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MSK Flashcards

1
Q

looking at spine

A

look from side: curvatures of spine

behind: spinal alignment, symmetry,, scoliosis, abnormal hair growth

scars, bruising

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2
Q

feeling spine

A

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

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3
Q

movement of cervical spine

A

active -

flexion: touch chin to chest
extension: tilt head backwards
- lateral flexion: touch ear to shoulder
- rotation: look over each shoulder

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4
Q

movement of lumbar spine

A

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

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5
Q

neurological examination spine

A

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

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6
Q

ankle and foot: looking

A

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

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7
Q

ankle and foot: feel

A

temperature
pulses
MTP joint squeeze for tenderness

palpate for tenderness, swelling, irregularity

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8
Q

ankle and foot: move

A

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

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9
Q

ankle and foot function

A

assess gait

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10
Q

shoulder: look

A 
asymmetry 
deformity 
scapula winging
muscle wasting - deltoid and infra-/supra-spinatous
scars
wounds
bruises
swelling
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11
Q

shoulder: feel

A

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
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12
Q

shoulder: active movement

A

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

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13
Q

shoulder: passive movement

A

all those for active

extension, flexion, abduction, external rotation

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14
Q

elbow: look

A 
scars
swellings
rashes
deformity 
normal carrying angles
muscle wasting 
bruising
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15
Q

elbow: feel

A

temp

tenderness over medial and lateral epicondyles, olecranon process, radial head

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16
Q

elbow: movement

A

active then passive

flex
extend
supination then pronation

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17
Q

elbow: function

A

check ability to put hand to mouth for feeding

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18
Q

phalen’s test

A

detection carpal tunnel syndrome

wrist in full flexion for 60s

if +ive pts symptoms elicited by this manouvre

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19
Q

tinnel’s test

A

detect carpal tunnel syndrome

tapping over median nerve as it passes through wrist
+ive if tingling in thimb, index and middle fingers

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20
Q

hand + wrist: look

A 
scars 
wounds 
thinning skin 
rash
clubbing 
nail pitting 
splinter haemorrhages
deformity 
muscle wasting 
fasical thickening on palm
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21
Q

hand + wrist: feel

A 
temp 
muscle bulk thenar + hypothenar
distal radius, ulnar, carpals and metacarpals 
fingers
MCP and wrist joint
22
Q

hand + wrist: move

A

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

23
Q

hand + wrist: function

A

power grip: patient to grip your 2 fingers

pincer grip: patient to pick up small object

24
Q

hand + wrist: neurological examination

A

sensation median, ulnar and radial nerves and then their power

25
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
26
true leg length
measured from anterrior superior iliac spine to just below the ipsilateral medial malleolus
27
apparent leg lenght
point in patient's midline (either umbilicus or xiphi-sternum) to medial malleolus of ankle of each leg
28
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
29
hip: look
``` deformity symmetry scars swellings muscle wasting leg length discrepency ```
30
hip: feel
tenderness over greater trochanter | apparent and true leg length
31
hip: move
thomas's test flexion rotation: internal and external abduction adduction trendelenburg test
32
hip: function
gait - looking for limp
33
antalgic limp
pain on weight bearing
34
ataxic gait
wide based and marked clumsiness
35
high stepping gait
presence of foot drop
36
knee: valgus deformity
distal part of tibia is deviated laterally/away from midline bilateral valgus deformity will give knock-kneed appearance
37
knee: varus deformity
distal part of tibia is deviated medially if deformity bilateral then bow legged appearance
38
two methods to examine for knee effusions
patellar tap bulge sign
39
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
40
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)
41
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
42
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
43
knee: look
standing then lying ``` symmetry, alignment varus or valgus deformity fixed flexion of knee rashes, wounds, scars, swelling wasting of quadriceps muscles ```
44
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
45
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
46
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
47
knee move - cruciate ligaments
posterior sag/draw test anterior draw test
48
knee: function
get them to walk | look for limp, valgus/varus deformity or fixed flexion gait
49
reasons for inc temp felt over joints
septic arthritis | inflammatory arthritis
50
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 ```

mOSCEs (13 decks)

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