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Musculoskeletal > MSK- Clinical Skills > Flashcards

MSK- Clinical Skills Flashcards

1
Q

Explain what parts of the spine you look at in a spinal examination?

A

Lumbar and cervical- there isn’t much movement normally in thoracic spine to begin with.

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2
Q

What movements do you look at in cervical spine?

A

Flexion, extension, rotation to the left and right, lateral flexion left and right

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3
Q

What movements do you look at lumbar spine?

A

Quantitative flexion (schogers test), qualitative test of extension and lateral flexion.

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4
Q

Describe shobers test?

A

Identify level of sacro iliac joints. Make a mark 10 cm above this level and 5 cm below. Then get patient to bend down and measure, should be a 5cm increase to 20 cm at least. Anything less than this suggests spinal stiffness. Ankylosing spondylitis could be a cause of this.

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5
Q

Normal curvatures of the spine?

A

Cervical lordosis
Thoracic Kyphosis
Lumbar Lordosis

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6
Q

Define lordosis

A

Inward curvature of the spine

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7
Q

Define kyphosis

A

Outward curvature of the spine

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8
Q

Why may head be held to one side?

A

Muscle spasm

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9
Q

What may cause excessive flexion of the neck?

A

Thoracic kyphosis

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10
Q

Causes of thoracic kyphosis?

A

Ankylosing spondylitis or thoracic vertebrae wedge fractures (bone collapses and anterior part forms a wedge shape)

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11
Q

Deviations of 3 spinal curvatures would be caused by?

A

Deformity or spasm

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12
Q

What is a gibbus?

A

Focal angular deformity in the spine that caused by kyphosis and the vertebrae becomes wedged.

In elderly may be due to fracture of vertebrae caused by osteoporosis but in young should ring alarm bells.

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13
Q

What is scoliosis? Causes?

A

Sideways curvature of the spine. Can be caused by cerebral palsy or muscular dystrophy but may not be known.

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14
Q

Why may there be a prominence of the scapula on one side?

A

Scoliosis- as its a rotational deformity there will be asymmetry.

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15
Q

What are you palpating in spine exam?

A

Supraclavicular fossae for cervical ribs or enlarged lymph nodes. Feel spinous processes to check for alignment. Feel for a step due to Spondylolisthesis. Palpate para spinal muscle bulk and assess. Assess iliac crest height and palpate sacro iliac joints for tenderness. Exam chest expansion for restriction that may occur due to fusion of costo vertebral joints in ankylosing spondylitis.

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16
Q

What is spondylolisthesis?

A

Slipping of vertebra.

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17
Q

What five things should you always palpate in a knee exam?

A 
Tibial tuberosity
Patella tendon
Medial and lateral joint lines
Medial and lateral collateral ligaments
Stability of cruciate ligaments (drawer tests)
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18
Q

When you suspect patella instability what test should you do?

A

Patella apprehension tests

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19
Q

When you suspect arthritis what test should you do?

A

Patella grind test and checking for crepitations

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20
Q

When you suspect an acute meniscal tear what test should you do?

A

Stienmann’s test

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21
Q

What five things indicate heel height testing to check for locked knee?

A 
Young
Twisting knee injury
Can't straighten the knee
Unilateral joint line tenderness 
Positive Stienmann's test
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22
Q

What should you inspect in knee exam?

A

Muscle bulk and symmetry
Valgus - varus deformities
Swelling in the popliteal fossa
Bakers cysts

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23
Q

What does joint line tenderness suggest?

A

Generalised- arthritis

Focal and in young person - meniscal tear

24
Q

Describe fixed flexion deformity?

A

Hold knee flat to couch and lift heel on each side, if the knee won’t go straight this is a fixed flexion deformity probably caused by arthritis. If leg goes straight but heel won’t lift up this is normal and there is hyperextension if leg goes straight and the heel lifts up.

25
Q

What do you inspect in a rheumatoid hand examination?

A

Wrist / elbow: Swelling (synovitis), rheumatoid nodules, psoriatic plaques
MCPJs: Ulnar deviation
Digits: Swan neck / Boutonniere deformities / Z-shaped thumb
Nails for psoriatic changes/ nailfold infarcts
Skin for sclerodactyly or signs of steroid use
Muscle wasting dorsum of hand and thenar/hypothenar eminence

26
Q

Describe ulnar deviation

A

Hand faces outward when palms on table, hands sort of point towards the wrist- deformity associated with rheumatoid

27
Q

Describe swan neck deformity

A

Permanent flexion of the end of finger towards the palm, there is DIP flexion and PIP hyper extension. This is associated with rheumatoid.

28
Q

Describe boutonnière deformity

A

Permanent flexion of PIP joint with hyperextension of the DIP joint. This is associated with rheumatoid.

29
Q

Describe Z shaped thumb deformity

A

IP flexion, MP hyperextension and CMC flexion

30
Q

What function tests should you do in rheumatoid hand examination?

A 
Check wrist flexion/extension
Make a fist
Power of pincer grip
Fine pinch (picking up a coin)
Chuck or tripod grip (holding a pen)
Power grip (squeezing your fingers)
Hook grip (resisting decoupling of your hooked hands when pulling away)
31
Q

3 screening questions for GALS examination?

A

‘Do you have any pain or stiffness in your muscles, joints or back?’
‘Can you dress yourself completely without any difficulty?’
‘Can you walk up and down stairs without any difficulty?’

32
Q

Describe Arms part of GALS exam?

A
  • Ask the patient to put their hands behind their head. Assess shoulder abduction and external rotation, and elbow flexion.
  • With the patient’s hands held out, palms down, fingers outstretched, observe the backs of the hands for joint swelling and deformity.
  • Ask the patient to turn their hands over.
  • Look at the palms for muscle bulk and for any visual signs of abnormality.
  • Ask the patient to make a fist. Visually assess power grip, hand and wrist function, and range of movement in the fingers.
  • Ask the patient to squeeze your fingers. Assess grip strength.
  • Ask the patient to bring each finger in turn to meet the thumb. Assess fine precision pinch (this is important functionally).
  • Gently squeeze across the metacarpophalangeal (MCP) joints to check for tenderness suggesting inflammatory joint disease. (Watch the patient’s face for signs of discomfort)
33
Q

Describe legs part of GALS exam?

A
  • With the patient lying on the couch, assess full flexion and extension of both knees, feeling for crepitus.
  • With the hip and knee flexed to 90º, holding the knee and ankle to guide the movement, assess internal rotation of each hip in flexion (this is often the first movement affected by hip problems).
  • Perform a patellar tap to check for a knee effusion. Slide your hand down the thigh, pushing down over the suprapatellar pouch so that any effusion is forced behind the patella. When you reach the upper pole of the patella, keep your hand there and maintain pressure. Use two or three fingers of the other hand to push the patella down gently. Does it bounce and ‘tap’? This indicates the presence of an effusion.
  • From the end of the couch, inspect the feet for swelling, deformity, and callosities on the soles.
  • Squeeze across the metatarsophalangeal (MTP) joints to check for tenderness suggesting inflammatory joint disease. (Watch the patient’s face for any sign of discomfort)
34
Q

Describe spine part of GALS exam?

A
  • With the patient standing, ask the patient to tilt their head to each side, bringing the ear towards the shoulder. Assess lateral flexion of the neck (this is sensitive in the detection of early neck problems).
  • Ask the patient to bend to touch their toes. Assess lumbar spine flexion by placing two or three fingers on the lumbar vertebrae. Your fingers should move apart on flexion and back together on extension
35
Q

Why is it important to test abductors in hip exam?

A

These are important muscles in walking

36
Q

Why is it important to look for muscle wasting in the hip exam?

A

Sign of disuse secondary to pain and misuse

37
Q

Describe what an antalgic gait is?

A

An antalgic gait is a gait that develops as a way to avoid pain while walking. It is a form of gait abnormality where the stance phase of gait is abnormally shortened relative to the swing phase.

38
Q

Describe trendelnbergs test?

A

Get person to face you and hold hands. Get them to lift each leg in turn, if abductors are weka then the standing leg will move into adduction and iliac crest will move down.

39
Q

Describe Thomas’s test?

A

Used to check for fixed flexion deformities- hand placed on lumbar lordosis and couch. Patient maximally flexes leg and occludes lumbar lordosis, the other leg should stay flat on the couch, if it leaves the couch then fixed flexion deformity.

40
Q

Describe true and apparent limb lengths in hip exam?

A

True- from ASIS to tip of medial malleolus

Apparent- xyphoid sternum to medial malleolus

41
Q

Normal degrees of passive flexion of the hip?

A

100-130

42
Q

Normal degrees of IR in hip?

A

15

43
Q

Normal degrees of ER in hip?

A

40

44
Q

Normal degrees of adduction in hip?

A

15

45
Q

Normal degrees of abduction in hip?

A

45

46
Q

What is the most sensitive shoulder movement test? How do you test this?

A

External rotation

Elbows at side move arms outwards

47
Q

What should you check for with abduction of shoulder? What may this suggest?

A

Painful arc- impingement

48
Q

What two movements of the shoulder do you not test of the shoulder?

A

Adduction or extension

49
Q

Explain when you test active and passive movement of the shoulder? Explain what this can show?

A

Test active first, only if you notice reduction you should test passive movement.
If you don’t have active movement but get passive this suggests a weakness e.g. in rotator cuff
If active and passive movement both reduced this suggests a joint issue e.g. arthritis.

50
Q

What muscle of the rotator cuff do you not test in undergrad shoulder exam?

A

Teres minor

51
Q

Winged scapula suggests weakness of….

A

serratus anterior

52
Q

What should you palpate in the shoulder exam?

A

Clavicle from the sternoclavicular joint all the way along. The border of the acromion. The long head of the biceps tendon. The scapula spine and body.

53
Q

Order of shoulder exam?

A

Look, feel, move, rotator cuff, special tests.

54
Q

Tests for impingement of shoulder?

A

Hawkins kennedy, Jobes (same as supraspinatous test), scarf (positive suggests acromioclavicular arthritis which is a common differential in older people)

55
Q

Tests for instability of shoulder?

A

Sulcus sign

Anterior (ER to displace) and posterior drawer test (pressure through elbow to displace)

Musculoskeletal (18 decks)

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