| Course | NUR-5160 Advanced Health Assessment |
|---|---|
| Module | Module 3 |
| Paper type | Regional system examination write-up |
| Length | About 1,013 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | Master of Science in Nursing |
| Updated | October 2026 |
Free sample paper for NUR 5160 Module 3
A Violin Maker's Elbow: Organizing the Objective Data of a Regional Upper Extremity Examination
Student Name
Master of Science in Nursing (MSN), Thomas Edison State University
NUR-5160: Advanced Health Assessment
Mentor Name
Month Day, Year
A Violin Maker's Elbow: Organizing the Objective Data of a Regional Upper Extremity Examination
Regional examinations test whether an advanced practice nurse can gather objective data in a logical order, record it clearly and know what each finding can and cannot show. This paper documents a regional examination of the upper extremity for a composite patient, a forty-seven-year-old violin maker with three months of pain at the outside of the right elbow. A brief subjective summary is included only to show why the examination took the form it did; the focus is the objective data, how they were organized and how far the findings can be trusted. Identifying details are invented.
Brief Subjective Context
The patient is right-handed and spends six to eight hours a day carving and scraping maple and spruce with hand tools, gripping small gouges and planes. Pain began gradually over three months at the lateral elbow, is worst when lifting a full kettle or gripping a tool tightly and eases with rest. There was no injury. The patient denies neck pain, numbness or tingling in the hand, weakness, night pain unrelated to position, fever and swelling. Ibuprofen helps partly. The history pointed toward a tendon problem at the lateral elbow but required the examination to separate it from nerve entrapment, joint disease and referred pain from the neck.
Objective Data: Inspection, Palpation and Range of Motion
Inspection: both upper extremities exposed from the shoulders down. No swelling, erythema, deformity or muscle wasting at the elbow, forearm or hand. Carrying angle symmetric at about ten degrees of valgus. Skin intact with calluses on the right palm and thumb consistent with tool use. Palpation: point tenderness about one centimeter distal and slightly anterior to the right lateral epicondyle, at the origin of the common extensor tendon, reproducing the patient's pain. No tenderness over the lateral epicondyle itself, the radial head, the olecranon, the medial epicondyle or the distal biceps tendon. No warmth or effusion; no tenderness along the radial tunnel about four centimeters distal to the epicondyle.
Range of motion: active and passive elbow flexion 0 to 145 degrees bilaterally, extension to 0, pronation and supination 80 degrees each way bilaterally, all without pain at end range. Wrist and finger range of motion full and painless. Shoulder and cervical range of motion full; Spurling maneuver negative on the right, without reproduction of arm symptoms.
Range of motion was measured with a goniometer rather than estimated, because a later visit may need to show whether stiffness has developed. The patient's habitual working posture was also observed: when demonstrating how a gouge is held, the patient gripped with the wrist slightly flexed and the forearm pronated, the position that loads the extensor origin most, which is an objective observation worth recording even though it comes from a demonstration rather than a test.
Objective Data: Strength, Special Tests and Neurovascular Status
Strength: five of five for elbow flexion and extension, wrist flexion and supination; resisted wrist extension with the elbow extended reproduced lateral elbow pain with strength four plus of five, limited by pain; resisted extension of the middle finger reproduced pain. Grip strength measured with a dynamometer: right 28 kilograms, left 41 kilograms, with pain at the lateral elbow during right grip; grip with the elbow flexed to ninety degrees was less painful than with the elbow extended. Special tests: the passive stretch test with the elbow extended, forearm pronated and wrist flexed reproduced pain. Valgus and varus stress at 30 degrees of flexion were stable without pain. The tennis elbow tests were therefore positive and ligament stress tests negative.
Neurovascular: radial and ulnar pulses two plus bilaterally, capillary refill under two seconds. Sensation to light touch and two-point discrimination intact in the radial, median and ulnar distributions. Tinel sign negative at the cubital tunnel and over the radial tunnel. Biceps, brachioradialis and triceps reflexes two plus and symmetric. No weakness of finger extension at the metacarpophalangeal joints or thumb extension, which argues against posterior interosseous nerve involvement.
| Domain | Right | Left |
|---|---|---|
| Point tenderness | Common extensor origin, reproduces pain | None |
| Elbow range of motion | 0 to 145 degrees, painless | 0 to 145 degrees, painless |
| Resisted wrist extension | Painful, 4+/5 | Painless, 5/5 |
| Grip strength (dynamometer) | 28 kg, painful | 41 kg |
| Ligament stress tests | Stable, painless | Stable, painless |
| Neurologic screen | Intact sensation, reflexes, finger and thumb extension | Intact |
Interpreting the Findings and Their Limits
The objective data form a consistent pattern: tenderness pinned to the extensor tendon origin, pain whenever the wrist or middle finger extends against resistance or the extensors are stretched, reduced pain-free grip on the affected side, normal range of motion, stable ligaments, a negative cervical screen and no neurological deficit. Coombes et al. (2015) describe lateral elbow tendinopathy as a condition usually diagnosed clinically from exactly this pattern, with pain-free grip strength serving as a useful measure for following change over time. The negative Spurling maneuver, intact reflexes and sensation, normal finger extension and absence of radial tunnel tenderness make cervical radiculopathy and radial nerve entrapment less likely, though not impossible.
Two limits need to be stated. First, individual special tests carry less certainty than their familiar names suggest. A systematic review of physical examination tests for the elbow by Zwerus et al. (2018) found that, although many tests are described, few have been studied for diagnostic accuracy, most studies carried a high or unclear risk of bias, and no test for lateral epicondylitis had strong accuracy data. The diagnosis therefore rests on the consistency of the whole pattern rather than on any single positive test. Second, examination cannot show tendon structure; imaging would be considered only if the pattern were atypical or if symptoms failed to improve with appropriate management.
Bickley et al. (2021) recommend that musculoskeletal findings always be compared with the opposite side and recorded with enough precision that change can be measured. That principle shaped the write-up: the grip measurements in kilograms and the painful resisted tests give a baseline against which the next visit can be judged, which is more useful to the patient than a label.
References
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bates' guide to physical examination and history taking (13th ed.). Wolters Kluwer.
Coombes, B. K., Bisset, L., & Vicenzino, B. (2015). Management of lateral elbow tendinopathy: One size does not fit all. Journal of Orthopaedic & Sports Physical Therapy, 45(11), 938-949. https://doi.org/10.2519/jospt.2015.5841
Zwerus, E. L., Somford, M. P., Maissan, F., Heisen, J., Eygendaal, D., & van den Bekerom, M. P. (2018). Physical examination of the elbow, what is the evidence? A systematic literature review. British Journal of Sports Medicine, 52(19), 1253-1260. https://doi.org/10.1136/bjsports-2016-096712
NUR 5160 Module 3 instructions, in plain terms
The third module of NUR-5160 usually moves through regional examinations. Directions in many sections ask you to perform and document an examination of one region or system on a volunteer or case, organize the objective data in a standard sequence, use appropriate special tests, interpret the findings and discuss their reliability. Some sections assign the region and others let you choose. Check the TESU classroom for whether subjective data should be included, whether a summary table is acceptable, and how many sources you need. When choosing special tests, include tests that would point to alternative diagnoses as well as the expected one, and record both positive and negative results. Note which special tests you chose to test alternatives, not only the expected diagnosis.
Inside the NUR 5160 Module 3 example
The example opens by stating that the paper's focus is objective data, then gives a short subjective summary only to explain the examination's shape. Objective findings follow in standard order: inspection, palpation with anatomic precision, measured active and passive range of motion with neck screening, strength, special tests, and neurovascular status including tests for nerve entrapment. A table compares the two sides. The interpretation section explains the consistent pattern, uses a review of management to support grip strength as a measure, and states the limits of special tests from a systematic review. The last paragraph explains why measured baselines matter more than a label. The subjective paragraph is deliberately short so the objective data stay the focus.
Reading the NUR 5160 Module 3 grading rubric
Regional examination write-ups are commonly assessed on correct technique and sequence, completeness of the regional examination, precision of documentation, appropriate selection and reporting of special tests, interpretation, and writing. Mentors look for side-to-side comparison, measured values and anatomic precision. Special tests should include ones that test alternatives to the likely diagnosis, and negative results should be recorded. Interpretation earns full credit when it explains the pattern and acknowledges limits, for example the uncertain accuracy of individual tests. Writing should keep subjective and objective data separate and use standard terminology throughout. Missing side-to-side comparison is one of the most frequent reasons for lost points.
NUR 5160 Module 3 help: mistakes that cost marks
Weak regional write-ups list special tests without results or record only positive findings. Document every test performed and whether it was positive or negative. Another common problem is skipping the joints above and below, especially the neck for upper extremity complaints; screen them. Students also overstate what a single special test proves. Interpret the overall pattern and cite evidence on test accuracy where possible. Measure what can be measured, such as range of motion and grip strength, so change can be tracked. Keep the subjective summary brief in an objective-focused module. Examination notes can be shaped into a finished regional write-up by the desk. A quick sketch of where tenderness sits can help you describe it precisely.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
More NUR 5160 and Master of Science in Nursing sample papers
- NUR 5160 Module 1: Baseline Comprehensive Write-Up
- NUR 5160 Module 2: Subjective History Write-Up
- NUR 5160 Module 4: Differential Diagnosis Write-Up
- NUR 5160 Module 5: Special Population Write-Up
- NUR 5160 Module 6: Comprehensive Encounter Write-Up
- NUR 5290 Module 4: Global Health System Comparison
- NUR 5300 Module 2: Evidence Search Strategy
- NUR 6410 Module 1: Pharmacokinetics Case: Apixaban Dosing in an 83-Year-Old Woman
- NUR 6400 Module 6: Neurologic Case: Multiple Sclerosis and Epstein-Barr Virus
NUR 5160 Module 3 questions, answered
Where can I find a free NUR 5160 Module 3 sample paper?
Above is the full elbow write-up, side-by-side table included, annotated sheet by sheet. Swap in the region your directions name and keep the order of the examination.
What order should a regional musculoskeletal examination follow?
Look first, then feel, then move the joint through its range, test strength and the targeted maneuvers, and finish with nerves and circulation, screening the joints above and below along the way. Always compare with the opposite side.
Do special tests prove a diagnosis?
Rarely on their own. Many have limited or uncertain accuracy data. Interpret them as part of a pattern with the history and other findings, and record negative tests that make alternatives less likely.
Why measure grip strength?
Grip strength is objective, easy to repeat and sensitive to pain from the forearm extensors, so it provides a baseline for following conditions such as lateral elbow tendinopathy over time.
Should I include imaging in a regional examination write-up?
Only as part of a plan when the examination is atypical or symptoms do not improve. The module focuses on the examination; mention imaging when you explain the limits of what the examination can show.