MSK and Neuro exam Flashcards
Inspection of Shoulder Exam
Skin (Bruising/ swelling)
Erythema
Atrophy of Muscles
Deformity
(abducted and externally rotated= anterior dislocation)
(adducted and internally rotated= posterior dislocation)
Signs in Shoulder Exam
Reduced External Rotation
Abduction High Arc Pain
Abduction Mid Arc Pain
Pain only on ACTIVE- MUSCLE PATHOLOGY
Empty Can
Painful arc
External Rotation against Resistance
Gerber’s Lift Off
Scarf Test-
Reduced External Rotation- Adhesive Capsulitis
Abduction High Arc Pain- Acromioclavicular joint Pathology- Osteoarthritis
Abduction Mid Arc Pain- ROTATOR CUFF PATHOLOGY
Empty Can- Supraspinatus
Painful arc- Supraspinatus Impingement
External Rotation against Resistance- Infraspinatus and Teres Minor
Gerber’s Lift Off- Subscapularis
Scarf Test- ACROMIOCLAVICULAR PATHOLOGY
Shoulder exam pathology
Impingement Syndrome (Physiotherapy and Analgesia)
Rotator Cuff Tears (if weakness in abduction + Impingement)- (Conservative/ Surgery if big)
Adhesive Capsulitis (loss of active and passive in all directions)- NSAIDs and Steroids if pain, Physiotherapy if STIFF
Anterior Dislocation- (MRI Angiogram if persistent and Physiotherapy
Osteoarthritis- Pain in all directions (Pain> stiffness)
Hand Exam Inspection
Remember to assess MEDIAN, ULNAR and RADIAL NERVES
Skin (thinning, bruising, scars)
Joints- Ulnar Deviation? ,Which ones are swollen? ,Zthumb/ boutteniere/ swan neck
Fingers- Swollen?
Nails- Psoriatic Arthritis- Onycholysis/ Pitting
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Palms- THENAR Wasting/ Hypothenar WASTING
Elbows- Rheumatoid Nodules, Gout Tophi if White
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Carpal Tunnel Scar
Hand Exam Pathology
Remember to assess MEDIAN, ULNAR and RADIAL NERVES
Rheumatoid Arthritis
Osteoarthritis
Carpal Tunnel Syndrome (Median Nerve Entrapment)- Splints and Steroids and Surgery
Trigger Finger- Splints, Steroids and Surgery
Spine Exam Inspection
Skin (Scars and Bruising) and Symmetry
Erythema
Atrophy of Muscles
Deformities (Scoliosis/ Kyphosis)
Also Hair Growth in Spine (Spina Bifida) and Neurofibromas
GAIT
Spine Pathology
Femoral Nerve (L2-L4)
Sciatic Nerve (L4-S1) (both cos of DISC HERNIATION)
Ankylosing Spondylitis
Sciatica
Osteoarthritis
CAUDA EQUINA- MRI to check (always mention to check for this at end!!!!)
Hip exam inspection
Skin (Scars and Bruising) and Symmetry
Erythema
Atrophy of Muscles
Deformities (Scoliosis/ Kyphosis)
GAIT
Hip Exam Signs
Unequal Apparent Length (Umbilicus)
Unequal True Length (ASIS)
Shortened leg and externally rotated
Loss of Internal Rotation
St Thomas
Unequal Apparent Length (Umbilicus)- Spinal or Pelvic Deformity (Scoliosis)
Unequal True Length (ASIS)- Fracture or Development
Shortened leg and externally rotated- NOF Fracture
Loss of Internal Rotation- Osteoarthritis
St Thomas- Osteoarthritis
Hip Exam Pathology
Hip Osteoarthritis
Trochanteric Bursitis- Pain over greater Trochanter
Childhood conditions- Perthe’s, SUFE, DDH
Knee Exam Inspection
Skin/ Swelling
Erythema
Atrophy of Muscles
Deformity
Anterior- Varus/ Valgus
Lateral- Hyperextension/ Fixed Flexion (Trauma or Neurological)
Posterior- Baker’s Cyst/ Popliteal Aneurysm
Knee Special Tests
Drawer Test
Collateral Ligaments
Drawer Test- ACL/ PCL Laxity
Collateral Ligaments- Collateral Ligament Laxity
Knee Exam Pathology
ACL/ PCL/ Collateral Ligament Tear- Physiotherapy and BRACE
Osteoarthritis
PREPATELLAR BURSITIS- Swelling over patella (Normal RANGE of MOVEMENT)- Aspiration and Steroid Injection
Ankle and Foot Inspection
Skin
Erythema
Atrophy of Muscles
Deformity
Anterior- Hallux Valgus, Mallet Toe (DIP- like swan neck), Hammer Toe (PIP), Clawed Toe, NAILS- Psoriasis/ ULCERS
Lateral- Pes Cavus/ Planus
Posterior- Achilles Tendon
Ankle and Foot Pathology
Pes Planus (due to Tarsal Coalition or Posterior Tendon Rupture or Marfans)
Hallux Valgus- Footwear to manage
Gout
Achille’s Tendon Rupture- Surgical Repair
Charcot Arthropathy- Pes Cavus and Champagne calf- TREAT THE CAUSE (Diabetes)
Lateral Ligament Sprain (rolled onto ankle)
Sprained Ankle (Syndesmosis Injury)
Causes of Spastic Gait. Unilateral and Bilateral
UMN (Multiple sclerosis, SOL/ Stroke, Motor Neurone Diseases)
What should you check if you notice foot drop?
For L5 Radiculopathy- Big toe extension/ Sensation impairment
Causes of Proximal Weakness
DENIM
Dystrophy
Endocrine (Diabetes Amyotropy, Cushings)
Neuromuscular (MG, LEMS)
Inflammatory (Dermatopolymyositis, Polymyositis)
Metabolic
Causes of Distal Weakness
ABCDEG
Alcohol/ Thiamine Deficiency
B12 Deficiency
Creutzfeldt Jakob Disease
Diabetes
Every Vasculitis
Guillain Barre
Causes of sensation loss over a single dermatome
Disc Herniation/ Osteoarthritis (Cervical Spondylosis)
Loss of sensation over brachial plexus?
Thoracic Outlet, Neoplasm, Trauma, Compression
Causes of Radial, Median and Ulnar Sensory Loss
Radial- Compression at Shoulder or Humeral Shaft Fracture
Ulnar- Compression at Elbow
Median- Carpal Tunnel Syndrome
Causes of CN 3-6 lesion
Cavernous Sinus Syndrome
Miller Fischer
Causes of Bulbar Palsy
Motor Neuron
GUILLAIN BARRE
Space Occupying Lesion
