Exam #5: Musculoskeletal Exam Flashcards
What is the purpose of the MSK focused history?
Narrowing of the physical exam
What questions should you ask the patient in regards to the MSK?
- Joint & neurological related
- Function/ ADL
What is the order for the MSK examination?
1) Inspection
2) ROM
3) Muscle strength eval
4) Reflexes & neuro
5) Special tests
6) Palpation
What is the preliminary step to the MSK exam?
Neurological screening exam
What are joint locking or crepitus associated with?
Meniscal injury
What is giving-way associated with?
Ligamentous or meniscal injury
What is weakness associated with?
Neurological
Mylopathy
Tendiopathy
Muscle injury
What is clicking, popping, or tearing associated with?
Soft tissue injury
Tear
What are tremors, spasms, and weakness associated with?
Neurologic or muscle injury
What is one of the most important things to know in regards to patient’s with MSK complaints?
How their ADLs are being affected, and how they’re changing
What are the major red flags that should be asked about in regards to MSK complaints?
Paresthesias Weakness Painless weakness Incontinence Retention Weight loss Night time pain
What is tendonitis?
Acute inflammation of a tendon
What is tendinosis?
Chronic degeneration of a tendon
What is tenosynovitis?
Inflammation of a sheath of a tendon (i.e. DeQuervain’s)
What is tendinopathy?
Disease of the tendon–a general term when precise etiology is not know
What is a tremor?
Involuntary rhythmic muscle movement
What is spasticity?
Velocity dependent resistance to muscle stretch
What is a strain?
Trauma to a muscle
What is Arthritis?
Joint inflammation
What does Arthrosis mean?
Joint degeneration
What does Arthraliga mean?
Joint pain
What does Arthropathy mean?
Disease of a joint
What is Bursitis?
Inflammation of the bursa
What is the difference between smooth weakness & breakaway?
Breakaway= painful/ MSK weakness
Smooth= neurologic
What is a positive babinksi sign? What is this is sign indicative of?
UMN injury in LE
Upward toes
What is Hoffman’s sign indicative of?
UMN injury in UE
Outline the 0-5 grading scale of muscle strength.
0= no movement 1= trace 2= gravity eliminated 3= full ROM against gravity but thats it 4= Full ROM against grav. but weak with DO applied 5= Full
How are ligaments generally evaluated?
Elongated by pushing or pulling bone away
How are joint surfaces evaluated?
Rub them together
How is cartilage evaluated?
Squeeze them between bones
In a positive trendelenburg sign, which side is the weakness on?
Side of the leg that is planted
What does Genu valgum mean?
knocked knee
What does Genu varus mean?
bow legged
What does Genu recurvatum?
back knee
What are Heberden & Bouchard nodes indicative of? Where are they?
H= DIP B= PIP
What are the common deformities associated with RA?
Swan neck deformity
Ulnar deviation
Boutonniere deformity
MCP swelling
What is the classic appearance of ankylosing spondyltis? What is the classic posture?
- Bamboo spine
- Head forward
What is Spurling’s test for? How is this test performed?
Patient is seated:
1) Extension of c-spine
2) Rotation of head/ neck
+/- sidebending
*Indicates nerve root compression or CERVICAL RADICULOPATHY
What is a Bragard’s test/ Lasegue’s Sign?
Straight Leg Raise= lumbar radiculopathy (L4, L5, S1)
*Confirmation with dorsiflexion SLR= Bragard test/ Lasegue’s Sign
What is the Apley “Scratch Test” for?
Shoulder ROM
What are the tests for shoulder impingement?
Neer’s Sign
Hawkin’ Sign
What tests are used for the Rotator Cuff?
Arm Drop
Empty Can
Lift off Test
What tests are used for the biceps tendon?
Speeds Test
Yergason’s Test
What test is used for shoulder instability?
Apprehension
What is Neer’s test? How is this test preformed and what is a positive test?
1) Fully internally rotate the shoulder w/ arm extended (thumb down)
2) Bring arm up overhead
*Pain with this test is a sign of IMPINGEMENT
What is the Hawkins test? How is this test preformed and what is a positive test?
1) ABduct arm to 90 degrees
2) Flex arm
3) Internally rotate
*Pain is a sign of IMPINGEMENT
What is the Arm Drop Test? How is this test preformed and what is a positive test?
1) Lift arm up for patient overhead
2) Ask to lower slowly
*Sudden drop-off of arm is a sign of a ROTATOR CUFF TEAR
What is the Empty Can Test? How is this test preformed and what is a positive test?
1) Arm straight & aBducted at 90 degrees
2) thumb down as if “emptying a can”
*Positive test (pain) indicates damage to the SUPRASPINATUS or more generally, the rotator cuff
What is the Lift off test? How is this test preformed and what is a positive test?
1) Put dorsum of hand behind back
2) Stabilize elbow
3) Ask patient to push into your hand
*Pain is an indication of SUBSCAPULARIS injury or rotator cuff injury more generally
What is Speeds Test? How is this test preformed and what is a positive test?
1) Arm is raised in front & supinated
2) Push the arm down & see if there is pain
*Positive test is pain in biceps region or tendon subluxation felt on exam, which indicate BICEPS TENDIOPATHY OR SUBLUXATION OF BICEPS TENDON
What is the Yergason Test? How is this test preformed and what is a positive test?
1) Place thumb in interteburucular groove
2) Flex biceps
3) Ask patient to supinate forearm against resistance
*Positive test is pain in biceps region or tendon subluxation felt on exam, which indicate BICEPS TENDIOPATHY OR SUBLUXATION OF BICEPS TENDON
What is the Apprehension test? How is this test preformed and what is a positive test?
1) ABduct arm & felx to 90 degrees
2) Stabilize shoulder
3) Pull up & back, looking for signs of apprehension
*Positive test is if there is obvious “apprehension” or guarding
What is lateral epicondylitis?
Tennis elbow
- Caused by overuse of wrist extensors and the supinator muscle
What is medial epicondylitis?
Golfer’s elbow
What is the carrying angle? In which sex is this normally larger?
Valgus angle between the upper arm and forearm with the elbow extended
- Females
> 20 degrees is abnormal
What is the Varus Test? How is this test preformed and what is a positive test?
1) Stabilize arm (flexed to 20 degrees)
2) Push forearm IN to body
*Positive test indicates damage to RADIAL COLLATERAL LIGAMENT
What is the Valgus Test? How is this test preformed and what is a positive test?
1) Stabilize arm (flexed to 20 degrees)
2) Push forearm AWAY from body
*Positive test indicates damage to ULNAR COLLATERAL LIGAMENT
What is Tinel Sign’s (Cubital Tunnel)? How is this test preformed and what is a positive test?
1) Find medial epicondyle & olecranon
2) Tap on area
*Positive test indicates CUBITAL TUNNEL SYNDROME or ULNAR NEUROPATHY
What is Cozen Test? How is this test preformed and what is a positive test?
1) Ask the patient to make a fist (palm down)
2) Grasp lateral epicondyle w/ one hand
3) With other hand ask patient to extend wrist against your resistance
*Positive test is indicative of LATERAL EPICONDYLITIS
What is Maudsley’s? How is this test preformed and what is a positive test?
This is also known as the “3rd finger Test”
1) Extend arm palm down
2) Ask patient to resist depression of 3rd PIP on extension
*Positive if pain is reproduced over LATERAL EPICONDYLE
What is Phalen’s Test? How is this test preformed and what is a positive test?
1) Extend the arm
2) Flex the wrist & apply pressure
*Reproduction of symptoms IN LESS THAN 30 SEC= CARPAL TUNNEL SYNDROME
What is Tinel’s Sign (Carpal Tunnel)? How is this test preformed and what is a positive test?
Tapping over the carpal tunnel
*Reproduction of symptoms= CARPAL TUNNEL SYNDROME
What is Finkelstein’s Test? How is this test preformed and what is a positive test?
1) Wrap fingers of the thumb
2) Ulnar deviation
*Positive test is reproduction of pain over radial wrist indicative of “DE QUERVAIN’S TENOSYNOVITIS”
What is Snuff Box Tenderness? How is this test preformed and what is a positive test?
1) Extend thumb
2) Ulnar deviate
3) Push on snuff box
*Need to R/O SCAPHOID FRACTURE if positive (with imaging)
What is Dupuytren’s Contracture?
Flexion/ contracture of digits 4 & 5
What is Trigger Finger?
Difficulty flexing until sudden snap on finger with full flexion & inability to extend
What is Mallet finger?
Trauma causes avulsion of extensor at DIP joint
What is APB weakness? How is this test preformed and what is a positive test?
This is a test for strength of the abductor pollicus brevis
- Weak in carpal tunnel syndrome
- Test abduction of pinkey
**If both are positive, likely more proximal (C8/T1) root level injury
What is Patrick’s FABER test? How is this test preformed and what is a positive test?
1) Flex hip
2) Flex knee
3) External rotation
**SI vs. Hip
What is Thomas’ Sign? How is this test preformed and what is a positive test?
1) Bring knee to chest (left)
2) Right knee follows
*Indicates Hip flexor tightness or contracture
What is Trendelenburg Sign? How is this test preformed and what is a positive test?
Weak or non-functioning gluteus medius (Superior Oblique)
What is Ober Test? How is this test preformed and what is a positive test?
1) Lay patient on side, hips “stacked”
2) Extend superior hip
3) Drop leg
*If the leg does not go down, test is positive & indicates a tight IT band–note that patients often complain of LATERAL KNEE PAIN in IT BAND SYNDROME
What is Ballottement Test? How is this test preformed and what is a positive test?
1) Compress from thigh down to knee
2) Alt. hand push down on patella
*Positive test is indicative of JOINT EFFUSION–feel like patella is just floating
What is the Anterior Drawer Test? How is this test preformed and what is a positive test?
*ACL
What is the Posterior Drawer test? How is this test preformed and what is a positive test?
*PCL
What is the McMurray Test? How is this test preformed and what is a positive test?
Meniscal test
What is Apley’s Compresison Test? How is this test preformed and what is a positive test?
1) Patient is prone
2) Compress toward table
3) Turn foot inward
*Positive test indicates MENISCUS INJURY
What is Valgus Stress Test? How is this test preformed and what is a positive test?
ABduct the distal leg
*MCL
What is Varus Stress Test? How is this test preformed and what is a positive test?
ADduct the distal leg
*LCL injury
What is Apley’s Distraction Test? How is this test preformed and what is a positive test?
1) Patient is prone
2) Pull leg from table while stabilizing hip
3) Turn foot inward
*Positive test indicates MENISCUS INJURY
What is Ankle Anterior Drawer Test? How is this test preformed and what is a positive test?
1) Cup heel
2) Push posterior on tibia
*ATF Ligment Injury
What is the Talar Tilt? How is this test preformed and what is a positive test?
1) Cup heel
2) INvert heel
*ATF, CF Ligament Injury
What is Squeeze Test? How is this test preformed and what is a positive test?
Squeeze tib & fib together
*Indicates high ankle sprain
What is the External Rotation Test? How is this test preformed and what is a positive test?
1) Dorsiflex the foot
2) Externally rotate foot
*Interosseous membrane injury
What are the spinal levels associated with the major movements of the upper extremity?
C5= elbow flexion & shoulder aBduction C6= wrist extension C7= elbow extension C8= long finger flexors T1= small finger abduction/ adduction
What are the spinal levels associated with the major movements of the lower extremity?
L2= hip flexion L3= knee extension L4= ankle dorsiflexion L5= long toe extension (EHL) S1= ankle plantar flexion
What spinal levels are associated with the major reflexes typically evaluated?
Biceps brachii= C5
Brachioradialis= C6
Triceps= C7
Patellar= L4
Medial Hamstring= L5
Achilles= S1
What is the specific name for the standing flexion/ scoliosis screen?
Adam’s Forward Bend
What is the femoral nerve stretch test? How is this test performed?
Patient is prone; passively flex the knee & hip
*Positive test has radicular pain to anterior thigh–indicates high lumbar disc hernation (L2, L3, L4)
What is the CMC grind test?
Thumb Grind Test
- Push/ twist MCP against trapzeium
*Pain & grinding are indicative of OSTEOARTHRITIS
