MSK Flashcards
looking at spine
look from side: curvatures of spine
behind: spinal alignment, symmetry,, scoliosis, abnormal hair growth
scars, bruising
feeling spine
paplate midline spinous processes from top downwards
feel sacroiliac joints: any ill-alignment, irregularities, tenderness
feel for paraspinal muscle tenderness or increased tone one side at a time
movement of cervical spine
active -
flexion: touch chin to chest
extension: tilt head backwards
- lateral flexion: touch ear to shoulder
- rotation: look over each shoulder
movement of lumbar spine
flexion: touch their toes, measure by placing fingers on 2 adjacent lumbar spinous processes
extension: lean back
lateral flexion: bend to side, running hand down their leg
neurological examination spine
straight leg raise: patient lying down, lift their leg up to their limit then dorsliflex foot: may exacerbate pain if nerve root entrapment or prolapsed disc
reflexes - upper and lower lumvs
-power and sensation upper and lower limbs
ankle and foot: looking
shoewear
nail changes, skin rashes, scars, wound, calluses
swelling or muscle wasting of calf muscles
toes for clawing or joint swelling or hallux valgus
sole for callus formation
toe alingment
standing: foot arch position, dropped/hihg arch, alignment if hind foot
varus or valgus deformity
achilles tendon swelling or thickening
ankle and foot: feel
temperature
pulses
MTP joint squeeze for tenderness
palpate for tenderness, swelling, irregularity
ankle and foot: move
active: dorsiflexion and plantar flexion ankle, flexion + extension big toe
passive; ankle plantar and dorsi flexiom, inversion and eversion subtalatr joint, mid tarsal and subtalar movements
ankle and foot function
assess gait
shoulder: look
asymmetry deformity scapula winging muscle wasting - deltoid and infra-/supra-spinatous scars wounds bruises swelling
shoulder: feel
temp at joints (4 in shoulder)
bony landmarks for tenderness
sternoclavicular joint spine scapula greater tuberosity humerus ant + pos joint lines humerus 3 muscles axillary nerve sensation
shoulder: active movement
hands behind head: abduction and external rotation
hands behind back: internal rotation
full extension
full flexion
full abduction
external + internal rotation shoulder: elbows flexed 90d, tucked into sides and rotate
shoulder: passive movement
all those for active
extension, flexion, abduction, external rotation
elbow: look
scars swellings rashes deformity normal carrying angles muscle wasting bruising
elbow: feel
temp
tenderness over medial and lateral epicondyles, olecranon process, radial head
elbow: movement
active then passive
flex
extend
supination then pronation
elbow: function
check ability to put hand to mouth for feeding
phalen’s test
detection carpal tunnel syndrome
wrist in full flexion for 60s
if +ive pts symptoms elicited by this manouvre
tinnel’s test
detect carpal tunnel syndrome
tapping over median nerve as it passes through wrist
+ive if tingling in thimb, index and middle fingers
hand + wrist: look
scars wounds thinning skin rash clubbing nail pitting splinter haemorrhages deformity muscle wasting fasical thickening on palm
hand + wrist: feel
temp muscle bulk thenar + hypothenar distal radius, ulnar, carpals and metacarpals fingers MCP and wrist joint
hand + wrist: move
straighten fingers fully then make fist
- finger flexion MCPJ, PIPJ and DIPJ
- wrist flexion and extension: prayer and reverse prayer sign (active then passive)
phalen’s and tinnel’s tests
hand + wrist: function
power grip: patient to grip your 2 fingers
pincer grip: patient to pick up small object
hand + wrist: neurological examination
sensation median, ulnar and radial nerves and then their power
trendelenburg sign
sign found in people with weak/paralysed hip abductor muscles
patient stand on one foot
test +ive if pelvis dips on side of non-weight bearing leg
true leg length
measured from anterrior superior iliac spine to just below the ipsilateral medial malleolus
apparent leg lenght
point in patient’s midline (either umbilicus or xiphi-sternum) to medial malleolus of ankle of each leg
thomas’ test
assessment of fixed flexion deformity
if fixed flexion deformity patient usually compensates by increasing lumbar lordosis - stop this by placing one hand under pt lumbar spine
flex normal hip until feel lumbar lordosis flatten on hand. if opposite leg is lifted off bed then there is fixed flexion deformity of that hip
hip: look
deformity symmetry scars swellings muscle wasting leg length discrepency
hip: feel
tenderness over greater trochanter
apparent and true leg length
hip: move
thomas’s test
flexion
rotation: internal and external
abduction
adduction
trendelenburg test
hip: function
gait - looking for limp
antalgic limp
pain on weight bearing
ataxic gait
wide based and marked clumsiness
high stepping gait
presence of foot drop
knee: valgus deformity
distal part of tibia is deviated laterally/away from midline
bilateral valgus deformity will give knock-kneed appearance
knee: varus deformity
distal part of tibia is deviated medially
if deformity bilateral then bow legged appearance
two methods to examine for knee effusions
patellar tap
bulge sign
examine for knee effusions: patellar tap
for moderate/large knee effusion
pt lie with leg fully extended. compress suprapatellar pouch by sliding hand down thing until the upper patella border
keep hand in this position and with 2 fingers on other hand press down on patella and you will feel a tap as it impacts on the femur
examine for knee effusions: bulge sign
smaller effusion
empty medial compartment of knee by sweeping hand upwards. Then stroke down suprapatellar are and on down lateral side of knee
if effusion a bulge will appear in medial side (medial gutter)
posterior cruciate sag/draw test
bring legs together, bend hips to 45 and flex knees to 90, feet flat on bed
if one tibia lying posterior to other this is sign the posterior cruciate is ruptured
place hands behind knee and thumbs on tibia either side patellar tendon. forward pull and tibia will be drawn forward into same position as opposite leg
+ive posterior draw sign is also sign of posterior cruciate damage
anterior cruciate draw test
bring legs together, bend hips to 45 and flex knees to 90, feet flat on bed
view both knees from side to check tibial tuberosities are aligned and no sag back
place hands behind knee and pull forward to attempt to draw tibia forwards.
significant movement indicates +ve test indicating anterior cruciate ligament damage
knee: look
standing then lying
symmetry, alignment varus or valgus deformity fixed flexion of knee rashes, wounds, scars, swelling wasting of quadriceps muscles
knee: feel
temp different, mid-thigh vs knee
tenderness along border of patella, extensor mechanism, medial + lateral joint lines
feel behind knee for popliteal cysts
assess for effusions: patellar tap then bulge test
knee: move (actions active then passive)
flex (bring as far in at possible to bum)
extend
hyperextension by lifting legs by heels and looking for excessive extension
assess extensor mechanism by getting pt to do straight leg raise
knee: move - collateral ligaments
flex knee to 20-30 and apply lateral and medial stress to knee
repeat extended
excessive movement suggests damage to ligament or wear in medial/lateral compartments in older patients
knee move - cruciate ligaments
posterior sag/draw test
anterior draw test
knee: function
get them to walk
look for limp, valgus/varus deformity or fixed flexion gait
reasons for inc temp felt over joints
septic arthritis
inflammatory arthritis
what specific things are felt during general palpation of foot/ankle
metatarsal + tarsal bones tarsal joint ankle joint subtalar joint calcaneum medial and lateral malleoli distal fibula
