MSK and Neuro exam

Question 1

Inspection of Shoulder Exam

Answer 1

Skin (Bruising/ swelling)
Erythema
Atrophy of Muscles
Deformity

(abducted and externally rotated= anterior dislocation)
(adducted and internally rotated= posterior dislocation)

Question 2

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-

Answer 2

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

Question 3

Shoulder exam pathology

Answer 3

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)

Question 4

Hand Exam Inspection

Remember to assess MEDIAN, ULNAR and RADIAL NERVES

Answer 4

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

Question 5

Hand Exam Pathology

Remember to assess MEDIAN, ULNAR and RADIAL NERVES

Answer 5

Rheumatoid Arthritis

Osteoarthritis

Carpal Tunnel Syndrome (Median Nerve Entrapment)- Splints and Steroids and Surgery

Trigger Finger- Splints, Steroids and Surgery

Question 6

Spine Exam Inspection

Answer 6

Skin (Scars and Bruising) and Symmetry
Erythema
Atrophy of Muscles
Deformities (Scoliosis/ Kyphosis)

Also Hair Growth in Spine (Spina Bifida) and Neurofibromas

GAIT

Question 7

Spine Pathology

Answer 7

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!!!!)

Question 8

Hip exam inspection

Answer 8

Skin (Scars and Bruising) and Symmetry
Erythema
Atrophy of Muscles
Deformities (Scoliosis/ Kyphosis)

GAIT

Question 9

Hip Exam Signs

Unequal Apparent Length (Umbilicus)
Unequal True Length (ASIS)
Shortened leg and externally rotated
Loss of Internal Rotation
St Thomas

Answer 9

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

Question 10

Hip Exam Pathology

Answer 10

Hip Osteoarthritis
Trochanteric Bursitis- Pain over greater Trochanter
Childhood conditions- Perthe’s, SUFE, DDH

Question 11

Knee Exam Inspection

Answer 11

Skin/ Swelling
Erythema
Atrophy of Muscles
Deformity

Anterior- Varus/ Valgus
Lateral- Hyperextension/ Fixed Flexion (Trauma or Neurological)
Posterior- Baker’s Cyst/ Popliteal Aneurysm

Question 12

Knee Special Tests
Drawer Test
Collateral Ligaments

Answer 12

Drawer Test- ACL/ PCL Laxity
Collateral Ligaments- Collateral Ligament Laxity

Question 13

Knee Exam Pathology

Answer 13

ACL/ PCL/ Collateral Ligament Tear- Physiotherapy and BRACE

Osteoarthritis

PREPATELLAR BURSITIS- Swelling over patella (Normal RANGE of MOVEMENT)- Aspiration and Steroid Injection

Question 14

Ankle and Foot Inspection

Answer 14

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

Question 15

Ankle and Foot Pathology

Answer 15

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)

Question 16

Causes of Spastic Gait. Unilateral and Bilateral

Answer 16

UMN (Multiple sclerosis, SOL/ Stroke, Motor Neurone Diseases)

Question 17

What should you check if you notice foot drop?

Answer 17

For L5 Radiculopathy- Big toe extension/ Sensation impairment

Question 18

Causes of Proximal Weakness

Answer 18

DENIM

Dystrophy
Endocrine (Diabetes Amyotropy, Cushings)
Neuromuscular (MG, LEMS)
Inflammatory (Dermatopolymyositis, Polymyositis)
Metabolic

Question 19

Causes of Distal Weakness

Answer 19

ABCDEG

Alcohol/ Thiamine Deficiency
B12 Deficiency
Creutzfeldt Jakob Disease
Diabetes
Every Vasculitis
Guillain Barre

Question 20

Causes of sensation loss over a single dermatome

Answer 20

Disc Herniation/ Osteoarthritis (Cervical Spondylosis)

Question 21

Loss of sensation over brachial plexus?

Answer 21

Thoracic Outlet, Neoplasm, Trauma, Compression

Question 22

Causes of Radial, Median and Ulnar Sensory Loss

Answer 22

Radial- Compression at Shoulder or Humeral Shaft Fracture
Ulnar- Compression at Elbow
Median- Carpal Tunnel Syndrome

Question 23

Causes of CN 3-6 lesion

Answer 23

Cavernous Sinus Syndrome

Miller Fischer

Question 24

Causes of Bulbar Palsy

Answer 24

Motor Neuron

GUILLAIN BARRE

Space Occupying Lesion

Question 25

Causes of Jugular Foramen Syndrome

Answer 25

GCA

VZV

Trauma

Neoplasm

Question 26

Causes of Optic Nerve Lesion

Answer 26

MS

GLAUCOMA

GCA

Question 27

What do you always say you check for at the end of a Cerebellar examination?

Answer 27

PAPILLOEDEMA for Space Occupying Lesion

Question 28

2 causes of Ptosis

Answer 28

Horners (Complete)

Myasthenia Gravis (Partial)