L2: Advanced MSK Assessment Flashcards
what makes up an subjective MSK assessment
- PC
- HPC
- PMH
- DH
- SH
- Goals and expectations
- Red flags
what are some red flags to look out for during an assessment
Cancer - night sweats, unexplained weight loss (4-6 weeks), previous history of cancer
Septic arthritis - joint looks infected + patient feels very unwell
Cauda equina syndrome (CES) - bladder retention, bowel incontinence, saddle anaesthesia, gait disturbance
Rheumatology - prolonged morning stiffness (>1 hour), widespread pain, cardinal signs of inflammation
VBI / CAD - 5 Ds and 3 Ns
what are the 5 Ds
dysphagia
diplopia
dysarthria
drop attacks
dizziness
what are the 3 Ns
nystagmus
nausea
numbness
What makes up an objective assessment?
- Observation
- AROM
- PROM
- Strength testing
- Palpation
- Gait
- Movement analysis
what is the art of clnical reasoning
correct subjective assessment leads to planned objective assessment leads to correct interventions and treatment technique
what are the things you need to do for a problem that a patient comes to you with?
- onset
- symptoms
- presentation (how it looks)
- tests
what is the onset for an ATFL tear
ankle inversion trauma
what are the sympoms for an ATFL tear
- Pain over lateral ankle
- Swelling
- Restricted ROM
- Worse with activity
what is the presentation of an ATFL tear
- Antalgic gait
- Swelling
- Bruising
what is the test for an ATFL tear
- AROM
- PROM
- Strength
- Anterior drawer test
- Palpation of ATFL
how do you complete an anterior drawer test for an ATFL tear
- patient has knee bent so foot is flat on the bed
- physio sits on foot to keep in place
- physio pushes tibia back until there is a lock
(positive result will be lack of end feel or excessive anterior translation relative to the contralateral side)
what is onset of hip OA
gradual onset from age/ overuse
what are symptoms of hip OA
- Pain around buttock, lateral hip and/or groin
- Morning stiffness <30 min
- Worse towards the end of the day
- Worse with activity
what is the presentation pf hip OA
- Antalgic gait
- trendelemburg gait (hip hitching)
- Reduced muscle bulk
how to test for hip OA
- AROM
- PROM
- Strength
- Palpation
- FABERs
- FADDIRs
how to carry out FABERs test for hip OA
- have patient lying down on plinth
- move hip into flexion
- then into abduction while still flexed
- then into external rotation
(positive result would be if there is pain and reduced ROM)
how to carry out FADDIRs test for hip OA
- have patient lying down
- move hip into flexion
- then into adduction while flexed
- then into internal rotation
( positive result would be pain/ reduced ROM)
what is the onset of a rotator cuff tear
traumatic FOOSH or degenerative
what are the symptoms of a rotator cuff tear
- Pain around shoulder and down humerus
- Pain with movement
- Unable to lift arm
- pain at night
what is the presentation of a rotator cuff tear
- reduced muscle bulk
- pseudo-paralysis
- arm being kept across body
- reduced range
what are the tests for rotator cuff tear
- AROM
- PROM
- Strength
- Palpation
- ExternalRotation/InternalRotation lag sign
- drop arm test
- lift-off test
how do you carry out external roatation lag sign test for rotator cuff test
gently move arm into external rotation and release
positive result is if arm moves back
how do you carry out drop arm test for rotator cuff test
gently move arm into hitler salut position
positive result would be if arm drops
how to carry out lift-off test for rotator cuff test
gentle position arm behing back with palm touch back (elbow bent). ask patient to move hand away from back
positive result is if patient cannot move hand off back
what is the onset of lateral epicondylitis
repetitive microtrauma (tendinopathy) without healing
what are the symptoms of lateral epicondylitis
- Pain around lateral epicondyle and surrounding musculature
- Pain with gripping tasks
what do you test for lateral epicondylitis
- AROM
- PROM
- Strength
- Palpation
- Passive wrist flexion (Mill’s)
- Resisted wrist extension (Cozen’s)
- Resisted middle finger extension (Maudsley’s)
how to carry out passive wrist flexion test for lateral epicondylitis
- move patient’s wrist into flexion
positive result is if pain is casued
how to carry out resisted wrist extension test for lateral epicondylitis
- resist patient moving theur wrist into extension
positive result would be if pain occurs
how to carry out resisted middle finger extension test for lateral epicondylitis
- resist patient’s middle finger going into extension
positive result would be if pain is caused
what is the onset for an ACL tear
Valgus trauma on planted foot + internal rotation
what are the symptoms of an ACL tear
- Giving-way/feels unstable
- Swelling
- Pain
what is the presentation of an ACL tear
- Antalgic gait
- Swelling
- Bruising
- Loss of muscle bulk
what are test to carry out to test an ACL tear
- AROM
- PROM
- Strength
- Lachman’s
- Anterior drawer
- Pivot-shift
- Lever sign
how to carry out lachman’s test for ACL tear
- band paitent knee about 20 degrees, put one hand on lower thigh and pull lower leg forward firmly while keeping thigh stable.
positive result is a lot of laxity
how to carry out anterior drawer test for an ACL tear
- sit on patients foot with thier knee bent
- firmly pull lower leg towards you
positive test would be lots of laxity
how to carry out pivot shift test for ACL tear
- internally rotate foot with straight leg
- lift leg and move into flexion and adduction
positive result would be pain
how to carry out lever sign test for ACL tear
- place one fist under the proximal third of the calf and then apply moderate downward force over the dustal third of the patient’s quads
positive result would be if heel did not lift off the plinth
what are special questions you need to ask when assessing the knee
- Giving-way: True vs pseudo - true giving-way could indicate significant ligament trauma (e.g. ACL) which causes a person to fall over/collapse, whereas pseudo is a short ‘snap’ of the knee more indicative of muscle weakness
- Locking: True vs pseudo - true lock could indicate significant meniscal damage (unable to bend or straighten knee), whereas pseudo is a temporary lock sensation more indicative of OA
- Swelling: Instant vs delayed - instant swelling may indicate significant trauma e.g. ligament tear
- Redness: Sign of infection and/or inflammation
- Heat: Sign of infection and/or inflammation
