MSK Flashcards
Format for MSK?
Subjective-history
Objective-exam
Analysis-diagnosis
Plan-Do what?
Subjective Examination AIM
To determine primary concern
To assist in the determination of a diagnosis and prognosis
To identify any precautions or contraindications
To determine any yellow, red or blue flags
Format of History
Introduction
Patient Profile
Social History
History of Present Illness
Past Medical History
Aggravating and Easing factors
Previous interventions
Medications
Investigations
General Health Screening (red, yellow, blue flags)
Opinion of patient
Flag meaning
Red flag-NIFTI (neurological, infection, fracture, tumour, inflammation-serious medical pathology)
Yellow flags-Psychological issues (anxiety)
Blue-litigation (sueing) involved
A scan exam?
A quick scan of the upper or lower part of the body involving the spine and extremities
Used to rule out symptoms that may be originating from the spine and referring to another part of the body
Cervical or lumbar assessment and active movements and neurological exam (dermatomes and myotomes)
When do we use the scan exam?
When neurological signs and symptoms are present or when it is not clear what is causing the symptoms
What is an example of neurological pain?
Neuro=sharp, burning, stabbing pain
Objective Examination
Posture
Alignment
Bony and soft tissue symmetry
Skin texture, tone, colour, and temp
Patient’s attitude and willigness tomove
Examination of Movement
willingness to move
when and where pain occurs
intensity and quality of the patient in pain
the ROM available and is it symmetrical
The pattern of movement (trick movement)
The movement of associated
Spinal Joint movement
flexion
extension
rotation
SB
Peripheral Joints
Upper-TMJ, shoulder, elbow and wrist/hand
Lower-hip, kneww, ankle/foot
How do you examine peripheral joint upper (TMJ)
TMJ
place index fingers over tragus (ear flap)
Test for open, close, retraction, protraction, lateral deviation
Note any pattern f restriction, pain or assymmetry
Examination of movement-peripheral joint-upper (shoulder)
elevation tests to include-abduction and flexion
medial and lateral rotation
Examination of movement-peripheral joint-upper-elbow
flexion
extension
supination
pronation
Examination of movement-peripheral joints (upper) hand and wrist
Wrist-flexion, extension, radial deviation, ulnar deviation
Hand-flexion, extension, abduction, adduction, opposition
Examination of movement-lower-hip joint
flexion
extension
abduction
adduction
medial rotation
lateral rotation
Examination of movement-peripheral lower
knee joint-flexion and extension
Examination of movement-peripheral joints-ankle and foot
ankle-plantarflexion
dorsiflexion
inversion
eversion
foot-toe flexion
toe extension
What is a myotomes
Myotomes-a muscle or a group of muscles supplied by a single nerve root
Dermatomes
The sensory distribution of an area of skin supplied by a single nerve root
Reflexes
An involuntary muscle contraction in response to a quick stretch of that same muscle
How do you test for myotomes
Have the patient seated comfortably
place the tested joint in its resting position
“don’t let me move you”
test with force
How do you test dermatomes
test the whole dermatome
do both sides at once
light touch
(if impaired do sharp/dull)
Reflexes
used to determine the integrity of the nerve or nerve roots supplying the reflex
patient must be relaxed
tendon is put on a slight stretch
apprpriate stimulus is applied by the reflex hammer onto the tendon
Jendrassik maneuver
Deep Tendon reflexes
biceps/brachioradialis
triceps
patellar tendon
achilles tendon
Upper Motor Neuron (UMN)
Babinski
clonus
hoffman
Deep Tendon Refle (LMN) Grading
0=absent
1=hypo
2=normal
3=hyper/brisk
4=clonus
Special Tests for an Upper Scan
Foraminal Compression (Spurling) axial load to the top of head directed downwards (positive test is pain down the side the head is directed towards)
Distraction Test-upward pull on neck (positive test is if the pain is relieved or decreased when the head is tractioned)
Lower Scan exam
Straight leg raise (SLR) life and lower leg
Prone knee bend (positive is shooting pain down the front of the thigh)
Regional Examination
Observation
Range of Motion
Strength
Special Tests
Palpation
Strength testing in a regional examination
0=no contraction
1=slight contraction
2=full passive ROM, no gravity
3=full ROM, with gravity
4=normal, active ROM, full resistance
Special tests in a regional examination
This is to confirm your potential diagnosis and to identify the key structures and tissues at fault
Diffrentiates between structures (Contractile vs noncontractile)
Special Tests-do they rule out disease?
They are suggestive of a particular disease but do not necessary rule out the disease when negative
positive also is also not conclusive
Regional Exam-palpation
Reserved to the end of the exam due to the provocative nature
Analysis
Brief statement that includes patients age, sex, purpose of visit and onset of presenting symptoms
Diagnosis-structure at fault
Cause-underlying cause of dysfunction
Stage-actube/chronic
Plan
Treatment goals