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OSCE > MSK Examination > Flashcards

MSK Examination Flashcards

1
Q

What is the patient positioning for a hand and wrist exam? (Intro –> consent, exposure and position)

A

Sitting, elbows out, Hands on pillow

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2
Q

What is the patient positioning for an elbow exam? (Intro –> consent, exposure and position)

A

standing in anatomical position

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3
Q

What is the patient positioning for a shoulder exam? (Intro –> consent, exposure and position)

A

Standing

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4
Q

What observations are looked at in H&W exam DORSUM of hand?

A 
Dorsum (palms down)
scars or swelling
skin colour (erythema/pallor)
Skin changes (thinning, bruising, psoriatic plaques)
Muscle wasting
nail changes (vasculitis, pitting, onycholysis)
Hand posture (contractures)
deformities (heberdens or bouchards nodes)

NB: if there are any clinical signs indicated note if they are symmetrical or not e.g. affecting both limbs or not

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5
Q

What observations are looked at in H&W exam SIDES of hand?

A 
Swan neck deformity
Boutonnieres deformity (opp of swan neck)

From thumb side: Z-thumb deformity

[all of these are assoc. with RA]

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6
Q

What observations are looked at in H&W exam PALM of hands?

A 
NB: looking at both hands
hand posture (symmetry, contractures,)
Scars or swelling
Colour - erythema/pallor
Thenar/hypothenar wasting (Ul or med nerve lesion; thenar only ~carpal tunnel)
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7
Q

What observations are looked at in H&W exam elbow?

A

Psoriatic plaques or rheumatoid nodules

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8
Q

What do you FEEL for in a H&W exam?

A

First: temp palms and forearm, wrist, MCPs), R&U pulse, {tendons, joints and bones}
Palm up:
thenar and hypothenar eminence bulk
palmar thickening
assess median and ulnar nerve sensation [thenar and index for M.nerve and hypothenar and little finger for U.nerve]
Dorsum:
radial nerve sensation (over first dorsal web space)
Palpate anatomical snuffbox
Squeeze MCP joints (tenderness=?active inflamm arthropathy)
Bimanually palp DIPs, PIPs, MCPs and CMC [comparing joints for tenderness, irregularities and warmth]
Palpate wrists (irregularities and tenderness)
Palpate elbow (from arm along ulnar boarder = rheum nodules or psoriatic plaques)

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9
Q

How do you move the patient in a H&W exam?

A

Do active, then passive (- for crepitus)
Finger extension/flexion (open/fist)
Wrist extension/flexion (prayer and ~phalens)
ALSO in H&W do motor (like power movements) assesment:
Radial nerve –> wrist/finger extension resisted
Ulnar nerve - index finger abduction
Median - thumb abduction

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10
Q

What are the special tests in H&W exam?

A

(as well as motor assessment of U,R &M nerve in H&W) also do a function assessment:

Power grip,
pincer grip
and pick up small object

Then
Tinnels
Phalens

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11
Q

What is the overall order for a H&W examination?

A

Consent, exposure, position
around bed
Look: palms down, sides, up
Feel: Palms up, down, MCP squeeze, bimanual palp of DIPs,PIPs,MCP,CMC, anatomical snuffbox, wrists and elbows
Move: active and passive; finger ext/flex and wrist ext/flex
Motor assessment (radial, ulnar and median)
Function assessment (power, pincer, pick up a small object)
ST: Tinnels; phalens

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12
Q

What do you look at in an elbow examination?

A

Around the bed
inspect from front: scars, swelling / erythema; carrying angle (cubitus valgus/varus)
Side: fixed flexion deformity, olecranon bursitis, scars / swelling / erythema
Behind: rheumatoid nodules, psoriatic plaques

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13
Q

What do you feel for in an elbow examination?

A

Temperature
Radial head - capitellum -lateral epicondyle, olecranon, medial epicondyle
Biceps tendon

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14
Q

How do you do “move” in an elbow examination?

A 
- Do both active and passive (p-to feel for crepitus)
Elbow:
Flexion
Extension
Pronation 
Supination
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15
Q

What are the special tests in elbow examination?

A

Medial epicondylitis (golfers elbow) A.K.A. active wrist flexion against resistance (while firmly feeling the medial epicondyle)

Lateral epicondylitis (tennis elbow) A.K.A active wrist extension against resistance

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16
Q

What do you look at in a shoulder examination?

A

Around bed (aids and adaptations- slings)
Front (scars, scoliosis, arthritis, trauma, swelling, muscle wasting)
Side (scars)
Behind (scars, asymmetry/deformity/ muscle bulk of traps and deltoids and para-vertebrals)

17
Q

What do you “feel” in a shoulder exam?

A

Assess temp, shoulder girdle components for swellings tenderness
SC->clav->acromio-clavicular joint-coracoid process->humerous head-greater tuberosity and scapular spine

18
Q

What do you “move” in a shoulder exam?

A

Active:
Hands behind head (external rotation and abduction)
Hands as far up back as you can
(internal rotation)
Ask them to move arms: forwards, back, away from sides, across trunk, int and ext rotation
Scapula movement on abduction
Passive:
Repeat above movements passively and feel for any crepitus during the movement of the joint

19
Q

What are the special tests in a shoulder exam?

A

Supraspinatus tests: empty can and painful arc
Infraspinatus: external rotation against resistance
Subscapularis – internal rotation against resistance
Teres minor – external rotation in abduction

20
Q

What consent and position do you do for ankle and foot examination?

A

position pt upright
“I’d like to examine your ankles and feet. This will involve having a look and feel of these joints, in addition to assessing the joints’ movement”

21
Q

What do you do for “look” in an ankle and foot exam?

A

GAIT- heel strike/toe off gait, step height normal? smooth and symmetrical; asymmetrical shoe wearing; walk on tip toes then on heels (arthritis, muscle strength in calves for DF and PF and anterior leg muscles for DF)
Front- symmetry - toe allignment (?valgus e.g. point out), MTP bunions, toe deformities, scars, calluses, swelling or erythema of foot/anke
Side - foot arches pes planus/pes cavus, stand on tiptoes to see if rigid or supple flat feet
Behind - foot/ankle symmetry - heel alignment (?var/val) achillies tendonitis (deformity/discontinuity/swelling/ery– ?tendonitis)

22
Q

What do you feel for in an ankle and foot exam?

A 
Temp
Pulse (post tibial and dorsalis pedis)
Tendons - achilles, gastronomicnemius muscle- ?focal tenderness or swelling (tendonitis)/apparent tendon gaps - ?rupture
Joints and bones (Dist-->prox); tenderness, swelling, irregularity;
Squeeze MTPJ; metatarsal and tarsal bones, tarsal joint, ankle joint, subtalar joint, calcaneum, medial/lateral malleoli/distal fibula
23
Q

what do you move in an ankle and foot exam?

A

Active
Passive (feeling for crepitus excluding toe flexion/extension)
Foot plantar/dorsi
toe flexion (curl)
toe extension (towards head)
Ankle/foot eversion and inversion
Passive assessment only: ankle joint, subtalar, mid-tarsal, MP and IP joints [bend toes]

24
Q

What special test do you do in an ankle and foot exam?

A

Simmonds test

e.g. calf squeeze while kneeling to see Achilles tendon rupture

25
Q

What is the intro and consent for a knee exam?

A

Intro
(Consent exposure and position pt standing upright)
“Today I need to examine your knee joint, this will involve looking, feeling and moving the joint.”

26
Q

What do you “look” at in a knee exam?

A 
GAIT
Heel strike/toe off gait?
High stepping gait?
Smooth and symmetrical?
?antalgia / waddling / broad based
Front 
Scars
Swellings
Asymmetry/leg discrepancy
Valgus or varus deformity
Quads wasting
Side 
Behind
Scars 
Asymmetry
Popliteal swellings e.g. bakers cyst or popliteal aneurysm
27
Q

What do you feel for in a knee exam?

A 
Straight knee:
Temp 
Quad-->patella tendon
Patella tap
Sweep test
Patella (bent to 90*)
Tendons, bones, ligs and popliteal fossa
Measure quads circum 20cm above tibal tuberosity
28
Q

What movement do you do in a knee exam?

A 
Active 
Flexion/extension (140*)
Passive
Same as above + feel for crepitus
lift legs by heel for hyperextension (<10* norm)
29
Q

What special tests are there in a knee exam?

A 
Anterior/posterior draw test
Ant move  ?ACL dam
Post move ?PCL dam
Lachmans test
Collateral ligaments (medial and lateral)
Lateral apprehension test
McMurrays
Childress
Apleys
30
Q

What intro do you do for hip exam?

A

?hip replacement (no >90*)

“Today I need to examine your hip joints, this will involve looking, feeling and moving the joints.”

31
Q

What do you “look” at in a hip exam?

A 
Front:
Scars, pelvic tilt, quadriceps wasting, foot deformity
Side:
normal or hyperlordosis
Behind:
Scoliosis, gluteal wasting, pelvic tilt
GAIT:
Assess speed, smoothness, turning, note any evidence of antalgic gait or Trendelenburg gait, assess the patients footwear
32
Q

What do you feel for in a hip exam?

A

(Pt lying down)
Palpate the tissues overlying the hip joint for tenderness/warmth
palpate greater trochanter (tenderness ?GT bursitis)
ASIS and mid-inguinal point
Assess leg length
apparent (umbillicus –> MM)
True (ASIS –> MM)

33
Q

What do you move in a hip exam?

A 
Supine--.
Active: flexion
Passive: internal and external rotation
abduction (45*) and adduction (30*)
Prone-->
Passive hip extension (10-20*)
34
Q

What special tests are there in hip exam?

A

Thomas’ and trendelenburgs

and FABER and FAIR

35
Q

What do you look for in spine exam?

A

Look for adaptations e.g. walking stick wheelchair
position patient standing
Front: Posture of head and neck (symmetry, abnormality)
Side:
Cervical lordosis (hyper, spondylolisthesis, osteoporosis, discitis),
thoracic kyphosis (20-45*); vertebral fracture
Lumbar lordosis - assess for hyperlordosis - obesity, tight lower back muscles
behind: Scars, wasting (paraspinal muscles etc- chronic immobility), scoliosis, abnormal hair growth (spina bifida)
GAIT: foot drop, antalgic gait (may indicate spinal pathology)

36
Q

What should you feel for in a spinal exam?

A

(tenderness, irregularities and alignment) - spinal processes and sacroiliac joints
Palpate paraspinal muscles - tenderness or muscle spasms (looking at pts face)

37
Q

What should you “move” in a spinal exam?

A

Cervical -
active: flexion, extension (down/up) lateral flexion and rotation
Do passive if reduced movement on active; assess if pain/stiffness/muscle spasm is the restricting factor
Lumbar:
Flexion/extension/lateral flexion (toes, back, outer leg(s))
Thoracic spine:
pt sit down and turns with arms across chest (10-20*)

38
Q

What are the special tests in a spine exam?

A

Schobers test
5 below PSIS and 10 above PSIS, full lumbar flexion should be >20cm; reduced = ind ankylosing spondylitis etc
Sciatic stretch test - straight leg raise (passively flex hip, norm:80-90* then once as far as poss, Dorsiflex the foot)
Femoral nerve stretch test:
Prone pt, flex knee, extend hip, plantar-flex the foot

OSCE (30 decks)

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