MSK DIFFERENT CLINICAL SIGNS AND TESTS

Question 1

What is Thomas’s test? Describe how the test is carried out?

Answer 1

It is an MSK hip examination testing for a fixed flexion deformity of the hip Hand under patients back, on side you are examining, ask patient to pull opposite knee towards chest. Watch thigh on bed

Question 2

What is a positive thomas’s test showing?

Answer 2

positive test if thigh leaves bed when knee is flexed Normal test thigh should stay flat on bed Positive means there is a fixed flexion deformity of the hip

Question 3

What is the cause of trendelenburg’s? What disease is it seen in?

Answer 3

Caused by weak abductor muscles (gluteus medius and minimus) It is seen in gluteal muscle weakneess and Perthes also causes it

Question 4

After asking the patient to walk and see for gait abnormalities, what do you ask the patient to do on standing?

Answer 4

Stand on one leg, if there is trendelenburgs gait, the hip on the contralteral side will move down due to an ipsilateral pathology

Question 5

Which nerve can be damaged in trendelenburg’s causing the gait?

Answer 5

Damage to the superior gluteal nerve

Question 6

What do Barlow’s and Ortalni’s tests look for? Describe each test

Answer 6

They look for a developmental dysplasia of the hip

• Barlow’s - dislocates hip by adducting leg and moving posteriorly
• Ortalni’s - relocates hip by abducting lef and moving anteriorly

Question 7

If positive barlow and ortalani, what do you use to detect a DDH?

Answer 7

Ultrasound as not visible on xray until 6months

Question 8

What is schobers test and how do you carry it out?

Answer 8

This is a test of lumbar spine flexion and looks for ankylosing spondylitis Measure 10cm above and 5cm below the sacroiliac joints and ask the patient to bend forward and measure the new length

Question 9

What on schober’s test shows hyperflexion and what shows pathological hypoflexion?

Answer 9

Hyperflexion is measurement greater than 24cm Hypoflexion is anything less than 20cm

Question 10

Knee MSK exam Sweep medial side of leg to empty effusion then sweep lateral side to see effusion fill medial side of knee. Patellar tap may also be positive What is this and what is it looking for?

Answer 10

This is a medial gutter sweep test Tests for a small effusion of the leg

Question 11

Knee MSK exam Hold knee steady and push down on patella What is this? WHat other MSK examination is it used in?

Answer 11

This is a patellar tap test used for visible effusions Also used in GALS examination

Question 12

If there is medial joint line tenderness in a young patient with a twisting injury, what is carried out and what does it look for?

Answer 12

Carry out a steinman test to look for acute meniscal tear Flex knee with heel in hand and rotate foot externall for a medial meniscal tear Positive if pain is exacerbated

Question 13

How is lachmans test carried out? What does it look for?

Answer 13

Lachman’s test is carried out by flexing the knee to roughly 30degrees and move the tibia anteriorly Positive abnormality if the tibia translates forward with no resistance Looks for ACL integrity and ACL tear

Question 14

Posterior drawer test looks for the integrity of the PCL ligament How is this carried out?

Answer 14

As patient to flex both knees - tibial plateau should sit slightly anterior to the femoral condyles Then sit on patients foot to stabilise the leg and push tibia posteriorly, movement suggests a PCL rupture

Question 15

What test do you do to test the extensor mechanism of the knee? What examination is it carried out in?

Answer 15

This would be a straight leg raise Carried out in a knee examination

Question 16

How is the straight leg raise carried out?

Answer 16

Ask patient to dorsiflex angle and raise leg straight up to identify any extensor mechanism of the knee pathology

Question 17

What are the four tests that look for rotator cuff pathology and impingement?

Answer 17

Painful arc on abduction (50-130degrees) Hawkins-Kennedy Test - looks for impingement Jobe’s test - supraspinatus impingement or tear Scarf test - ACJ pathology or impingement

Question 18

How are hawkins-kennedy & jobes carried out?

Answer 18

Hakwin’s keenedy - elevate arm to shoulder height with elbow flexed, internally rotate the arm passively Pain is a positive test for impingement Jobes test - Arms straight out at shoulder height with thumbs pointed down and ask patient to resist force of you pushing their arm down Positive if pain (more specific to supraspinatus tear)

Question 19

How is a scarf test carried out on a patinet?

Answer 19

Adduct the patinets arm across the neck like its a scarf and pain suggests ACJ pathology or impingement

Question 20

Positive if no plantar flexion of the foot seen when squeezing the calf What is beeing tested and what is the test?

Answer 20

Achilles tendon is being tested by Simmond’s test

Question 21

Take patients, hold arm straight and passively flex and radially (laterally) deviate the wrist What does this test for and what is this called?

Answer 21

Tests for lateral epicondylitis Called a Mill’s test

Question 22

What are the two tests for carpal tunnel syndrome?

Answer 22

Have phalen’s and Tinel’s test

Question 23

Which out of phalen and Tinel test tests for both carpal and cubital tunnel syndrome?

Answer 23

Tinel test tests for both carpal and cubital tunnel syndrome

Question 24

How does phalen’s test work?

Answer 24

Ask patient to make an upside down prayer and it is positive if there is tingling in the thumb and lateral 2.5 fingers

Question 25

Tinel’s (tap) looks for both carpal or cubital tunnel syndrome What happens in the test?

Answer 25

Relax and support wrist and tap over the median nerve as it passes through the carpal tunnel. Positive if tingling in median nerve distribution in the hand Tap over ulnar nerve as it passes though the cubital tunnel. Positive if tingling in ulnar nerve distribution in the hand (medial 1.5 fingers)

Question 26

What test can test for cubital tunnel syndrome and carpal tunnel?

Answer 26

Carpal tunnel - Phalen and Tinel (tapping) Cubital - tinel (tapping)

Question 27

Which is the test that can test for cubital tunnel syndrome alone?

Answer 27

Froment’s test - positive if they bend thumb showing use of flexor pollicis longus due to ulnar nerve weakness to supply its muscle

Question 28

What is the muscle which is weak in froment’s test showing ulnar nerve palsy as it supplies this muscle?

Answer 28

This would be the adductor pollicus

Require the flexor pollicis longus due to no nerve supply to the adductor pollicis

Question 29

Place a piece of paper type stuff in corner of eye. Positive if don’t produce enough tears to keep piece of paper (and therefore eyes) moist what is this? What are the features? What are the antibodies?

Answer 29

This is schirmer test Used to test for sjorgen’s Dry eye, dry mouth, parotid gland swelling Anti-Ro and anti -La antibodies

Question 30

Light Bulb Sign on X-ray Sign of what?

Answer 30

Posterior shoulder dislocation

Question 31

Hanging Rope Sign on X-ray Sign of what?

Answer 31

AVN of femoral head in children are adults who have had perthe’s disease

Question 32

What is measured at 18 months if a child is unable to walk? What is believed to be the cause?

Answer 32

Measure creatine kinase Duchenne muscular dystrophy believed to be the cause

Question 33

What is the sign where a Young boy develops difficulty in standing. Support legs to stand up straight? Mode of inheritance?

Answer 33

This is Gower’s sign X-lined recessive disorder

Question 34

What are the signs of hypocalcaemia?

Answer 34

Trossau’s and chovstek’s sign Also prolonged QT on ECG

Question 35

What is chovstek and what is trossau sign?

Answer 35

Chovstek - tetany (muscle hyperexcitability) and twitching in face when tapping over facial nerve Troussau - blood pressure cuff on arm and when pumped, it occludes the brachial artery and the patinets hand goes into spasm

Question 36

What is the treatment of hypocalcaemia?

Answer 36

10% IV calcium gluconate

Question 37

What are two cutaneous signs of dermatomyositis? What is the antibody?

Answer 37

Gottrons papules on the hands and Shawl sign on the back (can see on pic) Measure anti-Jo1 antibody

Question 38

What is important to take in poly/dermatomysoitis? What muscles are affected?

Answer 38

Take a muscle biopsy Commonly the proximal limb muscles

Question 39

DeQuervain’s Tenosynovitis What is the test?

Answer 39

Finkelstein’s test - Make a fist over thumb and ulnar deviate the wrist (move laterally) Positive if elicits pain in wrist Tendons concerned are extensor pollicus longus and the abductor pollicus longus