MSK Flashcards
What are you assessing for in gait as the patient is walking ?
- smoothness
- symmetry
- turning ability/speed
- armswing
- stride length
- pelvic tilt
What do you inspect for from the back during GALS exam ?
- muscle bulk and symmetry: shoulders, paraspinals, gluteal, calf
- bones: level shoulders and iliac crests
- abnormalities: popliteal swellings, hind foot abnormalities
What are you inspecting for from the side in a GALS exam ?
- Normal cervical and lumbar lordosis
- Normal thoracic kyphosis
- knee flexion/hyperextension
What movements are tested for the spine part of GALS ?
- cervical lateral flexion (ear to shoulder)
- TMJ - jaw side to side
- hip and lumbar flexion (touch toes)
What do you inspect for from the from in a GALS exam ?
- Muscle bulk and symmetry: shoulders, quadriceps
- elbow flexion & look for rheumatoid nodules
- knee swelling/deformity (varus, valgum), foot arches, fore and mid foot abnormalities
- hands - ulnar deviation, heberdons nodes etc
Which movements are tested in the arms part of GALS ?
- shoulder abduction and external rotation (hands behind head)
- shoulder internal rotation (hands behind back)
- elbow extension (elbow down and straighten arm)
- wrist and finger extension (prayer sign)
- wrist flexion (reverse prayer)
- power grip
- precise grip
What are the 3 questions to be asked at the start of a GALS screening exam ?
- Any pain or stiffness in muscles, joints or back
- Can you dress yourself completely without difficulty
- Can you walk up and down the stairs without difficulty
What movements are tested in the legs during a GALS exam?
- knee flexion & internal rotation if the hip
- ankle Dorsi and plantar flexion
What drugs may cause adverse MSK effects ?
- statins - myalgia, myopathy
- ACEi - myalgia
- anticonvulsants - osteomalacia
- quinolone - tendonopathy
- diuretics, aspirin, alcohol: gout
Why may it be appropriate to take a sexual history in a MSK history ?
Reactive arthritis and Reiter’s syndrome caused by chlamydia and gonorrhoea
What psoriatic changes may be seen in the nails ?
Pitting, Oncholysis
Where is sensory innervation if radial nerve best tested ?
Thumb or index webbing
Where would you test sensory supply of median nerve
Index finger
Or thenar eminence
Where would you test ulnar nerve sensory supply ?
Little finger
What movements are tested in a focused hand exam ?
- straighten fingers against gravity
- make fist
- prayer and reverse prayer
- thumb abduction
- finger spread
- power grip
- pincer grip
How do you test power if median nerve ?.
Thumb abduction against resistance
How do you test power of ulnar nerve ?
Finger spread against resistance
Special test for carpel tunnel ?
Phalens
What are the characteristics of bone pain ?
Boring, penetrating pain often worse at night
Which type of joint disease has characteristic early morning stiffness ?
Inflammatory joint disease
Which type of joint pain gets worse as the day goes on ?
Mechanical e.g. Osteoarthritis
What is valgus joint deformity ?
The bone or part of limb distal to joint is displaced laterally
E.g, valgus deformity of knee = knock knee
What is varus joint deformity ?
Bone or part of limb distal to joint is deviated medially
E.g. Varus knee deformity = bow leg
Limitation of active movement of a joint only reflects what ?
Underlying pathology of tendons and muscles surrounding joint
Limitation of both active and passive movements suggest what ?
An intrinsic joint problem
What are you inspecting for on the elbow ?
- scars
- swellings
- rashes
- olecranon bursitis
- rheumatoid nodules
- psoriatic plaques
What movements should be assessed in an elbow exam ?
- full extension and flexion
- pronation and supination
*actively and passively
Which epicondyle is affected in golfers elbow ?
Medial
How would you assess the function of the elbow joint ?.
Ask patient to pour glass of water and out on a jacket
What movements are tested in a shoulder exam ?
- hands behind head
- hands behind back
- extension - in front
- flexion - behind
- abduction - out to side (assess scapula)
- addiction - by side
Limited external rotation if the shoulder with elbow flexed at 90 degrees suggests which condition ?
Frozen shoulder
What movements of the spine are assessed in a regional spine exam ?
- lumbar flexion and extension
- lateral flexion (run hand down side of leg)
- cervical - lat flexion, rotation (look over side), flexion (chin to chest), extension
- thoracic rotation
- straight leg raise with dorsiflexion
What is included in the brief neuro vascular exam in a regional spine exam ?
- limb reflexes
- dorsiflex big toe against resistance
- peripheral pulses
What would you palpate for in a regional spine exam ?
Tenderness in: spinous processes, sacroiliac joint, paraspinals
What is the classic appearance of the spine in ankylosing spondylitis ?
Question mark spine wi exaggerated thoracic kyphosis and loss of lumbar lordosis
What is palpated for in a regional hip exam ?.
Greater trochanter and surround area for tenderness
Temperature
What movements are assessed actively in a regional hip exam ?
Full flexion
Abduction, adduction
Which movements are assessed passively in a regional exam of the hip?
Flexion (and actively)
Internal and external rotation
Extension (prone position)
What is done in palpation on a regional exam of the knee ?
- temp (from mid thigh down)
- border of patella for tenderness
- behind knee for popliteal swellings
- patella Tap/bulge sign
- patella tendon (knee at 90 degrees)
What movements are assessed in a regional exam of the knee
Flexion and extension (actively and passively)
*lift feet with straight leg to look for hyperextension)
