MSK

Question 1

What are the 5 general principles of examination?

Answer 1

• Introduction
• Look
• Feel
• Move (active then passive)
• Function

Question 2

What are you checking for in look?

Answer 2

• Deformity
• Swelling
• Rashes or other skin changes
• Muscle bulk or wasting

Question 3

What are you checking for in “feel”?

Answer 3

• Temperature
• Palpate swellings for fluctuance
• Tenderness around joints

Question 4

What are you doing in “move”?

Answer 4

• Full range of movement
  
  • Active then passive

Question 5

What is the normal range of motion for cervical:

• flexion
• extension
• lateral flexsion
• lateral rotation

Answer 5

Flexion - 80 from neutral

Extension - 50 from neutral

Lateral flexion - 45 from neutral

Rotation - 80 from neutral

Question 6

What spinal nerve routes control reflexes for:

• biceps
• triceps
• knee
• ankle jerk

Answer 6

Biceps - C5/6

Triceps - C7/8

Knee - L3/4

Ankle jerk - S1/2

Question 7

What special tests are done in hand examination?

Answer 7

• Phalen’s test
  
  • Hand held in full flexion for 60 seconds, positive if patients symptoms elicited by this
• Tinel’s test
  
  • Lightly tap over median nerve as passes through wrist, positive when tingling in thumb, index and middle finger

Question 8

What special tests are done in hip examination?

Answer 8

• Trendelenburg test
  
  • Patient stands in front, hold iliac crests, positive if pelvis drips on the side of non-weight bearing leg
• Thomas test
  
  • Assessment of fixed flexion deformity
  • Place hand under patients lumbar spine, fully flex normal hip until you feel lumbar spine flatten in hand, observe opposite leg and if it is lifted of bed then there is fixed flexion deformity of that hip

Question 9

What are you looking for when assessing gait as part of hips?

Answer 9

• Limps
  
  • Antalgic - pain on weight bearing
  • Trendelenburg dip - weak abductors giving waddling gait
  • Ataxic gait - wide based and marked clumsiness
  • High stepping - presence of foot drop

Question 10

What is valgus and varus?

Answer 10

• Valgus
  
  • Distal part deviated laterally from midline
• Varus
  
  • Distal part deviated medially from midline

Question 11

What are the 2 tests to test for knee effusion?

Answer 11

• Patellar tap
  
  • Moderate or large knee effusion (>50ml)
• Bulse sign
  
  • Small effusion
  • Empty medial compartment

Question 12

What tests are done to assess cruciate ligaments?

Answer 12

• Posterior draw test
  
  • Observe both knees when at 90 degrees and hips at 45 degrees for one tibia lying posterior to other
  • If sad present, pull forward to test
• Anterior draw test
  
  • Check both tibial tuberosities aligned from side
  • Pull tibia forwards to attempt to draw forwards

Question 13

What are you checking for in gait for feet?

Answer 13

• Normal cycle of heel strike and toe off
• Height of step, as in foot drop

Question 14

What are you checking for in gait for knee?

Answer 14

• Limp
• Valgus/varus deformity
• Fixed flexion gait