MSK Clinical Assessment

Question 1

What does GALS stand for?

Answer 1

Gait
Arms
Legs
Spine

Question 2

What are the GALS screening questions for MSK history?

Answer 2

Any pain or stiffness in muscles, joints, or back?
Can you dress yourself COMPLETELY without any DIFFICULTY?
Can you walk up and down stairs WITHOUT DIFFICULTY?

Question 3

What are the 3 main categories of orthopaedic symptoms?

Answer 3

Something FEELS wrong
Something MOVES wrong
Something LOOKS wrong

Question 4

What are orthopaedic symptoms that feel wrong?

Answer 4

Pain
Dysaesthesiae
Weakness

Question 5

What are orthopaedic symptoms that move wrong?

Answer 5

Stiffness
Reduced range of movement
Limp
Instability
Crepitus

Question 6

What are orthopaedic symptoms that look wrong?

Answer 6

Swelling
Deformity
Wasting
Shortening
Discolouration
Wounds

Question 7

What questions should be asked in the history of a typical morning?

Answer 7

Are they woken by pain or do they wake at a normal time?
How are they first thing in the morning - are they sore/stiff? How long do they take to get going?
Can they dress fully without difficulty?
Can they cut their own toenails
Can they get in and out of a bath?

Question 8

What questions should be asked regarding walking ability?

Answer 8

How far can they walk on flat?
What stops them when they do stop
Do they use walking aids?
How are they on stairs and rough ground?
Do they drive
Can they do their own shopping?
Does their pain stop them doing anything?

Question 9

What are red flags indicative of in the history?

Answer 9

Serious pathology such as tumour or infection

Question 10

What are red flags in the history?

Answer 10

Severe and worsening pain
Night pain disturbing sleep
Non-mechanical pain
General malaise, febrile, rigors
Unexplained weight loss, anorexia, night sweats
Past history of malignant disease

Question 11

What are the MISTI THREAD questions?

Answer 11

Have you ever had:
MI
Stroke
Thrombosis
Icterus
TB
Hypertension
Rheumatic fever
Epilepsy
Asthma
Diabetes

Question 12

What are important allergies to find out about?

Answer 12

Penicillin
Iodine
General anaesthetic
Latex
Elastoplast
Any other known allergies

Question 13

What questions should be asked of drug history?

Answer 13

Currently/recently taken
When drugs were started/stopped
Over the counter drugs
Recreational - IV?
Oral contraceptive pill
Anticoagulants
NSAIDs
Steroids

Question 14

What are principles of MSK examination?

Answer 14

Quiet private room - chaperone necessary?
Space to observe gait
Adequate exposure and position
Always compare right and left - examine the normal side first

Question 15

How are the fingers named?

Answer 15

Small/little
Ring
Long/middle
Index
Thumb

Question 16

How are locations of the hand and forearm distinguished?

Answer 16

Ulnar/radial instead of lateral/medial

Volar/palmar instead of Posterior/anterior

Question 17

How should children be examined?

Answer 17

Make sure the child is not overwhelmed at the start, ie let the child sit on mother’s lap or divert their attention

Question 18

What should you try to look at before examination?

Answer 18

Any available X-rays

Question 19

What is important to LOOK for in examination?

Answer 19

Posture
Weight bearing in lower limbs
Gait
Skin abnormalities
Swelling
Wasting
Deformity
Limb length

Question 20

What should be FELT in examination?

Answer 20

Skin - temp, sweating, cap refill
Tenderness - localised or diffused?
Swelling
Deformity - palpate normal anatomical landmarks

Question 21

What should be assessed in movement?

Answer 21

Range of movement
Accompanied by pain, crepitus, stiffness
Rhythm/smoothness
Muscle tone
Power/strength
Joint laxity/hypermobility