Physical examination Examination includes Vascular and neurologic assessment distal to the injury Inspection for open wounds, deformity, swelling, ecchymoses, and decreased or abnormal range of motion Palpation for tenderness, crepitation, and gross defects in bone or tendon Examination of the joints above and below the injured area (eg, for the shoulder joint, the cervical spine and elbow) 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.