MSK Exam

Question 1

“Acute”

Answer 1

Hours to a few days

Question 2

“Subacute”

Answer 2

Days to a few weeks

Question 3

“Chronic”

Answer 3

more than 6 weeks

Question 4

History taking for the MSK exam

Answer 4

• Onset
• Provocation/Paliation
• Region/Radiation
• Severity
• Timing
• Alleviating/aggravating factors
• Associated symptoms

Question 5

Monoarticular

Answer 5

1 joint

Question 6

Oligoarticular

Answer 6

2-4 joints

Question 7

Polyarticular

Answer 7

5+ joints

Question 8

Erythema

Answer 8

redness

Question 9

Atraumatic

Answer 9

Occuring without any preceeding trauma to the area

Question 10

Sequence of the Articular Exam

Answer 10

1. Insepction
2. Palpation
3. Range of motion
4. Special maneuvers

Question 11

If a patient describes pain in a joint, you should inspect. . .

Answer 11

. . . the joint indicated as well as joints above and below

Referred pain is common for joints.

Question 12

Answer 12

Bony nodules called Heberden’s nodes, typical of osteoarthritis

Question 13

Answer 13

Tophus of the elbow, commonly seen after recurrent gout

Question 14

Joints that are too deep to inspect and palpate

Answer 14

The shoulder and the hip joints

Question 15

Tests for shoulder joint function

Answer 15

1. “Empty Can Test” (supraspinatous muscle)
2. Resisted external rotation test (infraspinatous muscle)
3. Resisted internal rotation test (subscapularis muscle)

Question 16

“Empty Can Test”

Answer 16

These tests help evaluate the integrity of the rotator cuff tendons and muscles. Patient holds their arm 90^o abducted and 30^o flexed. Clinician then attempts to adduct the arm while the patient resists.

Pain = tendinopathy of rotator cuff

Pain + weakness = tendon tear or muscle dysfunction of rotator cuff

Question 17

Shoulder internal rotation test

Answer 17

Patient puts their hand behind their back with the palm facing out. Clinician pushes posteriorly against the palm while the patient resists.

Checks subscapularis muscle

Question 18

Shoulder external rotation test

Answer 18

Patient holds the shoulder in adduction and bends the elbow to 90^o flexion. The clinician pushes the forearm toward the patient midline while the patient resists.

Checks infraspinatus and teres minor muscles

Question 19

Tests for knee joint function

Answer 19

• Lachman’s test (anterior cruciate ligament)
• Posterior drawer test (posterior cruciate ligament)
• Valgus stress (medial collateral ligament)
• Varus stress (lateral collateral ligament)

Question 20

Lachman’s test

Answer 20

The patient flexes their knee approximately 30^o and the clinician stabilizes the distal femur with one hand. The clinician’s other hand pulls the tibia anteriorly from behind, attempting to produce anterior translation of the tibia.

An intact ACL limits tendon motion to a small range. A torn ACL has no defined endpoint of motion.

Question 21

Posterior Drawer Test

Answer 21

The patient flexes the knee to 90^o and the examiner sits at the patient’s foot and holds the proximal tibia firmly with two hands. The clinician attempts to push the tibia posteriorly with both thumbs and palms.

Laxity indicates a tear to the PCL.

Question 22

Valgus stress test, left leg

Answer 22

evaluates the medial collateral ligament (MCL)

Question 23

Varus stress test, left leg

Answer 23

evaluates the lateral collateral ligament (LCL)

Question 24

Tests for spinal joint function

Answer 24

• Straight leg raising test (sciatic nerve compression)

Question 25

Straight Leg Raise test

Answer 25

The patient lies supine and dorsiflexes their foot. The clinician passively raises the extended leg with its foot dorsiflexed.

If this results in pain in the lower back or radiating down from the sacrum to the leg while the leg is between 30 and 70 degrees, the test is positive. This may be confirmed by reproducing the ipsilateral pain by raising the contralateral leg (crossed straight leg raise test). A positive finding indicates sciatic nerve root compression.

Question 26

Rotator cuff

Answer 26

4 muscles make this up – supraspinatus, infraspinatus, teres minor, and subscapularis

Question 27

Bursa

Answer 27

Anatomic pockets of fluid which surround most joints and provide cushioning and protection. When a bursa is inflamed the resulting condition is termed bursitis

Question 28

“True” hip pain is felt ____.

So if someone reports feeling pain in their hip, ____.

Answer 28

“True” hip pain is felt in the groin region.

So if someone reports feeling pain in their hip, it is actually more likely to originate in the trochanteric bursa.

Question 29

Log roll test

Answer 29

Moves the patient’s femoral head in the acetabular joint. If the acetabular joint is damaged or inflamed, this will cause pain in the groin region.

Question 30

Pain vs Weakness

Answer 30

Pain suggests inflammation

Weakness suggests tendon tear, muscle dysfunction, or neuropathy