MSK EXAMINATION: UPPER LIMB Flashcards
What are 5 stages of MSK examination
INTRO
LOOK
FEEL
MOVE: active then passive (check for crepitus)
FUNCTION: joints during daily living
MSK Exam: LOOK
Relevant area, both sides
SWELLING
SKIN CHANGES - RASHES
MUSCL. BULK/WASTING
JOINT CONTOUR CHANGES = dislocation or fracture
FEEL
Temperature, palpate swellings, look for tenderness or deformities
Deep palpations, look for guarding or signs of pain
MOVE
move the full angle
FUNCTION
how joints are used daily
Elbow Examination
- SUPINE; carrying angle = assymetry?
scarring, swelling @ posterior of the joint etc. - Palpate OLECRANON
MEDIAL EPICONDYLE
LATERAL EPICONDYLE
RADIAL HEAD (pronate/supinate forearm, under lateral epicondyle)
- olecranon relationship between med. and lat. epicondyle can hint to prev. fracture of distal humerus
3. MOVEMENT: supinate (full extension), to full flexion BOTH SIDES (elbow joint)
Check for supination and pronation
- NEURO: touch fingers, grip, pull wrist upwards
Hand & Wrist Examination
- ASSESS for deform, scars, swelling, wasting
DORSUM: first web space = ulnar nerve problem
interossei = guttering (wsting)
FIST: normal cascade of fingers
PALMAR rpt.
normal movements and cascade
ELBOWs: rheumatoid nodules, psoriasis
FOREARM: alighnment
- FEEL ?pain, firm palpate
- Radial styloid, across to DRUJ, to the ulna
- carpal bones: scaphoid (snuffbox), carpometacarpal joint (osteoarthritis)
- feel up metacarpals
- feel each joint (RA = bogginess)
PALMAR: flexor sheaths, feel downwards - MOVE:
PRAY dorsiflexion of wrist
DOWNWARD SHARK
MCP joint: active/passive movements
thumb extension, flexion, abduction adduction
- CARPAL TUNNEL SPECIAL TEST
Tinnels Test: tap over carpal tunnel = tingling (+)
Phalan’s Test: downward shark for 1min = pins and needles (+)
power of pollicis brevis (median nerve) = test for abduction overpower (MCR scale)
Sensation: thumb, index, middle +ring, little
+Radial sensation = 1st webspace dorsum
Median = palmar index finger
Ulnar = palmar little finge
+CAP
Cervical Spine / Neck Examination
WALK up and down room ?balance, gait
- pain in neck
- look up ceiling, floow, rotate left and right
- SPURLING’S TEST: pain right arm = provoke by looking up to ceiling and affected side = reproduce pain
* trapped nerve etc. - Touch toes and bend backwards + lateral flexion
* - sensation of upper limbs = dermatomes @ anatomical position
- motor function
- (both) biceps reflex (C5,C6), triceps reflex (C7) , brachialis reflex (C6)
Hoffman’s Test = reflex contracture (UMN)
Cervical Spine / Neck Examination Motor Function
Chicken push down = C5
Pull me towards you. (elbow flexion) = C5, C6
Push away (elbow extension) = C7
Finger flexion = C8
Spread fingers, resist pushing together (abduction) = T1
Shoulder Examination
- exposed. muscle wasting in deltoid or pec mj,
symmetry of shoulders and wasting
scoliosis - PALPATE: cervical spine to cervicothoracic junction, move outwards along spine of scapula to acromion to acromiclavic joint.
clavicle to steroclavicular joint
(both sides can assess tenderness simultaneously)
humerus: greater tuberosity and post and ant shoulder
- hand behind head (abduction and ext. rotation)
hands behind back (internal rotation)
full flexion/forward elevation of shoulder and back down
abduction / sideward elevation
rotation: robot arms move outwards and back in
internal rot: see which vertebral level arm can reach
rotary cuff:
lateral rotation (infraspinatus and teres mn) = robot > rotate outwards
belly press
supraspinatus = resist pushing down, outwards arm (about to breaststroke/part red sea)
*passive movements rpt, check for crepitus
Lumbar Spine
- Gait, tiptoes, heels
?antalgic gait
?weakness
?unbalanced, broad gait - LOOK @ back
alignment, deform., scoliosis, abn hairy patches (spina bifida), axillary freckling (neurofibromatosis)
Sagittal profile of spine = +ve C7 infront of sacrum, -ve C7 behind sacrum - Pain and tenderness upon percussion along vertebra,
sacroiliac - Movment: finger on spine, bend down, see how much distance.
Then extension - Sensation by drmatomes
lower limb: L1-S2 - knee flexion, knee extension, pull toes up
reflexes - Sciatic nerve pain = angle
C7 name
Vertebra prominens
Winging Scapula
ask the patient to push against a wall with both hands spaced shoulder-width apart whilst you inspect the back. The protrusion of a scapula (known as scapular winging) is suggestive of ipsilateral serratus anterior muscle weakness, typically secondary to a long thoracic nerve injury.
