examinations

Question 1

What assessment method is generally used?

Answer 1

GALS

gait
arms
legs
spine

Question 2

what can cause a bow legged/varus deformity?

Answer 2

OA as the medial compartment takes the most load in medial compartment arthritis

Question 3

what can cause valgus/knocked knees deformity?

Answer 3

inflammatory arthritis on both the medial and lateral compartments

Question 4

what nerve does wrist/finger extension indicate function of?

Answer 4

radial nerve

Question 5

what nerve does finger ABduction of the index finger indicate function of?

Answer 5

ulnar nerve

Question 6

what nerve does thumb ABduction indicate the function of?

Answer 6

median nerve

Question 7

what is tinel’s test?

Answer 7

used to help diagnose carpal tunnel syndrome.

tap over carpal tunnel with your index and middle fingers for 30-60 seconds. If the patient develops tingling in the thumb and radial two and a half fingers, this suggests median nerve irritation

Question 8

what is Phalens test?

Answer 8

if history suggests carpal tunnel, can do.

Ask patient to hold their wrist in complete and forced flexion for 60secs. if the patients symptoms develops then the test is positive.

Question 9

what are the clinical features of a median nerve palsy?

Answer 9

• if damaged at wrist, can get CTS with numbness of hand in median nerve distribution but with sparing of the palm due to intact palmar cutaneous branch
• CTS, weakness of thumb opposition and abduction
• CTS, thenar eminence wasting is a late feature

Question 10

what are the clinical features of an ulnar nerve palsy?

Answer 10

• numbness over hypothenar eminence and in ulnar nerve distribution of hand
• paralysis of flexor carpi ulnas = weak wrist flexion and adduction
• paralysis of flexor digitorum profundis medial two parts causes weak flexion of ring and little finger DIPJs.

Question 11

what is froments test?

Answer 11

to test adductor pollicis, ask patient to grip card between thumb and side of index finer.

in ulnar nerve palsy, the IPJ and MCPJ of thumb will flex as patient tries to grip the card.
Test adduction by asking the patient to grip the card between the little and ring finger while holding fingers extended.

test the first dorsal interosseous muscle by asking the patient to abduct the extended index finger against resistance.

Question 12

what is claw hand deformity?

Answer 12

a feature of ulnar nerve palsy

may be present at rest and on attempted finger extension the patient can’t extend the IPJ of their ring or little finger due to unopposed median nerve function.

Most pronounced when nerve is injured at the wrist e.g by compression of Guyon’s canal, as the function of flexor digitorum profundus will be preserved.