MSK Examination Flashcards by Eleanor Duckett

Questions before knee exam

Which knee is sore?
Where is the pain?
Can I expose both knees, I would like to compare them?

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What are you looking for in a knee examination

Mobility aids
Symmetry of knees
Redness/swelling
Thigh circumference of both legs above knee

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What are you feeling for in a knee examination

Temperature
Joint lines and tendon insertion (knee at 90*)
Patellar border, behind knee (leg straight)
Patellar tap
Sweep test

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What active movement do you ask the patient to perform in a knee examination

Flexion (heel into bottom)
Extension (straighten again)
Hyperextension (push knee into the bed)
Straight leg raise (keep leg straight and raise off bed)

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What passive movement do you perform on the patient in a knee examination

Flexion and extension (with hand on patella)
Anterior and posterior drawer tests
McMurray's test
Collateral ligament stress test
Patellar apprehension test

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What can be done to complete a knee examination

Examine the other knee
Examine hip and ankle
Perform full MSK assessment
X-ray, MRI, aspiration of any effusion

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What can you assess in a standing patient in a knee examination

Inspect for deformity, wasting etc...
Gait
Sensation in feet
Foot pulses
Big toe cap refill

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What is fixed flexion of the knee indicative of

Osteoarthritis

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What is thigh circumference indicative of

Reduced indicates wasting of hamstrings or quadriceps

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What does palpation of the joint tendons indicate

Patients may flinch if tender - inflammation

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What does palpation behind the knee indicate

Baker’s cyst

Popliteal aneurysm

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What does a patellar tap indicate

Large knee effusion

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What does a sweep test indicate

Small knee effusion

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Why ask a patient to perform active movements in a knee exam

To assess ROM

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Why perform passive movements on the patient in a knee exam

Feel for crepitus and observe patient’s discomfort

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What do the anterior and posterior drawers indicate

ACL and PCL integrity

What does McMurray’s test for

Meniscal tear

What does the collateral ligament stress test test for

MCL and LCL weakness

What does the patellar apprehension test test for

Previous patellar dislocation

What knee deformities can be observed

Varus deformity (bow-legged)
Valgus deformity (knock-kneed)

What is a varus deformity indicative of

osteoarthritis, rickets

What is a valgus deformity indicative of

osteoarthritis, rheumatoid arthritis

Questions for a hand exam

Are you in any pain in your hands or arms

What do you look for on the nails in a hand exam (with causes)

Pitting (psoriasis)
Nailfold infarcts (Vasculitis, lupus)
Clubbing (other systems)

What do you look for on the fingers in a hand exam (with causes)

Scars (surgery) Swelling (Synovitis, infection) Swan-neck deformity (Rheumatoid) Heberdens and Bouchards nodes (osteoarthritis)

What do you look for on the MCP joints in a hand exam (with causes)

Ulnar deviation (Rheumatoid) Sublux/dislocation (rheumatoid) Swelling (infection)

What do you look for on the dorsum in a hand exam (with causes)

``` Tight, cold, waxy skin (scleroderma) Interossei wasting (Rheumatoid, ulnar nerve palsy) ```

What do you look for on the wrists in a hand exam (with causes)

``` Radiocarpal subluxation (rheumatoid) Prominent ulnar styloid (rheumatoid) ```

What do you look for on the palms in a hand exam (with causes)

``` Scars (Duputryns release surgery) Wasting of thenar/hypothenar eminence (median/ulnar nerve palsy) Palmar erythema (Rheumatoid, liver disease, hyperthyroidism, pregnancy) ```

What do you look for with the hands in a praying position in a hand exam (with causes)

Flexion deformity (RA, OA, Duputryns)

What do you look for with the hands clenched in a hand exam (with causes)

Loss of valleys between metacarpals (swelling)

What do you look for with the hands up to the chin in a hand exam (with causes)

``` Rheumatoid nodules (RA) Psoriatic plaques (psoriasis) ```

What do you feel for in a hand exam (causes)

``` Temperature (increased due to inflammation) Squeeze across wrists, MCP and interphalangeal joints (tenderness due to inflammation) Palmar thickening (Duputryns) ```

What active movement do you ask the patient to perform in a hand exam

``` Finger flexion and extension (Make fists) Finger abduction and adduction Wrist flexion/extension Wrist radial/ulnar deviation Pronation/supination ```

What passive movement do you perform on a patient in a hand exam

Any movements patient struggled with actively | Any joint with an abnormality

How do you assess function in a hand exam

Pinch grip Power grip Fine motor control

How do you assess neurovascular integrity

Test median, ulnar and radial nerve sensitivity Radial pulse CRT in both hands

Further investigations after hand exam

Examine elbow/shoulder joint Rheumatoid serology Joint aspiration X-ray