Clinical Skills: MSK Examination Flashcards
Outline the relevant parts of MSK exam. (8)
General inspection
Set of basic observations
Look
Feel
Movement (active/passive/resistance/function)
Define flexion. (1)
Joint bending from neutral position (reduces angle)
Define extension. (1)
Straightening a joint back to the neutral position and into a reversed position.
Define hyper extension. (1)
Movement beyond the anatomical position.
Define adduction. (1)
Movement towards midline of body.
Define abduction. (1)
Movement away from midline.
Define supination. (1)
Facing upwards.
Define pronation. (1)
Facing down/backwards.
Define inversion. (1)
Supination of foot (raised medial edge)
Define eversion. (1)
Protonation of foot (raised lateral edge).
Define ulnar deviation. (1)
Movement towards ulnar
Define radial deviation. (1)
Movement towards radius.
Define dorsi-flexion. (1)
Foot towards shin.
Define plantarflexion. (1)
Pointing toes down.
Define opposition. (1)
Tip of thumb to touch tips of other fingers.
Define internal rotation. (1)
Rotation towards midline.
Define external flexion. (1)
Rotation away from midline.
What are the possible MSK diagnosis? (2)
Soft tissue injury
Fracture
State the management of soft tissue injury. (3)
PRICE + HARM
Analgesia
Safety netting advice
State the management of fracture. (3)
X-ray referral
Don’t use affected limb.
Take analgesia.
What factors is considered for look in MSK examination? (7)
Swelling
Inflammation
Deformities
Differences in sizes
Bruising/wounds
Colour/Pallor
What factors is considered for feel in MSK examination? (3)
Skin temperature:
- Hot/warm = inflammation/infection
- Cold = Poor circulation.
Area of tenderness: General/Bony
Check for swellings/mobility
Sensation (NVD)
What factors is considered for move in MSK examination? (5)
ROM
Actively (1st) and passively (2nd)
Active = px moves with instruction
Passive = practitioner moves limb/joint.
During passive movements one hand to remain on joint for crepitations.
What factors is considered for function in MSK examination? (2)
Functional assessment on affected joint/limb.
Movement against resistance (caution)
Perform the Hand/Wrist in MSK examination. (4)
Look : Swelling, inflammation, deformities (wrist/metacarpal) differences in size, bruising/wounds, colour/pallor.
Feel: skin temperature, tenderness, check for swellings, sensation (NVD), ASB for tenderness.
Move: active then passive. Wrist (flexion, extension, ulnar/radial deviation), Hand (fingers flexion, extension, abduction, adduction, thumb opposition
Function: hand function/grip test, power/resistance
Perform the Elbow in MSK examination. (4)
Look : Swelling, inflammation (olecranon bursitis/infection) , deformities, differences in size, bruising/wounds, colour/pallor.
Feel: skin temperature, general/bony (lateral/medial epicondyle, olecranon) tenderness, check for swellings.
Move: active then passive. Elbow: Flexion, Extension, Pronation, Supination
Function: hand function/grip test, power/resistance
What are the OTTAWA rules for knee examination? (5)
< 18 yrs.
If injury occurred < 7 days.
Inability to bear weight both immediately and in emergency department
Isolated tenderness of patella/fibula
Inability to flex to 90 degrees.
Perform the Knee in MSK examination. (4)
Look : > 55 yrs, Swelling, inflammation, deformities, differences in size, bruising/wounds.
Feel: skin temperature, tenderness (patella/head of fibula), check for swellings and mobility.
Move: active then passive. Knee (flexion, extension, straight leg raise, anterior crucuate lag test, posterior cruciate laf test, lateral/medial stress test.
Function: power/resistance, walk 4 steps at time of incident and consultation.
What are the OTTAWA rules of ankle in MSK examination? (2)
> 18 years
Injury occurred < 10 days ago.
Perform the ankle/foot in MSK examination. (4)
Look : Swelling, inflammation, deformities (ankle/metatarsals) differences in size, bruising/wounds.
Feel: skin temperature, tenderness (navicular, base of 5th metatarsals, medial + lateral Malle plus 6cm, check for swellings, pain and fluctuation, sensation (NVD).
Move: active then passive. Ankle (Dorsiflexion, Plantarflexion, inversion, eversion, rotation). Foot (Toe dorsiflexion/plantarflexion).
Function: power/resistance. Walk 4-5 steps at time of incident and consultation.
What is PRICE? (5)
Protect
Rest
Ice
Compression
Elevation
What is HARM? (7)
Heat
Alcohol
Running
Massage
Analgesia
Gently mobilisation
Recover period
What analgesics advice is given for px with soft tissue injury? (5)
Paracetamol
Topical NSAIDs (Ibuprofen gel)
Codeine
Medical review after 5-7 days:
- No signs of improvement
- Worsening condition
- Can take several weeks to fully heal.
