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Orthopaedics r > MSK examinations > Flashcards

MSK examinations Flashcards

1
Q

what is the empty can test and what does it assess

A

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

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2
Q

what is lift off test

A

dorsum of hand on the back and examiner presses against it to assess the strength

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3
Q

what does lift off test assess

A

subscapularis muscle

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4
Q

what is the scarf test

A

patient is asked to touch their opposite shoulder with the hand and examiner can press against it

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5
Q

what does positive scarf test indicate

A

pathology of ACJ e.g. arthritis

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6
Q

what does a positive schoebers test indicate

A

reduced lumbar flexion e.g. ankylosing spondylitis

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7
Q

what movement is commonly restricted in osteoarthritis and frozen shoulder/adhesive capsulitis

A

external rotation

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8
Q

which shoulder pathology is of higher risk in patients with diabetes or thyroid disease

A

adhesive capsulitis

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9
Q

what % of patients with diabetes will develop adhesive capsulitis

A

10-20%

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10
Q

what is the most commonly injured nerve in shoulder dislocation

A

axillary nerve

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11
Q

how can you test the axillary nerve (sensory and motor)

A

sensation of the regimental badge area

deltoid muscle strength

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12
Q

what is the most cost effective way to differentiate between osteoarthritis of the shoulder and adhesive capsulitis?

A

plain x- ray: as in OA there are arthritis changes

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13
Q

name 4 arthritic changes seen on x-ray

A

loss of joint space
subchondral sclerosis
subchondral cyst formation
osteophytes

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14
Q

what is a trendelenburg gait?

A

weakness of the abductor muscles causes a contralateral pelvis drop

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15
Q

what nerve innervates the abductor muscles

A

superior gluteal nerve

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16
Q

what causes a foot drop gait

A

inability to dorsiflex the foot and raise the toes

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17
Q

name 3 causes of foot drop

A

common peroneal palsy
MND
stroke

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18
Q

what is a lipoma

A

soft, moveable, painless benign tumour made of fat tissue

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19
Q

what could hair growth on the spine be a sign of?

A

spina bifida

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20
Q

what 2 condition are cafe au lait spots seen in?

A

neurofibromatosis type 1 + McCune Albright syndrome

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21
Q

what condition do you lose lumbar lordosis in?

A

spondylolithesis of lumbar vertebra

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22
Q

name the prominences palpated in the spine examination

A
  • spinous processes from the c spine to sacrum

- sacroiliac joints

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23
Q

name the 3 muscles palpated in the spine exam

A
  • trapezius
  • paraspinal
  • interscapular
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24
Q

name the 4 movements of the cervical spine

A
  • flexion
  • extension
  • rotation
  • lateral flexion (x2)
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25
Q

name the movements of the thoracic spine

A
  • rotation

- chest expansion

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26
Q

name the lumbar spine movements

A

flexion
extension
lateral flexion

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27
Q

name the 4 special tests of the spinal examination

A

1 Schober’s test
2 Wall test for increased kyphosis
3 Straight leg raise test
4 Femoral stretch test

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28
Q

What is the straight leg raise test and what is it testing?

A

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

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29
Q

What is the femoral stretch test and what is it testing?

A

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)

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30
Q

what is schober’s test and what is it testing

A

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

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31
Q

what is the wall test and what does it suggest

A

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

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32
Q

what test should you do to examine the joint below of the spine

A

test internal rotation of the hip

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33
Q

what should you palpate in the hip examination

A

greater trochanter, ASIS, midpoint of inguinal ligament

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34
Q

what pathology could pain on palpation of greater trochanter be

A

trochanteric bursitis

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35
Q

name the 5 movements in the hip examination

A 
flexion 
internal rotation 
external rotation 
abduction 
adduction
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36
Q

what are the 3 special tests in the hip examination

A

1 thomas test
2 leg length
3 trendelenburg test

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37
Q

what is the thomas test

A

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

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38
Q

what causes a positive thomas test

A

fixed flexion deformity: tightening and shortening of the hip flexors

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39
Q

femoral nerve - test for power and sensation

A

power - quadriceps

sensation - anteromedial thigh

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40
Q

peroneal nerve - test for power and sensation

A

power - toe extension

sensation - dorsum of foot

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41
Q

tibial nerve - test for power and sensation

A

power - plantarflexion

sensation - sole of foot

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42
Q

what is the APPARENT + TRUE ways of measuring leg length

A

apparent - belly button to medial malleolus on both sides

true - ASIS to medial malleolus on both sides

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43
Q

possible pathology if apparent measure alone is different

A

pelvic deformity

44
Q

both apparent and true leg length measures are different suggests what

A

bone length difference

45
Q

nerve roots of the femoral nerve

A

L2, L3, L4

46
Q

nerve roots of the sciatic nerve

A

L4, L5, S1, S2, S3

47
Q

what is the examination finding in a patient with a neck of femur fractrue

A

pulled upwards/shortened + externally rotated

48
Q

what is valgus and varus

A

refer to the angulation of a shaft of bone from the midline

49
Q

what foot deformity is associated with flat foot

A

valgus

50
Q

what 2 tests do you do to look for effusions in the knee?

A

bulge test

patella tap test

51
Q

how do you perform the patella tap test?

A

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

52
Q

what are the special tests in knee examination

A

medial collateral ligament
lateral collateral ligament
anterior draw test
posterior draw test

53
Q

what deformities can you look for in the foot and ankle examination?

A 
varus, valgus 
claw toe
hammer toe 
flat foot
subluxation of joints
54
Q

what is the name of the special test in the ankle and foot examination?

A

simmons test

55
Q

what is simmons test

A

patient lies flat, prone, with feet hanging over end, squeeze calf and look for plantarflexion of the foot

56
Q

what could a positive simmons test be due to?

A

achilles tendon rupture

57
Q

3 examination findings in with flat foot deformity?

A
  • valgus deformity
  • collapsed foot arch
  • when viewing posteriorly; can see more toes that normal
58
Q

a cause of difficult ankle inversion + eversion is?

A

subtalar arthritis

59
Q

name the rotator cuff muscles

A

supraspinatus
infraspinatus
subscapularis
teres minor

60
Q

name the landmarks palpated in the shoulder examination

A

sternoclavicular joint
clavicle
acromioclavicular joint
acromion

borders of scapula
greater tubercle of humerus
coracoid process
biceps tendon

61
Q

what muscle inserts along the entire length of the scapula

A

serratus anterior

62
Q

what nerve innervates serratus anterior

A

long thoracic nerve

63
Q

what effect does trapezius wasting have on the appearance of patient

A

squaring of shoulders

64
Q

what is the name of the sign in bicep tendonitis

A

poppi sign

65
Q

name the movements tested in the shoulder examination

A

flexion
abduction
external rotation
internal rotation

66
Q

what pathology does pain at 80-90 deg abduction suggest?

A

supraspinatus impingement

67
Q

what movement is lost in adhesive capsulitis?

A

external rotation

68
Q

what movement tests internal rotation?

A

reach up back as far as you can

69
Q

what is the empty can test and what does it test?

A

supraspinatus

70
Q

what does external rotation against resistance test?

A

infraspinatus + teres minor

71
Q

what is the hawkins kennedy test and what does it test?

A

aducted arm across chest and internal rotation against resistance, pain suggests supraspinatus impingement

72
Q

how do you test the subscapularis?

A

patient puts arm behind their back with palms facing outwards and pushes against resistance

73
Q

what is the scarf and what pain suggest?

A

arm abducted across chest, with pressure;

pain indicates ACJ arthritis

74
Q

sensory and motor supply of axillary nerve?

A

sensory - regimental badge area

motor - deltoid muscle

75
Q

name of test for shoulder dislocation?

A

apprehension test

76
Q

where would a scar for ulnar surgery be located?

A

medial epicondyle

77
Q

name the structures to palpate in the elbow examination

A

medial epicondyle
lateral epicondyle
olecranon fossa
ulnar nerve

78
Q

name the 2 special tests in the elbow exam

A

tests for medial and lateral epicondylitis

79
Q

what is the management of medial and lateral epicondylitis

A
  • physiotherapy
  • advice on avoiding muscle overload
  • analgesia
  • steroid injection
80
Q

what are the movements that cause aggravation of pain in medial epicondylitis?

A

wrist flexion

wrist pronation

81
Q

what is medial epicondylitis?

A

inflammation of the medial epicondyle which is the location of insertion of the flexors muscles of the forearm

82
Q

what is the special test for medial epicondylitis?

A

stabilise the patients forearm and hand and ask the patient to push up against you: active wrist flexion against resistance

83
Q

which nerve may be involved in medial epicondylitis and what symptoms may this cause?

A

ulnar nerve

tingling sensation in the 4th and 5th finger

84
Q

what is lateral epicondylitis?

A

(tennis elbow) pain and tenderness at the lateral epicondyle which is the origin for the extensor muscles of the forearm

85
Q

what is the special test for lateral epicondylitis?

A

stabilise the hand and forearm: ask patient to extend their wrist up against your resistance

86
Q

what movements exacerbate the pain in lateral epicondylitis?

A

wrist extension with elbow extended
and
supination of the forearm with elbow extended

87
Q

name the special tests for carpal tunnel syndrome?

A

tinnels and phalens

88
Q

which muscles are affected in carpal tunnel syndrome?

A

thenar eminence (atrophy and wasting occurs)

89
Q

what are the sensory symptoms in carpal tunnel syndrome?

A

numbness and tingling over median nerve distribution… palmar surface of thumb, 2sr+2nd finger

90
Q

sensory distribution of the ulnar nerve?

A

4th+5th finger palmar and dorsal surface

91
Q

sensory distribution of the radial nerve?

A

thumb, 1st+2nd finger dorsal surface

92
Q

sensory distribution of the median nerve?

A

palmar surface: thumb, 1st+2nd finger

93
Q

Describe the cause + clinical presentation of a scaphoid fracture?

A
  • falling on an outstretched hand
  • tenderness in anatomical snuffbox
  • loss of grip strength
94
Q

Why is a scaphoid fracture an emergency?

A

risk of avascular necrosis due to interruption of dorsal branch of radial artery

95
Q

name 2 nail signs seen in psoriatic arthritis?

A

nail pitting + onycholysis

96
Q

what condition is nail fold infarcts seen in?

A

vasculitis

97
Q

what condition is telangiectasia seen in?

A

scleroderma

98
Q

what condition could thenar muscle wasting be seen in?

A

carpal tunnel syndrome

99
Q

name the clinical examination findings in OA

A
  • bouchards nodes (PIPJ)

- heberdens nodes (DIPJ)

100
Q

what could synovitis/boggy swelling in the hands be due to?

A
  • trauma

- Rheumatoid arthritis

101
Q

name 5 deformities that could be found in Rheumatoid Arthritis

A
  • z thumb
  • ulnar deviation
  • swan neck
  • boutonnieres
  • subluxation of MCPJs
102
Q

what causes a swan neck deformity?

A

PIP hyperextension + DIP flexion

103
Q

what is gouty tophi? and where may it appear

A

nodular masses of urate crystals deposited in gout

- elbow, ear helix

104
Q

what can you look behind the ear for?

A

psoriatic rashes

105
Q

what can cause radial styloid process tenderness?

A

De Quervain’s tensosynovitis

106
Q

name the special tests in elbow examination

A

tinnels
phalens
froment’s

Orthopaedics r (10 decks)

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