History and examinations Flashcards
Which conditions are important to ask about in suspected carpal tunnel? (2)
HypoT and DM
What medication is it important to ask about in suspected acute gout?
New diuretic
In suspected osteoporosis what medication is it important to find out whether they’re taking?
Long term corticosteroids
Medial epicondyle is the muscle origin of which forearm muscles?
Flexors
Lateral epicondyle is the muscle origin of which forearm muscles?
Extensors
What stigmata of systemic disease might you be looking for in the elbow exam?
psoriatic plaques
rheumatoid nodules
Golfers elbow =
tendonitis of the flexors (medial epicondyle insertion)
Tennis elbow =
tendonitis of the extensors (lateral epicondyle insertion)
Basic tests for functional problems with the elbow (3)
- both hands behind head
- both hands up to their mouth
- both hands down to their bottom
pes planus can cause -
foot pronation and valgus deformity of the heel
pes cavus can cause -
varus deformation of the hind foot
Simmonds test -
tests achilles tendon integrity
Hip flexion myotome
L2+3
Hip extension myotome
L4+5
Knee extension myotome
L3+4
Knee flexion myotome
L5+S1
Ankle dorsiflexion myotome
L4+5
Great toe extension
L5
Ankle plantar flexion
S1
Power of 0
no movement
Power of 1 =
flicker of movement
Power of 2 =
movement with gravity eliminated
Power 3 =
movement of limb against gravity
Power 4 =
reduced from normal
Power 5 =
normal power
Knee reflex myotome
L3/4
Ankle reflex myotome
L5/S1
Tredenlenburg gait cause
loss of abductor function
High stepping gait cause
Peroneal or sciatic nerve palsy
4 joints of the shoulder
sternoclavicular
acromiclavicular joint
glenohumeral joint
scapulothoracic
Movements of the shoulder
Flex Extend Abduct Adduct Internal rotation External rotation
Jobes test
Shoulder abduction against resistance
Tests supraspinatus
Lift off test
Tests subscapularis - medial rotation against resistance
What is used to test teres minor and infraspinatus?
External rotation against rotation
Where is the axillary nerve tested for? (sensation)
regimental badge area
Where is the sensation aspect of the median nerve tested for?
lateral aspect of the index finger
Where is the sensation aspect of the ulnar nerve tested for?
medial aspect of the little finger
Where is the sensation aspect of the radial nerve tested for?
dorsal 1st IO space
which way does the shoulder usually dislocate?
anteriorly
how to test for biceps tendonitis?
shoulder in 60 degrees flexion
elbow in full extension
arm fully supinated
+ve for biceps tendonitis, pain where?
bicipital groove
Muscle(s) that cause extension of the shoulder
Produced by the posterior deltoid, latissimus dorsi and teres major.
Muscle(s) that cause flexion of the shoulder
Produced by the biceps brachii (both heads), pectoralis major, anterior deltoid and coracobrachialis.
Muscle(s) that cause 0-15 degrees of abduction of the shoulder
supraspinatus
Muscle(s) that cause 15-90 degree of abduction of the shoulder
middle fibres of deltoid
Muscle(s) that cause 90+ abduction of the shoulder
trapezius and serratus anterior
Muscle(s) that cause adduction of the shoulder
Produced by contraction of pectoralis major, latissimus dorsi and teres major.
Muscle(s) that cause lateral rotation of the shoulder
teres minor and infraspinatus
Muscle(s) that cause medial rotation of the shoulder
Produced by contraction of subscapularis, pectoralis major, latissimus dorsi, teres major and anterior deltoid.
True hip pain often felt…?
in the groin
True leg length
ASIS to MM
Apparent leg length
Umbilicus ro MM
Tibial discrepancy showed by
one knee higher than the other
Femoral discrepancy showed by
one knee behind the other
-ve trendeleburg test
pelvis tilts upwards on the unsupported side
+ve trendelenburg test
pelvis tilts downwards on the unsupported side
Muscle(s) that cause flexion of the hip -
Iliopsoas
Rectus femoris
Sartorius
Muscle(s) that cause Extension of the hip -
Gluteus maximus
Hamstrings
Muscle(s) that cause Abduction of the hip -
Glut medius and minimus
Deep gluteals
Muscle(s) that cause Adduction of the hip
Adductor longus, brevis and magnus
Muscle(s) that cause Lateral rotation of the hip
Biceps femoris
Gluteus max
Deep gluteals
Muscle(s) that cause Medial rotation of the hip
Glut medius and minimus
Semitendinosus and semimbranosus
Heberdens nodes found where?
DIPJ
Bouchards nodes found where?
PIPJ
What type of subluxation is found in RA?
Radiocarpal
Ulnar claw is due to?
Hyperextension of MCP and flexion of PIPJ
Active movements of the hand (8)
Wrist flex / extend
Finger flexion / extend
Finger abduction and adduction
Pronation and supination
3 function test
Pinch grip
Power grip
Fine motor control
Muscle(s) that cause Wrist flexion -
Flexor carpi radialis
FCU
Palmaris longus
Muscle(s) that cause Wrist extension
Extensor CR (longus and brevis)
ECU
(R)
Muscle(s) that cause DIPJ flexion
Flexor digitorum profundus (M&U)
Muscle(s) that cause PIPJ flexion
Flexor digitorum superficialis (M)
Muscle(s) that cause MCPJ flexion and IP extension
Lumbricals (M&U)
Muscle(s) that cause Finger abduction
Dorsal interossei (U)
Muscle(s) that cause Finger adduction
Palmar interossei (U)
Muscle(s) that cause Extension of all joints in the hand
Extensor digitorum
Muscle(s) that cause Thumb abduction
Abductor policis brevis (M)
Abductor policis longus (R)
Muscle(s) that cause Thumb adduction
Adductor pollicis (U)
Muscle(s) that cause Thumb opposition
Opponens pollicis (M)
Muscle(s) that cause Thumb extension
Extensor pollicis longus
Phalen test -
wrist held in max plantar flexion to reproduce CT symptoms
Tinel test
Tap over the median nerve
Schobers test aim
to quantify lumbar spine flexion
Straight leg raise tests which myotomes?
L5/S1
Femoral stretch test, tests which myotome?
L4
In adhesive capsulitis which movement is first and most restricted
External rotation
RF for adhesive capsulitis
female
diabetes
non dominant hand
Presentation of adhesive capsulitis
painful stiff shoulder with restriction of active and passive range of motion in abduction, internal and external rotation.
Presentation of acromioclavicular degeneration
popping, swelling, clicking and grinding
+ve scarf test
Subacromial impingement
painful arc on abduction, worse at 90 - 120 degrees
Rotator cuff tear presentation
specific trauma / chronic
weakness and pain
may be muscle wasting and tenderness
painful arc
Ortaloni test
Can reduce the hip when abducted
Barlow test
Hip dislocated with adduction
When is developmental dysplasia of the hip usually picked up ?
6 week baby check
main imaging used to pick up DDH?
USS
DDH diagnosed at <6m age, treatment
Pavlik harness
Perthes disease =
avascular necrosis of the femoral head
Age group affected by perthes disease?
3 -12 years old
Presentation of perthes disease
Hip / groin pain
Limp
X-ray presentation of perthes disease
flattening of femoral ossific nucleus
thickening of the femoral neck
Slipped upper femoral epiphysis presenation
hip pain, limp, pain referred to the knee
Ddx for a limping child
Septic arthritis Trauma Developmental dysplasia Perthes SUFE Junvenile arthritis
Test for De Quervain’s Tendinosis
Finkelstein test by placing your thumb against your hand, making a fist with your fingers closed over your thumb, and then bending your wrist toward your little finger.
Osgood–Schlatter disease presents …
prominent tibial tuberosity and knee pain
