MSK Examinations Flashcards
Shoulder examination inspection
scars - previous surgery/trauma
asymmetry/deformity - winged scapula, scoliosis
muscle bulk of trapezius and deltoids - symmetry, wasting
paravertebral muscles - swelling, wasting
muscle wasting in the supra and infraspinatus fossa - nerve injury, chronic rotator cuff tear
Shoulder examination palpation
Temperature - inflammatory arthropathy/infection
sternoclavicular joint > clavicle > acromioclavicular joint > coracoid process > head of humerus > greater tuberosity of humerus > spine of scapula
Shoulder examinations active movements
Flexion (forwards) Extension (backwards) ABduction Adduction External rotations Internal rotation
Shoulder examination passive movements
Flexion Extension Adduction Abduction External rotation Internal rotation
Feel for crepitus
Shoulder examination resisted movements
Abduction
Adduction
External rotation (infraspinatus)
Internal rotation (subscapularis)
Shoulder examination special tests
Jobe’s test - supraspinatus impingement/weakness
Painful arc - supraspinatus impingement
Gerber lift-off test - test of subscapularis muscle function
Elbow join general inspection
Scars - injury, surgery
Swelling/erythema of joint - acute injury, inflammatory arthritis, septic arthritis, cellulitis
Carrying angel - cubits valgus/varus deformity ( trauma/childhood fracture)
Fixed flexion deformity - often post traumatic
Olecranon bursitis - swelling
Rheumatoid nodules - systemic rheumatoid disease
Psoriatic plaques - well defined pink/red lesions wth silvery scale
Elbow passive and active movements
Flexion
Extension
Pronation
Supination
Elbow exam special tests
Medial Epicondylitis (aka Golfer’s elbow) - resisted FLEXION
Lateral epicondylitis (aka Tennis elbow) - resisted EXTENSION
Biceps tendon tenderness
Biceps tendonitis
Hand examination inspection
inspect hand posture
scars or swellings
erythema - cellulitis, palmar erythema
pallor - peripheral vascular disease, anaemia
deformities - bouchards, heberdens, swan neck, z thumb, boutonnieres
skin changes
muscle wasting
nail changes
thenar/hypothenar wasting
elbows - psoriatic plaques or rheumatoid nodules
Palms - palpation
temperature (forearm, wrist, MCP joints) - inflammatory/septic arthritis
radial and ulnar pulse
thenar/hypothenar eminence bulk
palmar thickening
median and ulnar nerve sensation (thenar eminence/index finger - median nerve) (hypothenar eminence/little finger - ulnar nerve)
assess radial nerve sensation (first dorsal web space)
gently squeeze MCP joints - inflammatory arthropathy
bimanually palpate hand joints
palpate anatomical snuffbox
wrists
along ulnar border from elbow
Hand examination passive and active movements
finger extension
finger flexion
wrist extension
finger flexion
Hand examination motor assessment
wrist/finger extension against resistance (radial nerve)
finger abduction against resistance - ulnar nerve
thumb abduction against resistance (median nerve)
power grip
pincer grip
pick up small object/do up a button
Hand examination special tests
Tine’s test (tap over carpal tunnel)
Phalen’s test (inverted prayer)
both for carpal tunnel syndrome
Hip examination inspection
scars pelvic tilt quadriceps wasting foot deformity scoliosis gluteal wasting gait unequal sole wearing
Hip examination palpation
tenderness/warmth - inflammation, infection
greater trochanter - tenderness = greater trochanteric bursitis
assess leg length (apparent and actual)
Hip examinait active movements
flexion (with hand under lumbar spine)
Hip examination passive movements
flexion internal rotation external rotation abduction adduction hip extension (prone)
Hip examination special tests
Thomas’s test - see if not flexed thigh raises off bed - FIXED FLEXION DEFORMITY (do not perform on patients with hip replacements)
Trendelenburg’s sign - weak hip abductors on the contralateral side of the pelvis
Knee examination inspection
gait scars swellings asymmetry/leg length discrepancy valgus or varus deformity quadriceps wasting asymmetry popliteal swellings - baker's cyst, popliteal aneurysm
Knee examination palpation
knee and surrounding structures quadriceps tendon patella patella tendon tibial tuberosity joint line head of fibula collateral ligaments popliteal fossa
patella tap
sweep test
Knee examination active and passive movements
extension
flexion
?hyperextension
Knee examinations special tests
anterior/posterior drawer test - posterior/anterior cruciate laxity/rupture
medial collateral ligament test - laxity/rupture
Foot and ankle examination inspection
gait symmetry toe alignment - hallux valgus bunions deformities of the toes - claw, mallet, hammer scars - previous injury/surgery calluses - foot/gait deformity or poorly fitting footwear swelling or erythema - injury/inflammatory arthritis/septic arthritis/cellulitis foot arches - pes planus, pes cavus stand on tip toes symmetry achilles tendon
Ankle and foot examination palpation
temperature
pulses - posterior tibial and dorsalis pedis
achilles tendon
squeeze MTP joints > tarsal and metatarsal bones > tarsal joint > ankle joint > subtalar joint > calcaneum > medial/lateral malleoli > distal fibula
Ankle and foot examination active and passive movement
plantar flexion dorsiflexion to flexion toe extension ankle/foot inversion ankle/foot eversion
PASSIVE ONLY:
ankle joint
subtler joint
mid tarsal joint
Ankle and foot examination special tests
Simmond’s test - squeeze calf for achilles tendon rupture
GALS examination screening questions
do you have any pain in your muscles, joints or back?
are you able to dress yourself completely without any difficulties?
are you able to walk up and down the stairs without any difficulty?
GALS examination inspection
Gait shoulders - bulk and symmetry elbow extension - carrying angle quadriceps - bulk and symmetry knees - swelling, deformity, asymmetry feet - deformity, asymmetry cervical spine, thoracic spine, lumbar sine knee joints - hyperextension foot arches - low or high tow clawing shoulder muscles spinal alignment iliac crest alignment popliteal swellings kind foot abnormalities
GALS arm assessment
hand behind head hands out in front of them supination fist power grip precision grip squeeze MCP joints
GALS leg assessment
passive full knee flexion and extension
passive internal rotation of the hip
patellar tap
squeeze MTP joints
GALS spine assessment
inspect
lateral flexion of cervical spine (ear to shoulder)
lumbar flexion
Spine examination - inspection
posture of head and neck symmetry of shoulders cervical lordosis thoracic kyphosis lumbar lordosis scars wasting scoliosis abnormal hair growth (spina bifida)
assess gait
Spine examination - feel
palpate spinal processes and sacroiliac joints
Palpate paraspinal muscles
Spine examination - movement
cervical spine - flexion, extension, lateral flexion, rotation
lumbar spine - flexion, extension, lateral flexion
thoracic spine - rotation (sit down, arms across chest, twist)
Spine examination - special tests
Schooner’s test - marking lumbar spine and touch toes and should increase by 5cm
Sciatic stretch test - sciatica
Femoral nerve stretch test - femoral nerve impingement
