instability If muscle spasm and pain limit physical examination (particularly stress testing), examination is sometimes easier after the patient is given a systemic analgesic or local anesthetic.