MSK hand, elbow and shoulder Flashcards
What do you ask before any of the examinations?
Whether they have any pain?
what skin changes are you looking for in the hands?
Erythema –> cellulitis
Pallor–> PVD
Thinning –> long term steroid use
Rashes–> psoriatic plaque
What abnormalities are you looking for in the nails?
pitting/ Oncholysis (psoriatic changes)
Nail vasculitis and infective endocarditis (ra)
What are the abnormalities in the hand for RA?
Swan neck deformity
Z-thumb
Boutonnières deformity
Ulnar deviation
What are the deformities you see in OA in the hand?
- Bouchard’s node
* Herbeden’s node
What features are you looking for when the palm is facing up in inspection?
Muscle wasting in thenar and hypothenar eminence
Dupytren’s contracture
Elbows for psoriatic plaque and rheumatoid nodules
Scar for CPT
What do you palpate with the palms facing up?
Hypothena and thenar area
temperature
where do you feel for sensation for
a) median nerve
b) ulnar nerve
c) radial nerve
a) thenar and index finger
b) hypothenar and little finger
c) back of hand near thumb
When assessing temperature what part of the arm are you palpating?
From elbow to the hands
What joints do you squeeze for assessment of pain for RA?
Squeeze across row of MCP
Why do you manually palpate all of the joints in the hand?
For signs of bone swelling or synovitis
Why do you run your hands down the ulnar border of the forearm ?
For rheumatoid nodules or psoriatic plaques
What test is done to assess the present of carpal tunnel syndrome?
Phalen’s test
Tinnel’s test
What is Phalen’s test?
It is forced flexion of the wrist for 60 seconds
Where do you palpate for fracture of scaphoid?
Anatomical snuff box
What are the bones in the wrist from proximal to distal?
Proximal =Scaphiod, lunate, triquetrum, pisiform
Distal= Trapezium, trapeziod, capitate, hamate
How do you test for radial nerve function?
wrist, hand extension against resistance
What nerve are you testing when doing thumb abduction abduction resistance
median nerve
How do you test for the function of ulnar nerve?
finger abduction against resistance
What are the three function tests do you do?
Squeeze my hand
Pincer grip my hand
Pick a penny up
What are the two special test?
Phanels test
Tinnels test
How do you do Tinnel’s test?
Tap over the carpal tunnel and should cause symptoms of CPT
When doing a hand msk examination should you rest the wrist on a pillow?
Yes
When looking at the elbow directly what are you looking for?
Scar
Swelling/erythema
Carrying angle
When looking at the elbow from the side what are you looking for?
Bursitis and hyperflexion and extension
Muscle wasting
When looking at the elbow from behidn what are you looking for?
Rhuematic nodules
Psoriatic plaques
rashes/muscle wasting
What is another name for
a) medial epicondylitis
b) lateral epicondylitis
a) golfers elbow
b) tennis elbow
How do you test for the function of the elbow?
Can they touch their nose with their fingers
Can they touch the back of their hand
What actions are done passively and actively in elbow examination?
Extension and flexion
Pronation and supination
What is the name of the two test for tennis elbow?
Conzens test
Mills test
How do you test for golfer elbow?
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
How do you do the Mills test for tennis elbow?
1,Position the patient standing
- Stabilise the elbow whilst also palpating the lateral epicondyle
- Passively pronate the patient’s forearm
- Flex the patient’s wrist
- Extend the forearm fully
How do you assess for frozen shoulder?
Ask patient to put flexed elbows next to their side then assess them to spread their arms
How do you assess the movement of the scapula?
Ask the patient to abduction of their arm while you palpate their scapula
What are the special test that you would do?
Supraspinator assessment
Painful arc
External rotation assessment
Internal rotation assessment
What muscle are you testing for when doing internal rotation against resistance?
Subscapularis muscle
What muscle are you testing for in painful arc?
Deltiod and supraspinator
