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year 3 OSCE > MSK hand, elbow and shoulder > Flashcards

MSK hand, elbow and shoulder Flashcards

1
Q

What do you ask before any of the examinations?

A

Whether they have any pain?

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2
Q

what skin changes are you looking for in the hands?

A

Erythema –> cellulitis
Pallor–> PVD
Thinning –> long term steroid use
Rashes–> psoriatic plaque

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3
Q

What abnormalities are you looking for in the nails?

A

pitting/ Oncholysis (psoriatic changes)

Nail vasculitis and infective endocarditis (ra)

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4
Q

What are the abnormalities in the hand for RA?

A

Swan neck deformity
Z-thumb
Boutonnières deformity
Ulnar deviation

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5
Q

What are the deformities you see in OA in the hand?

A
  • Bouchard’s node

* Herbeden’s node

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6
Q

What features are you looking for when the palm is facing up in inspection?

A

Muscle wasting in thenar and hypothenar eminence
Dupytren’s contracture
Elbows for psoriatic plaque and rheumatoid nodules
Scar for CPT

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7
Q

What do you palpate with the palms facing up?

A

Hypothena and thenar area

temperature

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8
Q

where do you feel for sensation for

a) median nerve
b) ulnar nerve
c) radial nerve

A

a) thenar and index finger
b) hypothenar and little finger
c) back of hand near thumb

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9
Q

When assessing temperature what part of the arm are you palpating?

A

From elbow to the hands

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10
Q

What joints do you squeeze for assessment of pain for RA?

A

Squeeze across row of MCP

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11
Q

Why do you manually palpate all of the joints in the hand?

A

For signs of bone swelling or synovitis

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12
Q

Why do you run your hands down the ulnar border of the forearm ?

A

For rheumatoid nodules or psoriatic plaques

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13
Q

What test is done to assess the present of carpal tunnel syndrome?

A

Phalen’s test

Tinnel’s test

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14
Q

What is Phalen’s test?

A

It is forced flexion of the wrist for 60 seconds

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15
Q

Where do you palpate for fracture of scaphoid?

A

Anatomical snuff box

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16
Q

What are the bones in the wrist from proximal to distal?

A

Proximal =Scaphiod, lunate, triquetrum, pisiform

Distal= Trapezium, trapeziod, capitate, hamate

17
Q

How do you test for radial nerve function?

A

wrist, hand extension against resistance

18
Q

What nerve are you testing when doing thumb abduction abduction resistance

A

median nerve

19
Q

How do you test for the function of ulnar nerve?

A

finger abduction against resistance

20
Q

What are the three function tests do you do?

A

Squeeze my hand
Pincer grip my hand
Pick a penny up

21
Q

What are the two special test?

A

Phanels test

Tinnels test

22
Q

How do you do Tinnel’s test?

A

Tap over the carpal tunnel and should cause symptoms of CPT

23
Q

When doing a hand msk examination should you rest the wrist on a pillow?

A

Yes

24
Q

When looking at the elbow directly what are you looking for?

A

Scar
Swelling/erythema
Carrying angle

25
Q

When looking at the elbow from the side what are you looking for?

A

Bursitis and hyperflexion and extension

Muscle wasting

26
Q

When looking at the elbow from behidn what are you looking for?

A

Rhuematic nodules
Psoriatic plaques
rashes/muscle wasting

27
Q

What is another name for

a) medial epicondylitis
b) lateral epicondylitis

A

a) golfers elbow

b) tennis elbow

28
Q

How do you test for the function of the elbow?

A

Can they touch their nose with their fingers

Can they touch the back of their hand

29
Q

What actions are done passively and actively in elbow examination?

A

Extension and flexion

Pronation and supination

30
Q

What is the name of the two test for tennis elbow?

A

Conzens test

Mills test

31
Q

How do you test for golfer elbow?

A

1) The patient should be seated or standing
2. Stabilise the elbow whilst palpating the medial epicondyle
3. Passively supinate the forearm
4. Extend the patient’s wrist
5. Extend the patient’s elbow fully

32
Q

How do you do the Mills test for tennis elbow?

A

1,Position the patient standing

  1. Stabilise the elbow whilst also palpating the lateral epicondyle
  2. Passively pronate the patient’s forearm
  3. Flex the patient’s wrist
  4. Extend the forearm fully
33
Q

How do you assess for frozen shoulder?

A

Ask patient to put flexed elbows next to their side then assess them to spread their arms

34
Q

How do you assess the movement of the scapula?

A

Ask the patient to abduction of their arm while you palpate their scapula

35
Q

What are the special test that you would do?

A

Supraspinator assessment
Painful arc
External rotation assessment
Internal rotation assessment

36
Q

What muscle are you testing for when doing internal rotation against resistance?

A

Subscapularis muscle

37
Q

What muscle are you testing for in painful arc?

A

Deltiod and supraspinator

year 3 OSCE (14 decks)

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