Exam: MSK Flashcards
What should you ask them before you start the examination
Do you have any pain
Shoulder: What do you look for
Scars, shoulder alignment, swelling, muscle wasting
What would deformity at the medial clavicle suggest
Previous clavicular fracture
What would distal clavicle deformity suggest
AC joint subluxation
Why would you ask the patient to press against the wall
Winged scapula from long thoracic nerve damaging the serratus anterior
Shoulder: What do you feel for
Temperature Sternoclavicular joint Clavicle Acromioclavicular joint Coracoid process Humerus Spine of the scapula Border of the scapula
Where is the coracoid process
2cm inferior and medial to the clavicle tip
Shoulder: How should the patient move (quick)
Press against the wall
Hands behind back high up
Hands behind head, elbow back
Shoulder: Full assessment of ROM
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)
How do you assess supraspinatus
Abduct against resistance
What does painful arc assessment (between 60-120 degrees) suggest
Impingement
How do you assess infraspinatus and teres minor
External rotation (pain, tendonitis, loss of power, tear)
Shoulder: What are the special tests for the shoulder
Gerbers lift off test
Gerbers lift off test
Lift back of hand off spine against resistance. Assesses subscapularis
Shoulder: How would you summarise
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.
Shoulder: How would you complete the examination
Examine cervical spine and elbow
Look at any appropriate imaging of the shoulder joint
Elbow: What are you looking for
Scars, swelling, erythema. Note the carrying angle (5-15 degrees). Rheumatoid or psoariatic lesions
Elbow: What do you feel
Temperature Lateral epicondyle Medial epicondyle Olecranon Biceps tendon (with elbow flexed at 90)
Elbow: How should the patient move
Full flexion and extension
Pronation and suppination
(passively, feeling for crepitus)
Elbow: special tests
Active wrist flexion against resistance
Active wrist extension against resistance
What does active wrist flexion against resistance test for
Medial epidocondylitis
What does active wrist flexion against resistance test for
Lateral epicondylitis
Elbow: How would you summarise
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.
Elbow: How would you complete the examination
Examine shoulder and wrist
Neurovascular examination of the upper limb
Hand: How should you prepare the patient
Get them to place their hands on a pillow
Hand: What are you looking for (on the backs)
Scars and swelling
Deformity
Skin and nail changes
Muscle wasting
Hand: What are you looking for (on the front)
Scars and swelling
Thenar and hypothenar wasting
Dupuytrens contracture
Hand: What are you looking at the elbows for
Psoriatic plaques
Rheumatoid noduels
Hand: What are you feeling for
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
Where do you touch to test median nerve
Base of thumb
Where do you touch to test ulnar nerve
Base of little finger
Where do you touch to test radial nerve
Back of base of thumb
What does tender anatomical snuffbox suggest
Scaphoid fracture
Hand: How should the patient move
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)
Which nerve causes finger extension
Radial nerve
Which nerve causes finger abduction
Ulnar nerve
Which nerve causes thumb abduction
Median nerve
Hand: How do you test function
Squeeze fingers Pincer grip Observe the patient picking up a coin Tinels test Phalens test
What is tinels test
Tap wrist and test for tingling or pain
What is phalens test
backs of hands together for 30s
Hand: How to conclude the examination
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.
Hand: How to complete the examination
Full neurovascular assessment of the upper limb
Examine the elbow
