MSK Flashcards
what questions should be asked in the presenting complaint of a MSK history?
acute vs chronic joint pain joint stiffness joint swelling associated symptoms
what questions should be asked about joint pain?
site; joint, muscle, body region distribution; number of joints, axial, a/symmetrical, small or large character radiation aggravating/relieving factors severity; waking from sleep
what questions should be asked about joint stiffness?
which joints?
what time of day?
does it relate to rest and exercise?
what is the duration of stiffness?
what associated symptoms should be asked about in an MSK history?
fever weakness fatigue weight loss eye symptoms; conjunctivitis preceding sore throat symptoms of urethritis; penile discharge, dysuria
what diseases should be asked about in the PHx and FHx of a MSK history?
IBD
psoriasis
STDs
iritis
rheumatoid arthritis
osteoarthritis
gout
any other type of arthritis
what questions should be asked in the social Hx of a MSK history?
domestic situation
occupation
affects on daily living; dressing, cooking, washing, mobility, leisure, sexual activity
describe the steps of the spine exam
exposure; shirt off and ideally wearing shorts
look; gait, observe spine from front, side and posterior, look for abnormal curvatures or scars
feel; palpate bony spine and para-vertebral muscles, tenderness
move;
C-spine; flexion, extension, lateral rotation, lateral flexion
thoracolumbar; flexion, extension, lateral flexion, trunchal rotation (stabilise pelvis)
special tests;
Schober’s test
straight leg raise test
other examinations;
peripheral neurological exam
abdominal exam
what are you looking for in the look section of the spine exam?
difficulties removing shirt
straight spine or scoliosis
rib cage asymmetry
normal muscle bulk
scars from previous spinal surgery
loss of normal cervical and lumbar lordosis
alteration of the normal mild thoracic kyphosis
gait;
easy following movement
symmetrical movement
antalgic gait
what are you looking for in the move section of the spine exam?
restricted movements
smoothness of movement
pain experienced during movements
explain and demonstrate the movements to the patient
describe Schober’s test
identify the dimples of Venus (S2)/feel bilaterally for the PSIS
go to the midline
using a tape measurer, mark a point 10cm above and 5cm below the midline
ask the patient to touch their toes
measure the distance between the 2 marks
the distance should increase to >21cm in a normal patient
describe a straight leg test
patient supine
use hand to fix the pelvis
patient attempts to raise one leg at a time with knee fully extended
assess the degree of movement from the horizontal
dorsiflex the ankle; assesses limitation of movement due to sciatic nerve root pressure
describe the steps of the shoulder exam
exposure; shirt off
examine both shoulders and compare one side with the other
look; from front, side and posterior aspects
scars, swelling, erythema, muscle wasting, abnormal contours
feel; palpate all aspects of both shoulders from tenderness, swelling or warmth
move;
active; flexion, extension, abduction, adduction, internal and external rotation
passive; flexion, extension, abduction, adduction (stabilise scapula), internal and external rotation
other tests; consider neck exam, upper neurological exam, circulation status
depending on findings; abdominal or cardiovascular exam (referred pain)
what are you looking for in the feel section of the shoulder exam?
1; sternoclavicular joint 2; clavicle 3; acromioclavicular joint 4; humeral head 5; coracoid process 6; deltoid muscle 7; spine of scapula 8; supraspinatus muscle 9; infraspinatus muscle 10; trapezius muscle
repeat on the other side
describe the move section of the shoulder exam
active; show the patients the movement
flexion and extension; flex your elbow 90 degrees
internal and external rotation; flex your elbow 90 degrees
passive; get them to relax as much as possible
flexion and extension; flex your elbow 90 degrees
abduction; stabilise the scapula
adduction; extend elbow fully, place their arm across their trunk as far as possible
internal and external rotation; flex your elbow 90 degrees
describe the steps of a hip exam
exposure; in shorts
examine both hips and compare one with the other
look; standing and supine, muscle wasting, obvious leg length discrepancy, gait abnormality
feel; true and apparent leg length, palpation for tenderness, swelling, warmth
move; flexion, abduction, adduction, internal and external rotation
special tests; Thomas’s test, trendelenburg test
describe the look section of a hip exam
standing; look from all sides with the patient stationary, level of the iliac crests, walk to the other side and walk back, gait, pelvic movements,
laying supine; scars, muscle wasting, obvious leg length discrepancy
describe the feel section of a hip exam
tenderness, heat or swelling around the inguinal or greater trochanter area
true leg length; ASIS to the medial malleolus
apparent leg length; xiphisternum to medial malleolus
describe the move section of a hip exam
flexion, internal and external rotation; flex knees and flex hip joint
abduction; stabilise the pelvis and hold the ankle
describe Thomas’ test
place your hand on the small of the patient’s back
flex the hip and feel the lumbar spine flatten
see if the other knee is flat on the couch
measure the angle of fixed hip flexion
repeat; clasp their knee up to their chest and observe for fixed flexion deformity
describe trendelenburg test
assesses for gluteus medius weakness
ask the patient to stand on each leg in turn
observe the pelvis for any tilt
positive test; pelvis may drop on the side of the leg that has been lifted
describe the steps of a knee exam
exposure; in shorts
look; standing and walking
feel; temperature, tenderness, patellar tap, bulge test
move;
active; full flexion and extension
passive; flexion and extension, place a hand on the knee
special tests;
medial and lateral collateral ligaments
anterior and posterior cruciate ligaments
describe the look section of a knee exam
walking and standing look at the front, sides and back limp appear to be in pain muscle wasting scars rash red/swollen bowing or knock kneed
describe the feel section of a knee exam
temperature; examine the unaffected side first
always compare one knee with the other
tenderness; patella, quadriceps tendon, prepatellar and collateral ligaments
bend and feel the medial and lateral joint lines
feel at the back of the knee for a baker’s cyst
patellar tap; slide your hand down the thigh
use the index and middle fingers to push down on the patella
bouncing indicates an effusion
bulge test; milk any fluid down the leg towards the knee
stroke the medial side and then the lateral side of the knee
observe for any bulging
describe the special tests of the knee exam
collateral ligament assessment; flex the knee to 30 degrees, apply valgus and varus pressure
cruciate ligament assessment; ask if they have a sore foot, sit on the foot, wrap your fingers around the back of the knee and keep your thumbs in front of the patella, pull anteriorly and then push posteriorly
describe the steps of the GALS exam
introduction screening questions gait inspection arms legs spine temporomandibular joint complete examination
what are the screening questions of the GALS exam?
do you have any pain or stiffness in your muscles, joints or back?
do you have any difficulty getting yourself dressed without any help?
do you have any problem going up and down the stairs?
describe the inspection section of the GALS exam
general; body habits, scars, muscle wasting, psoriasis
anterior; posture, scars, joint swelling, joint erythema, muscle bulk, elbow extension
lateral; lordosis, kyphosis, knee joint hyperextension, foot arch
posterior; muscle bulk, spinal alignment, iliac crest alignment, popliteal swelling, Achille’s tendon
describe the arms section of the GALS exam
hands behind head arms out with palms facing up/down make a fist grip strength precision grip metacarpal joint squeeze
describe the leg section of the GALS exam
passive; knee flexion, extension, internal hip rotation
metatarsophalangeal joint squeeze
patellar tap
describe the spine section of the GALS exam
cervical lateral flexion
lumbar flexion
describe the steps of a hand exam
introduction
look; general inspection, close inspection of the hand
feel; palms up, palms down, elbow
move; active and passive movement, motor assessment
function
special tests
complete examination
describe the introduction of a hand exam
introduction confirm patient details explain procedure expose hands, wrists and elbows ask if they are in any pain
describe the look section of a hand exam
general inspection; scars, muscle wasting, aids, adaptations, prescriptions
dorsal and palmar aspects of the hand
what are you looking for when examining the dorsal aspect of the hand?
hand posture
scars
swelling
skin colour; erythema indicates cellulitis or sepsis
bouchards nodes; PIP swelling
herbedens nodes; DIP swelling
swan neck deformity; DIP flexion, PIP hyperextension
boutonnieres deformity; DIP hyperextension, PIP flexion
z-shaped thumb; RA
skin thinning/bruising; steroids
psoriatic plaques
splinter haemorrhages; trauma, vasculitis, psoriasis, sepsis, infective endocarditis
nail pitting, onycholysis; psoriasis, psoriatic arthritis
what are you looking for when examining the ventral aspect of the hand?
hand posture scars swelling dupuytren's contracture thenar/hypothenar wasting; median nerve damage elbows; psoriatic plaques, RA
describe the feel section of a hand exam
ventral;
temperature; septic or inflammatory arthritis
radial and ulnar pulse
thenar and hypothenar eminence
palmar thickening; Dupuytren’s contracture
median and ulnar nerve sensation
dorsal; radial nerve sensation temperature metacarpophalangeal joint squeeze bimanual joint palpation anatomical snuffbox bimanual wrist palpation
elbow; tenderness, rheumatoid nodules, psoriatic plaques
describe the move section of a hand exam
active;
finger flexion/extension
wrist flexion/extension
passive;
finger flexion/extension
wrist flexion/extension
motor assessment;
wrist and finger extension against resistance
index finger abduction against resistance
thumb abduction against resistance
describe the function section of a hand exam
power grip
pincer grip
pick up a small object
describe the special tests of a hand exam
tinels test; tap over the carpal tunnel with your finger
phalens test; hold their wrists in maximum forced flexion for 60 seconds
