clinical skills Flashcards
GALS exam structure
screening questions. gait, arms, spine, legs.
what are the screening questions for the GALS exam?
manage stairs?
dressed by yourself?
current pain anywhere in joints/muscles?
what to look for when assessing Gait in GALS exam?
assess gait.
Inspect muscle bulk, symmetry,
inspect spine and iliac crests. Elbow and toes also
what to look for when assessing arms in GALS exam?
arm movements,
looks at hand both sides,
make fist, grip fingers, MCP’s, precision test
what to look for when assessing legs in GALS exam?
full flexion and extension of knees, feel for crepitus,
rotation of hip,
patellar tap,
look at feet and MTP’s
what to look for when assessing spine in GALS
tilt head to each side
touch toes with two fingers on back
what must be done before starting every exam in MSK?
Always adequate expose areas and check for pre-existing discomfort.
(plus intro, explain exam, consent, hands, ID )
Hand exam sections
look, feel, move
what to look for in hand exam?
deformity, skin, swelling, nails, muscle wasting
what to feel for in hand exam
warmth, MCP tenderness, bilaterally palpate swollen joints
movement/special test of Hand exam
make fist, finger squeeze, precision test, pick up coin, hold pen, power of pincer grip, hook (okay sign) grip
spine exam: look for?
behind - posture and scoliosis
side - kyphosis/lordosis
spine exam: feel for?
subclavicular LN/cervical rib,
spinous processes,
para-spinal muscles,
iliac crest height,
sacroiliac joints,
chest expansion
spine exam: move
C-spine 3 neck movements (up/down, side rotation, touch to ear)
L-spine 3 movements. (flex (schober’s test), extend, sides)
knee exam: look
limb alignment, quad/ham muscle bulk, popliteal fossa, Gait , local inspection of knee: erythema, skin, bruise, scars, hair changes, swelling
knee exam: feel
temperature, patella tendon, tibial tuberosity, joint lines, collateral ligaments. Pop fossa
knee exam: move
flexion active and passive
extension passive [+/- heel height testing for locked knee/suspected bucket handle tear])
Special Tests: Straight leg raise, effusion tests, patellar tests, Steinman’s test, collateral ligament test. Cruciate ligament test(ACL and PCL)
hip exam: structure
look standing up and walking. trendelenberg test. look, feel and move lying down
hip exam: look for
look at standing Quad/Ham/glut mass,
Gait,
Trendelenberg test,
lying on couch look for skin changes, scarring, bruising, hair changes, erthyema, attitidue of the limb, swelling over greater trochanter
hip exam: feel
up to greater trochanter and dow to mid-point of groin from iliac spine (sore indicate hip pathology)
tenderness on palpation of medial groin may indicate pubic rami #
hip exam: move
Thomas’ test,
flexion active and passive,
internal/external rotation passive,
abduction/adduction passive
limb lengths ture and apparent
shoulder exam structure
look [front, side,back and axilla]
feel
move
then decide if RC or instability
shoulder exam: look
Front= deltoid and trap bulk. Inspect sternoclavicular and acromoclavical joint, scars and deformity/assymtery.
Side = shoulder counter, sternoclavicular and acromoclavical.
Behind= supra and infraspinatus fossae in Scapula
Axilla
shoulder exam feel
sternoclavicular along clavical then acrominoclavucilar joint, then long head of biceps tendon and body and spine of scapula
shoulder exam move
external rotation, forward flexion, Abduction, internal rotation, scaula winging: chest = trapezium muscles supplied by spinal accessory nerve + waist = serratus anterior supplied by long thoracic nerve:
supraspinatus(examiner pushes down on forearms of thumb down arms ), infraspinatus (external roation against resistance), subscapularis (hand out against buttock)
shoulder exam if suspect RC pathology/inpingement
painful arc, Hawkins-,kennedy (bent elbow internally rotate arm) jobe’s (supraspinatus power), scarf test (push on elbow pain in acromialclavicular joint problem).
shoulder exam if suspect instability
subluaxtion/dislocation history.
Sulcus sign (pull downwards on arm humeral head sublaxes inferiorly),
ant.post drawer tests (try to displace anterior and posteriorly).
Ant and post aprhension test (rotate externally with flexed elbow and shoulder flexed push down on elbow.)
when to suspect RC tear/impingement or shoulder instability
instability = Hx of subluxation/dislocation
RC problem = stiffness/pain in shoulder
why does painful Arc occur?
RC tendon compressed subacromial space 80-150’ of abduction
what does a straight leg raise confirm? (knee exam). How is it done?
extensor mechanism is intact
ask to dorsifelx their ankle, lock knee and straight leg raise against resistance
what are the two effusion tests in knee exam?
medical gutter sweep (small effusion) or patellar tap (large effusion)
do one of the other NOT BOTH - if visible to naked eye then do patellar tap
what are the patellar tests and what do they indicate if positive.
patellar aphernsion test - gently express lateralising force on patella (patellar instability due to subluxation/dislocation) - look at patient face for ‘aprehension.’
-patellar grind test (patello-femoral OA gives pain/discomfort)
what is steinman’s test for
meniscal provocation test (for acute meniscal tear)
knee at 45 degrees - take heel in hand and rotate away from affected side
why and how to test collateral ligament?
stress of medial (valgus) or lateral ligaments (varus). - tenderness suggests sprain on palation
Hang leg off bed at 20 degrees and put one way or the other
how to test crucial ligament
posterior drawer test (PCL) and Lachan’s test (ACL)
compare to knees at 45 degrees then sit on foot and exert posterior force to tibia. tibia sits back in relation to femoral condyles to called posterior sag (looks sunken). Then move back to look normal.
lachman’s raise to 20 degrees with thumb over tibial tuberosity and lift tibial anteriorly while posterior pressure on femur. torn ACL gives laxity of this movement
what does pain in joint line suggest if generalised in elderly or if localised in young
elderly and genral - OA and degernative meincal tears (part of disease process )
young and localised suspect acute meniscal teat do Steinman’s
what ankle, wrist, elbow exams
-
MSK inspection MARS
muscle bulk, assymetry, redness, scaring/swelling
