MSK Exam UE

Question 1

What are radiographs good for demonstrating/benefits

Answer 1

• Inexpensive/readily available
• Used for viewing dysfunction and/or disease of bones
• Does NOT demonstrate soft tissues well

Question 2

What are the common views used for radiographs

Answer 2

• Anterior to posterior
• Lateral
• Negative is patient exposure to radiation

Question 3

What are CT scan used to assess

Answer 3

• Complex fractures
• Facet dysfunction
• Disc disease
• Stenosis
• Demonstrates bony structures better than radiograph but soft tissues not as well as MRI
• Exposure to radiation

Question 4

What is a discography

Answer 4

• Radiopaque dye is injected into the disc too identify abnormalities within the disc
• Needle inserted with assistance of fluoroscopy
• Risk of infection

Question 5

What is the difference between T1 and T2 MRI

Answer 5

• T1 demos fat within the tissues & typically used to assess bony structures
• T2 demos tissues with high water content & used to assess soft tissue structures (water appears white)
• No radiation exposure

Question 6

Purpose of an arthography

Answer 6

• Used to identify abnormalities within joints such as labral tears & tendon ruptures
• Injects dye and is observed using radiograph to demonstrate where fluid moves within the jooint

Question 7

Purpose of bone scans (osteoscintigraphy)

Answer 7

• Isotope settles in areas where there is a high metabolic activity of bone
• Radiograph is taken to observe hot spots
• Used for patients with RA, possible stress fx, bone CA, and/or bone infection

Question 8

Purpose of a myelography

Answer 8

• Dye is visualized as it passes through vertebral canal to observe anatomy within region
• Used for diagnostic assessment of discs and stenosis
• Not used as much due to MRI and CT being just as good

Question 9

Special tests for GHJ anterior instability

Answer 9

• Apprehension test: supine 90-90, move into ER until see apprehension
• Relocation test: after pos. apprehension test apply posterior glide; pos. is pt loses apprehension

Question 10

Special tests for GHJ posterior and inferior instability

Answer 10

• Jerk test: pt seated shoulder flexed to 90º, IR, axially load, and horizontally adduct; pos. if sudden jerk or clunk
• Sulcus sign: arm at side pull distally; pos. if presence of sulcus inferior to acromion combined with reproduction of sx

Question 11

Special tests for RTC tendinopathy/impingement

Answer 11

• Hawkins-Kennedy
• Neer test
• Painful arc
• Empty can test

Question 12

Special tests for full thickness RTC tear

Answer 12

• Drop arm test: supraspinatus
• ER lag sins: infraspinatus
• Infraspinatus muscle test: ER with arm bend 90º at side
• Hornblower sign: teres minor
• IR lag sign: subscapularis; arm behind back pos. if pt can’t hold when arm is released

Question 13

Special tests for the acromioclavicular (AC) joint

Answer 13

• Horizontal adduction test: active/passive full adduction; pos. if pain over AC
• Paxinos sign: place thumb over posterolateral aspect of acromion and index finger on middle part of clavicle, compress, pos. if pain at AC

Question 14

Special tests for a SLAP lesion (superior labrum anterior to posterior)

Answer 14

• Active compression test/O’Brien: resist with arms extended thumb down then with thumb up; pos. if pain is eliminated with thumb up
• Biceps load II: supine, 120º ABD and elbow flexed to 90º; position. if apprehension or pain
• Anterior slide test: hands on hips, push through elbow; pos. if pain or click
• Compression rotation test: supine, abduct to 20-90º, axial compression with passive circumduction of GHJ; pos. if pain/popping/clicking
• Yerguson test: elbow 90º, forearm pronated, tesist supination & ER
• Speed’s test: upper limb fully extended and supinated, resist shoulder flexion; pos. if pain at anterior shoulder

Question 15

Special tests for thoracic outlet syndrome (TOS)

Answer 15

• Adson’s: find radial pulse; rotate head toward extremity tested then extend & ER shoulder while extending the head
• Roos elevated arm test: shoulder ER, 90º ABD, slight horizontal ADD, pt open/closes hands for 3 min

Question 16

Special tests for elbow fracture

Answer 16

• Positive if patient is unable to fully extend the elbow

Question 17

Special tests for elbow ligamentous instability

Answer 17

• Varus/valgus stress tests
• Moving valgus stress test

Question 18

Special tests for biceps rupture

Answer 18

• “Popeye” sign: distal bunching of muscle with complete loss of function; indicates rupture of proximal head of biceps

Question 19

Special test for cubital tunnel syndrome

Answer 19

• Elbow flexion test: supine, shoulder in full ER & elbow actively held in maximal flexion with wrist extension for 1 min

Question 20

Special tests for entrapment of the anterior interosseous nerve

Answer 20

• Pinch grip test: pt is asked to pinch tips of index finger and thumb; pos. if unable to perform & has compensatory pulp to pulp pinch present

Question 21

Special tests for wrist/hand instability

Answer 21

• Ulnomeniscotriquetral: arm pronated, posterior glide applied with thumb over dorsal ulna and index over pisotriquetral complex anteriorly; excessive pain/laxity indicates TFCC pathology
• Watson (scaphoid shift): arm pronated, wrist in full ulnar deviation slight extension, apply pressure to distal pole of scaphoid while radially deviating & slightly flexing the wrist; painful shift & clunk when pressure removed = pos.
• Interphalangeal joint varus/valgus stress tests

Question 22

Describe Eichoff’s test

Answer 22

• Test for de Quervain’s tenosynovitis (abductor policis longus/extensor policis brevis)
• Make fist with thumb within confines of fingers and passively move wrist into ulnar deviation
• Performed by patient actively

Question 23

Describe Finkelstein’s test

Answer 23

• Test for de Quervain’s tenosynovitis
• Passively pull wrist and thumb into ulnar deviation & apply longitudinal traction

Question 24

Describe the wrist hyperabduction & abduction of the thumb test (WHAT)

Answer 24

• Test for de Quervain’s
• Wrist is hyper flexed with thumb abducted in full MCP and IP extension
• Resistance is applied against examiner’s index

Question 25

Special tests for wrist/hand neurological dysfunction

Answer 25

• Phalen’s: identifies carpal tunnel, maximally flex both wrist holding them against each other for 1 min
• 2-point discrimination: identifies sensory innervation within hand, uses a caliper or paper clips, apply device to palmar aspect of fingers, record smallest difference the apt can sense 2 separate points (norm is <6mm)
• Tinel’s sign: identifies carpal tunnel, tap region where median nerve passes through carpal tunnel

Question 26

Describe the modified Allen test

Answer 26

• Test for vascular compromise of wrist/hand
• Identify radial & ulnar arteries at wrist
• Have pt open/close fingers quickly several times & then make a closed fist
  -Compress ulnar artery and have pt open hand, observe palm then release compression & observe for vascular refilling
• Repeat for radial artery

Question 27

Describe the Bunnel-Littler test

Answer 27

• Identifies joints or intrinsic tightness at PIP
• MCP in slight extension flex PIP then test with both flexed
• If flexion limited in both cases = capsule tightness
• If more PIP flexion with MCP flexion = intrinsic muscle tightness

Question 28

Describe the tight retinacular test

Answer 28

• Identifies tightness around PIP
• PIP stabilized in neutral while DIP is flexed then both flex
• If flexion limited in both = capsule tightness
• If more DIP flexion with PIP flexion = retinacular ligament tightness