B6.043 MSK Exam Flashcards
major components of MSK system with clinical relevance
joint movements ligaments muscles tendons cartilage synovial fluid bursae
related history to injury
sensation at time of injury impairment mechanism of injury pain (qualifiers and quantifiers) swelling (immediate or delayed) bruising (temporal relationship to injury)
related PMH for MSK exam
trauma
surgery
chronic illness
congenital anomalies
related FH for MSK exam
congenital anomalies of hip/foot
scoliosis/back problems
arthritis
genetic disorders
goniometer
used to measure range of motion of a joint
characteristics of ROM on exam
PROM may exceed active ROM by 5 degrees
active ROM/passive ROM should be equal in contralateral joints
basics of exam for muscle strength
compare bilateral muscles (strength, symmetry, equality, resistance)
muscle function levels/grades
manual muscle testing grades w/ associated functions
0- no activation
1- trace activation, twitch
2- activation with gravity eliminated, achieving full ROM
3- activation against gravity, full ROM
4- activation against some resistance, full ROM
5- activation against examiners full resistance, full ROM
joint motions examined
flexion/ extension/ hyperextension internal/ external rotation ABductoin/ADduction lateral motions special motions related to a specific joint
inspection of elbow
contour
carrying angle
-males = 5 deg
-females= 10-15 deg
palpation of elbow
landmarks for tenderness (head of radius, olecranon, epicondyles)
swelling
thickening
ROM of elbow
flexion
extension
pronation
supination
moving valgus stress test
shoulder at 90 degrees abduction and external rotation
apply valgus torque to elbow (pushing forward), elbow is flexed and extended
pain = positive test
function of moving valgus stress test
diagnosing UCL injuries
milking maneuver
shoulder at 90 degrees abduction and external rotation
apply valgus torque to elbow (pushing forward) and gently pull thumb in posterior direction
function of milking maneuver
additional info about possible UCL injurt
function of middle finger test
assess for lateral epicondylitis if isolated pain at lateral epicondyle
inspection of shoulder
size symmetry contour dislocation winging of scap
palpation of shoulder
bone (acromion, coracoid)
joints (AC joint)
muscles
ROM assessment of shoulder
forward flexion hyperextension abduction/adduction internal/external rotation shrug
internal rotation of shoulder
ROM through body plane and hand on back of L spine
reach up back with thumb
nondominant side has greater ROM
external rotation of shoulder
ROM normal 45-60 deg
position of arm when testing both internal and external shoulder rotation
shoulder at 0 deg elbow at 90 deg OR shoulder at 90 deg elbow at 90 deg
Yerguson test
place patients hand with palm facing up and grasp their hand in yours
instruct patient to hold and flat and not let you turn it over
attempt to pronate patients hand against their resistance
function of Yerguson test
tenderness with supination of forearm against resistance is indicative of bicipital tendinitis
empty can test
extend elbows fully while you move their arms into a position of 70-80 deg of abduction and 30 deg of forward flexion
turn thumbs down as if emptying a can
pt cannot hold affected arm at 90 deg of abduction against resistance
function of empty can test
supraspinatus test
pain or inability to resist downward pressure
neer impingement sign
place hand on top of patient’s acromion to stabilize scapula while you grasp the forearm
with arm relaxed and palm facing down, passively flex the shoulder anteriorly, raising the arm overhead
function of neer impingement sign
compresses the greater tuberosity against the anterior undersurface of the acromion, compressing the superior rotator cuff (supraspinatus) near its insertion
pain may indicate inflammation, overuse injury, or tear of rotator cuff
Hawkins Kennedy test
place one hand on top of patients acromion to stabilize scapula
passively flex the shoulder to 90 deg of flexion with forearm parallel to the floor
internally rotate the humerus by moving the hand toward the floor
function of Hawkins Kennedy test
compresses the greater tuberosity against the anterior undersurface of the coracoacromial ligament, compressing the superior rotator cuff (supraspinatus) near its insertion
complementary to Neer test
drop arm test
arm is raised passively to 160 deg
patient asked to slowly lower arm
inability to lower = positive test
function of drop arm test
may indicate a large rotator cuff tear
infraspinatus/ teres minor test
hold arms at sides with elbows flexed 90 deg
actively externally rotate against resistance
positive test is weakness compared with contralateral side
lift off test
arm internally rotates behind the patients lower back
patient internally rotates against examiners hand
function of lift off test
inability to lift hand off back may indicate subscapularis tendinopathy or tear
cross body adduction test
arm is passively adducted across the patients body toward the contralateral shoulder
function of cross body adduction test
pain main indicate AC joint pathology, including chronic sprain or OA
hip inspection
symmetry (muscle mass, hip rotation and height)
size
gluteal folds
ability to bear weight - gait assessment
hip palpation
stability
tenderness
hip ROM
flexion/extension
hyperextension
abduction/adduction
internal/external rotation
hip muscle assessment
strength function symmetry
how can you increase hip flexion
by also flexing knee
90 deg without knee flexed
120 deg with knee flexed
how to test hip rotation
flex knee while seated
move foot inward and outward (foot inward = hip external rotation and vice versa)
FAB-ER test / Patrick test
flexion, abduction, external rotation
examiner moves leg into 45 deg of flexion (while pt is laying down) and then externally rotates and abducts the leg so that the ankle is proximal to the knee of the contralateral leg
function of FAB-ER test
looks for labral tears
FAD-IR / impingement test
flexion, adduction, internal rotation
examiner passively moves leg into full flexion and then into adduction and internal rotation
function of FAD-IR
looks for labral tears
log roll test / Freiberg test
passive supine rotation
patients leg is extended and relaxed on exam table as the examiner internally and externally rotates the leg
function of log roll test
looks for slipped capital femoral epiphysis
knee inspection
landmarks
concavities (loss = effusion)
alignment
palpations of knee
swelling
tenderness
bogginess
crepitus
ROM assessment of knee
flexion
extension
hyperextension
patellar tap test
press the patella against femoral condyles
function of patellar tap test
indicates fracture vs. inflammation
apprehension test
laterally displace patella
should be laxity in relaxed extension of the knee
function of apprehension test
in a positive test, patient will guard against movement
indicates potential instability or history of subluxation
anterior drawer test
place pts knee at 90 deg of flexion with hip flexed at 45 deg
anchor foot to prevent forward movement (sit on it)
relax hamstrings
grasp superior aspect of lower leg and gently pull forward displacing tibia anteriorly
evaluate for endpoint and forward motion
function of anterior drawer test
for ACL integrity
Lachman’s test more sensitive
posterior drawer test
similar to anterior drawer but displace tibia posteriorly
for PCL integrity
Lachman test
flex knee at 20 deg, hamstrings relaxed
stabilize distal femur with one hand and pull forward using a short quick motion on the proximal tibia with the other
function of Lachman test
most sensitive test for ACL test
with torn ACL, translation is noted and end point is soft or mushy
MCL test
hold ankle with one hand while other hand support the leg at level of knee
valgus stress applied at ankle (push knee medially and pull ankle laterally)
test at both 30 and 0 deg of knee extension
LCL test
varus stress applied at ankle (push knee laterally and ankle medially)
small motions
test at both 30 and 0 deg of knee flexion
Apley grind test
patient lie prone on exam table flex knee 90 deg grasp foot in palm apply downward pressure on the sole of foot to axially load lower leg rotate leg in grinding motion
function of Apley grind test
pain indicates meniscal pathology (tear)
McMurray test
used to test medial and lateral meniscys
iliotibial bad syndrome
occurs frequently in runners or cyclists
caused by a combo of overuse and biomechanical factors
exam shows tenderness over the lateral aspect of the knee about 2 cm above the joint line
Ober test
patient lays on side w affected leg on top
examiner stabilized the pelvis with one hand and moves the tested leg into knee flexion, hip abduction, and extension
THEN lower the leg into adduction until it stops via soft tissue stretch, posterior rotation of the pelvis, or both
function of Ober test
positive if the tested leg fails to adduct parallel to the table in a neutral position
Osgood Schlatter
pain is elicited on palpation of anterior tibial tuberosity
ankle inspection
contour/position
alignment
weight bearing
arch
ankle palpation
heat
swelling
tenderness
ankle ROM
flexion/extension
inversion/eversion
ligaments of ankle to palpate
anterio talofibular
posterior talofibular
calcaneofibular
medial ligament of ankle (deltoid)
thompsons test
squeeze thigh and see if foot moves
tests integrity of achilles
anterior drawer test of ankle
tests anterior talofibular ligament
talar tilt test of ankle
invert foot (no endpoint = tear, pain = sprain) tests integrity of calcaneofibular ligament
