MSK Exams Flashcards
What is Hoffman’s sign?
Flicking of middle finger downwards causes involuntary flexion of thumb +/- first finger
what does a +ve Hoffmans’s sing indicate?
cervical myelopathy or an UMN lesion
what should be assessed in a spine exam?
LOOK - all sides and GAIT
FEEL - down spine and SI joints
MOVE - passive movements of cervical, thoracic and lumbar spine
SPECIAL TESTS
what are the 3 special tests in a spine exam?
Schober’s test
Sciatic stretch test
Femoral stretch test
what is the sciatic stretch test?
Straight leg raise with knee extended - elicit sciatica type pain then +ve
what is the femoral stretch test?
prone patient
bend knee 90 degrees
extend hip
plantar flex foot
elicits pain in anterior thigh then +ve
what further assessments can be done after spine exam?
Examine hip and shoulders
Neurovascular exam of upper and lower limbs
imaging if indicated
what is Schober’s test?
Measure and mark 5cm above and 10cm below PSIS and ask to bend - distance between marks should increase to >20 cm
what special tests are done in a hip exam?
Trendelenburg test
what is trendelenburgh’s test?
Assesses hip abductor weakness - glut medius and minimus
Ask patient to stay on one leg while palpating iliac crest for lateral pelvic tilt
+ve if pelvis drops on side of leg lift - suggests contralateral hip abductor weakness
what further assessments can be done after a hip exam?
Neurovascular exam of lower limbs
examination of joint above and below
imaging if indicated
how is leg length assessed in hip exam?
true leg length measured from anterior superior iliac spine to medial malleolus
what is the name for knock knees?
valgus deformation of knee
what is the name for bow legs?
varus deformation of the knee
what is one extra thing measured in knee exam during inspection?
quadriceps bulk on each side 20cm above tibial tuberosity
what special tests are done on knee exam?
Patellar tap
sweep test
Posterior sag test
anterior draw test
posterior draw test
Lachman’s test
Lateral and medial collateral ligament assessment
McMurray’s test
what is the patellar tap?
Assess for moderate-large knee joint effusions
sweep hand down thigh with leg extended and press down on patella
what is the sweep test?
test for small knee effusions
sweep hand down thigh
sweep medially from below patella to upper border and hold hand there
sweep laterally from upper to lower border of patella
what is the posterior sag test?
for posterior cruciate ligament rupture - do BEFORE anterior draw
patient flexes knees to 90 degrees
loos at knees laterally - is there posterior sag of tibia?
what is the anterior draw test?
for ACL injury
flex knee
warp hands around proximal tibia
fix position of leg with lower arms
position thumbs over tibial tuberosity
pull tibia anteriorly and feel for anterior movement of tibia on femur
what is the posterior draw test?
for PCL laxity/rupture
like anterior draw but push tibia posteriorly
what is Lachlan’s test?
for ACL pathology
flex knee 30 degrees
hold lower leg and tibia
pull tibia forwards while stabilising femur with other hand
what test is used to assess the collateral ligaments in knee exam?
varus and valgus stress test
what is McMurray’s test?
For meniscal tears
flex knee of supine patient
hold patients by sole of foot and knee
Assess meniscus and Extend leg
medial meniscus - hold medial knee and apply abductive pressure while externally rotating tibia
lateral meniscus - hold lateral knee and apply adductive pressure while internally rotating tibia
what special test can be done on an ankle exam?
Simmonds calf squeeze test for achilles tendon rupture
what are the Ottawa ankle rules?
Any +ve = XR
Tenderness over posterior edge/tip of lateral or medial malleolus
Tenderness at base of 5th metatarsal
Tenderness over navicular
Inability to weight bear (4 steps)
