MSK CAS (Knee exam) Flashcards
Explain claw hand deformity and the ulnar paradox
Ulnar nerve injury leading to the deformity when hands are at rest.
Deformitu: finger hyper flexed at IPs and hyper extended at MCPs
Paradox:
“‘the closer to the paw, the worse the claw’”
This is because if it’s more proximal, you lose the flexing action of the FDP
*learn the table*
what causes foot drop and what are the different gait you can do to overcompensate
An injury that leads to weakness or loss in dorsiflexion and eversion
Hence cannot raise toes effectively durng gait cycle and hence will overcompensate and change gait.
Different gait compensation include:
- High stepping gait
- Waddling gait
- Swing out gait
what is the overarching structure of an MSK exam
Positioning and exposure
Look/Inspection
Feel
Same as palpation, often includes palpation of the joint and key structures around the joint
Move
Assessing movement in the joint, depending on the joint it can also be split into:
Active, Passive and Resisted movements in the joint
Special Tests
- Any tests for key structures which are not encompassed by the previous sections
- This can include tests for stability in the joint or tests of ligaments.
what should you look for in an MSK examination of the Knee.
Give causes
Wasting : due to LMN lesion or disuse becuase of the chronic pain
knee deformities: valgus or varus
when you are feeling for temperature at the knee, what does warmth indicate
Inflammatory conditions, e,g OA or septic arthritis
When you are palpating around the patient’s joint, what should you look for
Pain
Swelling
Effusion- excess of synovial fluid maybe caused by arthritis or damage to internal structures like meniscus
what does swelling in the popliteal fossa indicate?
Baker’s cyst
what two methods are used to palpate for effusion. Give postive result
Tap method- for large/moderate effusion
- Positive finding: You will feel a tap as the patella hits the femur
Sweep method- small effusions
- If there is a small effusion you will see a ripple or bulge of fluid appears on the medial side of the knee from the lateral compartment
what is the normal range of hyperextension?
Up to 10 degrees is normal provided it’s the same on the other side
what does the ACL and PCL prevent
ACL prevents anterior subluxation
PCL prevents posterior subluxation
when performing the Anterior drawer test, what must you look for in order to prevent a false positive of ligament laxity.
what is the result that shows ACL laxity/rupture
Look for posterior sag first (shows PCL compromised)
True positive:
When compared to the other one, affected knee is more lax.
Movement of more than 1.5cm shows ACL rupture and there is often an associated medial ligament injury
How do you test the intergrity of the medial and lateral collateral ligament
Medial- put a valgus stress on it
- If compromised, will be more laxed
Lateral- put varus stress on it
learn the exams
ALWAYS COMPARE BOTH LIMBS
what is the Intermediate Knee exam in order?
Positioning and Exposure- flat and exposed from knee down
Look: Looking for scars, knee deformity, muscle wasting
Feel:
- Temperature (use back of hand)
- Around the patellar
- Medial and lateral joint lines
- The tibial tuberosity and head of the fibula
- Popliteal fossa
Move:
- Active: Flexion and Extension
- Passive: Flexion and Extension
- Passive: Hyperextension
Special Tests
Anterior Draw and Posterior Sag
Medial and Lateral Collateral ligaments
what are Phalens and Tinels test?
Special tests Used to look for carpal tunnel syndrome
Phalens: pain in thumbs and flexors when you put dorsum of the hands together
Tinels: tap on flexxor part of cvarpal bone and positive sign is if there’s pain on the flexor or thumbs
what are the imaging options for capal tunnel syndrome?
MRI- show median nerve compression
USS: show synovitis nd swelling
EMG: confirm median nerve deficit
