MSK Exams Flashcards
Describe the order of the MSK exam
Intro (WIPER)
Screening questions
Gait
Inspection
Arms
Legs
Spine
Other tests
What are the screening questions for an MSK exam
Do you have any pain, swelling or stiffness in your joints, muscles or back?
Do you have any difficulty getting dressed without any help?
Do you have ay problem going up and down the stairs?
How do you assess gait in an MSK exam
Ask the patient to walk to the end of the examination room and then turn and walk back whilst you observe their gait paying attention to:
Gait cycle: e.g. abnormalities in toe-off or heel strike
Range of movement: often reduced in the context of chronic joint pathology (e.g. osteoarthritis, inflammatory arthritis).
Limping: may suggest joint pain (i.e. antalgic gait) or weakness.
Leg length: note any discrepancy which may be the cause or the result of joint pathology.
Turning: patients with joint disease may turn slowly due to restrictions in joint range of movement or instability.
Trendelenburg’s gait: an abnormal gait caused by unilateral weakness of the hip abductor muscles secondary to a superior gluteal nerve lesion or L5 radiculopathy.
Waddling gait: an abnormal gait caused by bilateral weakness of the hip abductor muscles, typically associated with myopathies (e.g. muscular dystrophy).
Assess the patient’s footwear: unequal sole wearing is suggestive of an abnormal gait.
GRLLTTWF
Give 6 things to look out for in the observation stage of an MSK exam
Body habitus: obesity is a significant risk factor for joint pathology due to increased mechanical load (e.g. osteoarthritis).
Scars: may provide clues regarding previous surgery.
Wasting of muscles: suggestive of disuse atrophy secondary to joint pathology or a lower motor neuron injury.
Psoriasis: typically presents with scaly salmon coloured plaques on extensor surfaces (associated with psoriatic arthritis).
Aids and adaptations: examples include support slings, splints, walking aids and wheelchairs.
Prescriptions: prescribing charts or personal prescriptions can provide useful information about the patient’s recent medications (e.g. analgesia).
What does the question “Do you have any pain or stiffness in your muscles, joints or back?” screen for?
This question screens for common symptoms present in most forms of joint pathology (e.g. osteoarthritis, rheumatoid arthritis, ankylosing spondylitis).
What does the question “Do you have any difficulty getting yourself dressed without any help?” screen for?
.This question screens for evidence of fine motor impairment and significant restriction joint range of movement.
What does the question “Do you have any problem going up and down the stairs?” screen for?
This question screens for evidence of impaired gross motor function (e.g. muscle wasting, lower motor neuron lesions) and general mobility issues (e.g. restricted range of movement in the joints of the lower limb).
What does the closer inspection screen for in an MSK exam
Ask the patient to stand in the anatomical position and turn in 90° increments as you inspect from each angle for evidence of pathology.
What do you look for in an anterior inspection in an MSK exam
Posture
Scars
Joint swelling: unilateral swelling (e.g. effusion, inflammatory arthropathy, septic arthritis).
Joint erythema: suggestive of active inflammation (e.g. inflammatory arthropathy or septic arthritis).
Muscle bulk: Asymmetry may be caused by disuse atrophy (secondary to joint pathology) or lower motor neuron injury.
Elbow extension: inspect the patient’s carrying angle which should be between 5-15°. An increased carrying angle=cubitus valgus. A decreased carrying angle is known as cubitus varus or ‘gunstock deformity’.
Valgus joint deformity: the bone segment distal to the joint is angled laterally.
Varus joint deformity: the bone segment distal to the joint is angled medially. In varus deformity of the knee, the tibia is turned inward in relation to the femur, resulting in a bowlegged appearance.
Pelvic tilt
Fixed flexion deformity of the toes: subtypes include hammer-toe and mallet-toe.
Big toe
What is cubitus valgus and what does it suggest
the patient’s carrying angle which should be between 5-15°. An increased carrying angle=cubitus valgus.
Cubitus valgus is typically associated with previous elbow joint trauma or congenital deformity (e.g. Turner’s syndrome).
What is cubitus varus
A decreased carrying angle is known as cubitus varus or ‘gunstock deformity’.
Cubitus varus typically develops after supracondylar fracture of the humerus.
What is valgus deformity
In valgus deformity of the knee, the tibia is turned outward in relation to the femur, resulting in the knees ‘knocking’ together.
What can cause a lateral pelvic tilt
lateral pelvic tilt can be caused by scoliosis, leg length discrepancy or hip abductor weakness.
What are types of Fixed flexion deformity of the toes?
subtypes include hammer-toe and mallet-toe.
What do you look for in the big toe during inspection the MSK exam
note any evidence of lateral (hallux valgus) or medial (hallux varus) angulation.
What are you looking for in the lateral inspection in the MSK exam
Cervical lordosis
Thoracic kyphosis - the normal amount of thoracic kyphosis is typically between 20-45º.
Lumbar lordosis
Knee joint hyperextension
Foot arch
What is cervical lordosis indicative of
hyperlordosis is associated with chronic degenerative joint disease (e.g. osteoarthritis).
What is thoracic kyphosis indicative of
the normal amount of thoracic kyphosis is typically between 20-45º. Hyperkyphosis is associated with Scheuermann’s disease (congenital wedging of the vertebrae).
