Exam: MSK

Question 1

What should you ask them before you start the examination

Answer 1

Do you have any pain

Question 2

Shoulder: What do you look for

Answer 2

Scars, shoulder alignment, swelling, muscle wasting

Question 3

What would deformity at the medial clavicle suggest

Answer 3

Previous clavicular fracture

Question 4

What would distal clavicle deformity suggest

Answer 4

AC joint subluxation

Question 5

Why would you ask the patient to press against the wall

Answer 5

Winged scapula from long thoracic nerve damaging the serratus anterior

Question 6

Shoulder: What do you feel for

Answer 6

Temperature
Sternoclavicular joint
Clavicle
Acromioclavicular joint
Coracoid process
Humerus
Spine of the scapula
Border of the scapula

Question 7

Where is the coracoid process

Answer 7

2cm inferior and medial to the clavicle tip

Question 8

Shoulder: How should the patient move (quick)

Answer 8

Press against the wall
Hands behind back high up
Hands behind head, elbow back

Question 9

Shoulder: Full assessment of ROM

Answer 9

Active shoulder flexion and extension
Active shoulder abduction and adduction
Active external rotation (elbows tuck in, rotate out)
Active internal rotation (hand high up on spine)
Assess scapular movement during abduction
(repeat, passively)

Question 10

How do you assess supraspinatus

Answer 10

Abduct against resistance

Question 11

What does painful arc assessment (between 60-120 degrees) suggest

Answer 11

Impingement

Question 12

How do you assess infraspinatus and teres minor

Answer 12

External rotation (pain, tendonitis, loss of power, tear)

Question 13

Shoulder: What are the special tests for the shoulder

Answer 13

Gerbers lift off test

Question 14

Gerbers lift off test

Answer 14

Lift back of hand off spine against resistance. Assesses subscapularis

Question 15

Shoulder: How would you summarise

Answer 15

Today I examined x a x year old male. On inspection there were no obvious abnormalities. On palpation there was no tenderness. There was a full range of active and passive movement. There were no positive findings on any of the special tests.

Question 16

Shoulder: How would you complete the examination

Answer 16

Examine cervical spine and elbow

Look at any appropriate imaging of the shoulder joint

Question 17

Elbow: What are you looking for

Answer 17

Scars, swelling, erythema. Note the carrying angle (5-15 degrees). Rheumatoid or psoariatic lesions

Question 18

Elbow: What do you feel

Answer 18

Temperature
Lateral epicondyle
Medial epicondyle
Olecranon
Biceps tendon (with elbow flexed at 90)

Question 19

Elbow: How should the patient move

Answer 19

Full flexion and extension
Pronation and suppination
(passively, feeling for crepitus)

Question 20

Elbow: special tests

Answer 20

Active wrist flexion against resistance

Active wrist extension against resistance

Question 21

What does active wrist flexion against resistance test for

Answer 21

Medial epidocondylitis

Question 22

What does active wrist flexion against resistance test for

Answer 22

Lateral epicondylitis

Question 23

Elbow: How would you summarise

Answer 23

On examination a x a x year old male. There were no abnormalities on inspection, palpation or active and passive movements of the elbow. In summary this was a normal elbow examination.

Question 24

Elbow: How would you complete the examination

Answer 24

Examine shoulder and wrist

Neurovascular examination of the upper limb

Question 25

Hand: How should you prepare the patient

Answer 25

Get them to place their hands on a pillow

Question 26

Hand: What are you looking for (on the backs)

Answer 26

Scars and swelling Deformity Skin and nail changes Muscle wasting

Question 27

Hand: What are you looking for (on the front)

Answer 27

Scars and swelling Thenar and hypothenar wasting Dupuytrens contracture

Question 28

Hand: What are you looking at the elbows for

Answer 28

Psoriatic plaques | Rheumatoid noduels

Question 29

Hand: What are you feeling for

Answer 29

``` Joint temperatures Ulnar and radial pulses Thenar and hypothenar muscle bulk Test sensation. Squeeze all MTPs Squeeze each joint individually (fingers and wrist) Palpate anatomical snuffbox Palpate ulnar border of each arm to the elbow ```

Question 30

Where do you touch to test median nerve

Answer 30

Base of thumb

Question 31

Where do you touch to test ulnar nerve

Answer 31

Base of little finger

Question 32

Where do you touch to test radial nerve

Answer 32

Back of base of thumb

Question 33

What does tender anatomical snuffbox suggest

Answer 33

Scaphoid fracture

Question 34

Hand: How should the patient move

Answer 34

Finger flexion and extension Wrist extension and flexion Passive wrist flexion and extension (checking for crepitus) Passive finger extension (against resistance) Passive finger abduction (against resistance) Thumb abduction (to ceiling, against resistance)

Question 35

Which nerve causes finger extension

Answer 35

Radial nerve

Question 36

Which nerve causes finger abduction

Answer 36

Ulnar nerve

Question 37

Which nerve causes thumb abduction

Answer 37

Median nerve

Question 38

Hand: How do you test function

Answer 38

``` Squeeze fingers Pincer grip Observe the patient picking up a coin Tinels test Phalens test ```

Question 39

What is tinels test

Answer 39

Tap wrist and test for tingling or pain

Question 40

What is phalens test

Answer 40

backs of hands together for 30s

Question 41

Hand: How to conclude the examination

Answer 41

On inspection of the hands they had a normal appearance with no evidence of scars, deformity or muscle wasting. On palpation there was a normal temperature and no tenderness. Sensation was entact and there was a normal range of movement.

Question 42

Hand: How to complete the examination

Answer 42

Full neurovascular assessment of the upper limb | Examine the elbow