MSK Examination Flashcards
Questions before knee exam
Which knee is sore?
Where is the pain?
Can I expose both knees, I would like to compare them?
What are you looking for in a knee examination
Mobility aids
Symmetry of knees
Redness/swelling
Thigh circumference of both legs above knee
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
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)
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
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
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
What is fixed flexion of the knee indicative of
Osteoarthritis
What is thigh circumference indicative of
Reduced indicates wasting of hamstrings or quadriceps
What does palpation of the joint tendons indicate
Patients may flinch if tender - inflammation
What does palpation behind the knee indicate
Baker’s cyst
Popliteal aneurysm
What does a patellar tap indicate
Large knee effusion
What does a sweep test indicate
Small knee effusion
Why ask a patient to perform active movements in a knee exam
To assess ROM
Why perform passive movements on the patient in a knee exam
Feel for crepitus and observe patient’s discomfort
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
