MSK examinations Flashcards
what is the empty can test and what does it assess
arms abducted to approx 70 deg, in 15 forwards flexion, thumbs pointing down; attempts to depress the arms, positive test is weakness or pain
supraspinatus impingement
what is lift off test
dorsum of hand on the back and examiner presses against it to assess the strength
what does lift off test assess
subscapularis muscle
what is the scarf test
patient is asked to touch their opposite shoulder with the hand and examiner can press against it
what does positive scarf test indicate
pathology of ACJ e.g. arthritis
what does a positive schoebers test indicate
reduced lumbar flexion e.g. ankylosing spondylitis
what movement is commonly restricted in osteoarthritis and frozen shoulder/adhesive capsulitis
external rotation
which shoulder pathology is of higher risk in patients with diabetes or thyroid disease
adhesive capsulitis
what % of patients with diabetes will develop adhesive capsulitis
10-20%
what is the most commonly injured nerve in shoulder dislocation
axillary nerve
how can you test the axillary nerve (sensory and motor)
sensation of the regimental badge area
deltoid muscle strength
what is the most cost effective way to differentiate between osteoarthritis of the shoulder and adhesive capsulitis?
plain x- ray: as in OA there are arthritis changes
name 4 arthritic changes seen on x-ray
loss of joint space
subchondral sclerosis
subchondral cyst formation
osteophytes
what is a trendelenburg gait?
weakness of the abductor muscles causes a contralateral pelvis drop
what nerve innervates the abductor muscles
superior gluteal nerve
what causes a foot drop gait
inability to dorsiflex the foot and raise the toes
name 3 causes of foot drop
common peroneal palsy
MND
stroke
what is a lipoma
soft, moveable, painless benign tumour made of fat tissue
what could hair growth on the spine be a sign of?
spina bifida
what 2 condition are cafe au lait spots seen in?
neurofibromatosis type 1 + McCune Albright syndrome
what condition do you lose lumbar lordosis in?
spondylolithesis of lumbar vertebra
name the prominences palpated in the spine examination
- spinous processes from the c spine to sacrum
- sacroiliac joints
name the 3 muscles palpated in the spine exam
- trapezius
- paraspinal
- interscapular
name the 4 movements of the cervical spine
- flexion
- extension
- rotation
- lateral flexion (x2)
name the movements of the thoracic spine
- rotation
- chest expansion
name the lumbar spine movements
flexion
extension
lateral flexion
name the 4 special tests of the spinal examination
1 Schober’s test
2 Wall test for increased kyphosis
3 Straight leg raise test
4 Femoral stretch test
What is the straight leg raise test and what is it testing?
Patient is supine on couch, leg is kept straight and passively raised; this could recreate the pain in the buttocks, lower back, leg between 30 and 70 degrees
would indicate disc herniation compression on L4, L5, S1
What is the femoral stretch test and what is it testing?
Patient is prone on couch with knee flexed to 90 degrees, patient extends their hip which may recreate pain in the anterior thigh
indicating nerve compression on L2, L3, L4 (femoral nerve)
what is schober’s test and what is it testing
measure 5 cm below and 10 cm above the lumbosacral junction with the patient standing, then ask the patient to flex forwards as much as they can and re measure the difference between the 2 points
< 5 cm increase indicates reduced flexion
what is the wall test and what does it suggest
ask patient to stand with their back against the wall with heels, buttocks and shoulders touching the wall, and
1) measure the distance from tragus to wall
2) if head is unable to touch the spine this indicated increased kyphosis
ankylosing spondylitis
what test should you do to examine the joint below of the spine
test internal rotation of the hip
what should you palpate in the hip examination
greater trochanter, ASIS, midpoint of inguinal ligament
what pathology could pain on palpation of greater trochanter be
trochanteric bursitis
name the 5 movements in the hip examination
flexion internal rotation external rotation abduction adduction
what are the 3 special tests in the hip examination
1 thomas test
2 leg length
3 trendelenburg test
what is the thomas test
hand is placed under the patients lumbar spine, the patient is asked to flex their non test hip (lumbar lordosis should be eliminated) and a positive sign would be if the contralateral hip raises of the couch
what causes a positive thomas test
fixed flexion deformity: tightening and shortening of the hip flexors
femoral nerve - test for power and sensation
power - quadriceps
sensation - anteromedial thigh
peroneal nerve - test for power and sensation
power - toe extension
sensation - dorsum of foot
tibial nerve - test for power and sensation
power - plantarflexion
sensation - sole of foot
what is the APPARENT + TRUE ways of measuring leg length
apparent - belly button to medial malleolus on both sides
true - ASIS to medial malleolus on both sides
possible pathology if apparent measure alone is different
pelvic deformity
both apparent and true leg length measures are different suggests what
bone length difference
nerve roots of the femoral nerve
L2, L3, L4
nerve roots of the sciatic nerve
L4, L5, S1, S2, S3
what is the examination finding in a patient with a neck of femur fractrue
pulled upwards/shortened + externally rotated
what is valgus and varus
refer to the angulation of a shaft of bone from the midline
what foot deformity is associated with flat foot
valgus
what 2 tests do you do to look for effusions in the knee?
bulge test
patella tap test
how do you perform the patella tap test?
one hand is placed above the supra patellar pouch and gently push downwards as if to push the fluid under the patella, then press down onto the patella: medium-large effusion will cause the tap on patella to feel like its bouncing
what are the special tests in knee examination
medial collateral ligament
lateral collateral ligament
anterior draw test
posterior draw test
what deformities can you look for in the foot and ankle examination?
varus, valgus claw toe hammer toe flat foot subluxation of joints
what is the name of the special test in the ankle and foot examination?
simmons test
what is simmons test
patient lies flat, prone, with feet hanging over end, squeeze calf and look for plantarflexion of the foot
what could a positive simmons test be due to?
achilles tendon rupture
3 examination findings in with flat foot deformity?
- valgus deformity
- collapsed foot arch
- when viewing posteriorly; can see more toes that normal
a cause of difficult ankle inversion + eversion is?
subtalar arthritis
name the rotator cuff muscles
supraspinatus
infraspinatus
subscapularis
teres minor
name the landmarks palpated in the shoulder examination
sternoclavicular joint
clavicle
acromioclavicular joint
acromion
borders of scapula
greater tubercle of humerus
coracoid process
biceps tendon
what muscle inserts along the entire length of the scapula
serratus anterior
what nerve innervates serratus anterior
long thoracic nerve
what effect does trapezius wasting have on the appearance of patient
squaring of shoulders
what is the name of the sign in bicep tendonitis
poppi sign
name the movements tested in the shoulder examination
flexion
abduction
external rotation
internal rotation
what pathology does pain at 80-90 deg abduction suggest?
supraspinatus impingement
what movement is lost in adhesive capsulitis?
external rotation
what movement tests internal rotation?
reach up back as far as you can
what is the empty can test and what does it test?
supraspinatus
what does external rotation against resistance test?
infraspinatus + teres minor
what is the hawkins kennedy test and what does it test?
aducted arm across chest and internal rotation against resistance, pain suggests supraspinatus impingement
how do you test the subscapularis?
patient puts arm behind their back with palms facing outwards and pushes against resistance
what is the scarf and what pain suggest?
arm abducted across chest, with pressure;
pain indicates ACJ arthritis
sensory and motor supply of axillary nerve?
sensory - regimental badge area
motor - deltoid muscle
name of test for shoulder dislocation?
apprehension test
where would a scar for ulnar surgery be located?
medial epicondyle
name the structures to palpate in the elbow examination
medial epicondyle
lateral epicondyle
olecranon fossa
ulnar nerve
name the 2 special tests in the elbow exam
tests for medial and lateral epicondylitis
what is the management of medial and lateral epicondylitis
- physiotherapy
- advice on avoiding muscle overload
- analgesia
- steroid injection
what are the movements that cause aggravation of pain in medial epicondylitis?
wrist flexion
wrist pronation
what is medial epicondylitis?
inflammation of the medial epicondyle which is the location of insertion of the flexors muscles of the forearm
what is the special test for medial epicondylitis?
stabilise the patients forearm and hand and ask the patient to push up against you: active wrist flexion against resistance
which nerve may be involved in medial epicondylitis and what symptoms may this cause?
ulnar nerve
tingling sensation in the 4th and 5th finger
what is lateral epicondylitis?
(tennis elbow) pain and tenderness at the lateral epicondyle which is the origin for the extensor muscles of the forearm
what is the special test for lateral epicondylitis?
stabilise the hand and forearm: ask patient to extend their wrist up against your resistance
what movements exacerbate the pain in lateral epicondylitis?
wrist extension with elbow extended
and
supination of the forearm with elbow extended
name the special tests for carpal tunnel syndrome?
tinnels and phalens
which muscles are affected in carpal tunnel syndrome?
thenar eminence (atrophy and wasting occurs)
what are the sensory symptoms in carpal tunnel syndrome?
numbness and tingling over median nerve distribution… palmar surface of thumb, 2sr+2nd finger
sensory distribution of the ulnar nerve?
4th+5th finger palmar and dorsal surface
sensory distribution of the radial nerve?
thumb, 1st+2nd finger dorsal surface
sensory distribution of the median nerve?
palmar surface: thumb, 1st+2nd finger
Describe the cause + clinical presentation of a scaphoid fracture?
- falling on an outstretched hand
- tenderness in anatomical snuffbox
- loss of grip strength
Why is a scaphoid fracture an emergency?
risk of avascular necrosis due to interruption of dorsal branch of radial artery
name 2 nail signs seen in psoriatic arthritis?
nail pitting + onycholysis
what condition is nail fold infarcts seen in?
vasculitis
what condition is telangiectasia seen in?
scleroderma
what condition could thenar muscle wasting be seen in?
carpal tunnel syndrome
name the clinical examination findings in OA
- bouchards nodes (PIPJ)
- heberdens nodes (DIPJ)
what could synovitis/boggy swelling in the hands be due to?
- trauma
- Rheumatoid arthritis
name 5 deformities that could be found in Rheumatoid Arthritis
- z thumb
- ulnar deviation
- swan neck
- boutonnieres
- subluxation of MCPJs
what causes a swan neck deformity?
PIP hyperextension + DIP flexion
what is gouty tophi? and where may it appear
nodular masses of urate crystals deposited in gout
- elbow, ear helix
what can you look behind the ear for?
psoriatic rashes
what can cause radial styloid process tenderness?
De Quervain’s tensosynovitis
name the special tests in elbow examination
tinnels
phalens
froment’s
