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
Causes of Jugular Foramen Syndrome
GCA
VZV
Trauma
Neoplasm
Causes of Optic Nerve Lesion
MS
GLAUCOMA
GCA
What do you always say you check for at the end of a Cerebellar examination?
PAPILLOEDEMA for Space Occupying Lesion
2 causes of Ptosis
Horners (Complete)
Myasthenia Gravis (Partial)
