Passive movement assesses tone, spasticity of upper motor neurone lesions and the clasp-like cog-wheel rigidity of diseases of the basal ganglia; it also locates joint pain and stiffness, and identifies contractures, as considered in the musculoskeletal section. Passive movement must always be preceded by active movement; the degree of pain and disability can then direct the extent of your subsequent examination (watch a patient’s face for signs of discomfort during all movements).

Tone in the upper and lower limbs is assessed by passive movement of the major joints, and by palpation of the bulk of large muscles and muscle groups, such as gluteus maximus and the erector spinae muscle mass (figure 7a–f).