MSK Flashcards
The 6 phases of gait cycle?
- Heel stroke
- Foot flat
- Mid-stance
- Heel- off
- Toe -off
- Swing
Simmond’s test
Used to assess achilles tendon rupture
Further assessments and investigations after a foot/ankle exam?
- Neurovasuclar examination of both lower limbs
- Examination of the knee and hip joint
- Further imaging if indicated (eg. x-ray and MRI)
Things to feel in ankle/foot exam?
- Temperature
- Pulses
- MTP joint squeeze
- Ankle and foot palpation
- Achilles tendon palpation
Anterior inspection of the foot and ankle?
- Scars
- Bruising
- Swelling
- Psoriasis plaques
- Fixed flexion deformity of the toes
- Big toe misalignment
- Calluses
Lateral inspection of the foot and ankle?
- foot arch
Posterior inspection of the foot and ankle?
- Scars
- Muscle wasting
- Heel misalignment
- Achilles tendon
Anterior inspection of the elbow joint?
- Carrying angle
- Cubitus valgus
- Cubitus varus
- Scars
- Bruising
- Swelling
- Abnormal bony prominence
Lateral inspection of the elbow joint?
- Scars
- Fixed flexion deformity of the arm
- Muscle wasting
Posterior inspection of the elbow joint?
- Scars
- Rheumatoid nodules
- Psoriatic plaques
What to feel for in the elbow exam?
- Temperature
- Elbow joint palpation
- Biceps tendon palpation
Special tests in elbow exam?
- Medial epicondylitis: active wrist flexion against resistance
- Lateral epicondylitis: active wrist extension against resistance
Further assessments and investigations after an elbow exam?
- Examination of the joint above (shoulder) and below (wrist)
- Full neuromuscular examination of the upper limbs
- Further imaging if indicated (eg. x-ray and MRI)
Screening questions GALS?
- 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?
GALS - anterior inspection?
- Posture
- Scars
- Joint swelling
- Joint erythema
- Muscle bulk
- Elbow extension
- Valgus/varus deformity
- Pelvic tilt
- Fixed flexion deformity of the toes
- Big toe
GALS - lateral inspection?
- Cervical lordosis
- Thoracic kyphosis
- Lumbar lordosis
- Knee joint hyperextension
- Foot arch
GALS - posterior inspection?
- Muscle bulk
- Spinal alignment
- Iliac crest alignment
- Popliteal swelling
- Achilles tendon thickening
- Valgus/varus deformity
Compound movements in GALS?
- Hands behind head
- Hands held out in front with palms facing down
- Hands held out in front with palms facing up
- Making a fist
- Grip stength
- Precision grip
Further assessment after GALS?
- Focussed examination of joints with suspected pathology
- Further imaging if indicated (eg. X-ray and MRI)
Things to do in legs - GALS
- Passive movement: Knee flexion, extension and passive internal rotation of hip
- MTP squeeze
- Patellar tap
Things to do in spine - GALS
- Cervical lateral flexion
- Lumbar flexion
Dorsum of the hand - inspection
- Hand posture
- Scars
- Swelling
- Skin colour
- Bouchards nodes, Heberdens nodes
- Swan neck deformity
- Z thumb
- Boutonieres deformity
- Skin thinning or bruising (steroid use)
- Psoriatic plaques
- Muscle wasting
- Splinter haemorrhages
- Nail pitting and onycholysis
Swan neck deformity?
DIPJ flexion with PIPJ hyperextension
Boutonieres deformity?
PIPJ flexion with DIPJ hyperextension
Risk factors for carpal tunnel syndrome?
- Fluid retention (pregnancy, obesity, menopause)
- inflammation in the area (repetitive strain, athropathy)
- Space occupying lesion (ganglion cyst, osteophyte, previous fracture)
- Other (diabetes, Hypothyroidism, smoking)
De Quervain’s tenosynovitis?
- pain on movement of thumb and/or wrist
- Worsens on heavy lifting
Management of Carpal tunnel syndrome?
- Conservative: splinting, activity change, analgesia
- Medical: corticosteroid injection
- Surgical: open release, endoscopic release
Which nerve is compressed in carpal tunnel?
median nerve
Main findings on carpal tunnel exam?
- Isolated sensory changes in median nerve distribution with sparing of thenar eminence
- Weakness in thumb abduction
Palmar aspect of the hand - inspection MSK
- Hand posture
- Scars + Swelling
- Duptyrens contracture
- Thenar/hypothenar wasting
- Elbows
- Janeway lesions
- Osler’s nodes
Phalen’s test?
Ask patient to hold their wrists in maximum forced flexion for 60 seconds
Suggestive of carpal tunnel syndrome
Further assessments and investigations after hand and wrist exam?
- Neurovascular examination of upper limbs
- Examination of elbow joint
- Further imaging if indicated (x-ray and MRI)
Close inspection of the Knee - anterior?
- Scars, bruising, swelling
- Psoriasis plaques
- Patellar position
- Valgus/varus deformity
- Quadriceps wasting
Close inspection of the Knee - Lateral?
- Extension abnormalities
- Flexion abnormalities
Close inspection of the Knee - Posterior?
- Scars
- Muscle wasting
- Popliteal swellings
Where to measure quadriceps bulk?
20cm above tibial tuberosity
What causes joint effusion?
- Ligament rupture
- Septic arthritis
- Inflammatory arthritis
- Osteoarthritis
Posterior sag sign?
- PCL rupture
Anterior drawer test?
Anterior cruciate ligament laxity/rupture
Posterior drawer test?
Posterior cruciate ligament laxity/rupture
Lachman’s test?
Test for laxity or rupture of the anterior cruciate ligament
Pull tibia onto the femur at 30 degree flexion
VaRus stress test?
Lateral collateral ligament assessment
ValGus stress test?
Medial collateral ligament assessment
McMurray’s test?
Tests for the meniscus tears
Further assessments and investigations - knee exam?
- Neuromuscular examination of both lower limbs
- Examination of the joints above and below (eg. ankle and hip)
- Further imaging if indicated (eg. x ray/MRI)
Anterior inspection of the shoulder?
- Scars, bruising, swelling
- Asymmetry
- Abnormal bony prominence
- Deltoid wasting
Lateral inspection of the shoulder?
- Scars
- Deltoid wasting
Posterior inspection of the shoulder?
- Scars
- Trapezius muscle asymmetry
- Supraspinatus and infraspinatus asymmetry
- Scoliosis
- Winged scapula
Empty can test?
Supraspinatus
Painful arc?
Impingement of supraspinatus
Lift off test?
Subscapularis
Scarf test?
Acromioclavicular joint function
Further assessments and investigations at end of shoulder exam?
- Neurovascular examination of the upper limb
- Examination of the joints above and below (cervical spine and elbow joint)
- Further imaging if indicated (x-ray/ MRI)
Anterior inspection of the hip?
- Scars, bruising, swelling
- Quadriceps wasting
- Leg lenght discrepancy
- Pelvic tilt
Lateral inspection of the hip?
- Flexion abnormalities
Posterior inspection of the hip?
- Scars
- Muscle wasting
Trendelenburg gait - pathology
Unilateral hip abductor weakness
Waddling gait - pathology?
Bilateral hip abductor weakness
Palpation of the hip joint for?
- Greater trochanter - trochanteric bursitis
- Temperature
- Leg length assessment
Apparent leg length?
Umbilicus and the tip of the medial malleolus of each limb
True leg length?
Anterior superior iliac spine to the tip of the medial malleolus
Further assessments and investigations - hip exam?
- Neurovascular examination of both lower limbs
- Examination of the joints above and below (lumbar spine and knee joint)
- Further imaging of indicated (eg. x ray/MRI)
Special tests of hip?
Thomas
Trendelendburg
