MSK-LE

Question 1

Landmarks

Answer 1

Inf Scapula- T7
Spine of Scapula-T4
C7-biggest bone in cerivical spine
Last rib-T12
Iliac crest- L4
PSIS-S2

Question 2

Bursa

Answer 2

Ischial bursitis- pt. has history of tenderness with sitting on hard surface on the sits bone; usually thin, boney frame

Trochanteric bursitis- tenderness of the bursa with radiation into the anterior/lateral thigh. Biggest bursa

Question 3

Sciatica

Answer 3

Common fibular n. (pierces piriformis sometimes)
Tibia n.
True sciatica radiates pain below the knee
Check straight leg raise for lumbar radiculopathy

Question 4

Pain referral

Answer 4

HIp pain- referred from back
Neck pain- referred from upper back
Shoulder pain- check neck and back

Question 5

HIP EXAM

Answer 5

INspect: gait; symmetry, atrophy, skin, deformity; leg length discrepancy (true or apparent)
Trendelenburg gait: if opposite drops during gait, ipsilateral GM weak
If patient is not ambulatory and/or in severe pain check one leg shorter and hip rotated (hip displaced)

Palpation: iliac crest, ASIS, greater trochanter, inguinal ligament, PSIS, SI joints, ischial tuberosity, bursae

Active ROM and Strength: flexion, extension, abduction, adduction, internal and external rotation
Passive ROM if indicated

Question 6

Knee compartments

Answer 6

Medial compartment
Lateral compartment
Patellofemoral compartment

Question 7

Patellar Tendon

Answer 7

tenderness or inability to extend knee may suggest complete or partial tear of patellar tendon
Patella Alta
AROM EXT w/ any ant. KNEE pain

Question 8

Ligaments and Meniscus

Answer 8

Meniscal palpable along jt line.

Question 9

Examination of the Knee

Answer 9

Inspection: swelling, deformity, quadriceps atrophy
Palpation: femoral and tibial condyles, joint line, patella, tibial tuberosity, posterior aspect of knee, infrapatellar space
ROM & Strength: flexion (hamstrings), extension (quads)

Question 10

Special Test-Ballotement

Answer 10

joint effusion inside. (rigid spread)

compress suprapatellar pouch then push “ballot” patella and watch for return of fluid to the pouch

Question 11

Bulge

Answer 11

milk effusion down from suprapatellar pouch, then stroke downward on the medial aspect of the knee with pressure to displace fluid into the lateral area then tap just lateral to the patella and look for a bulge in the medial compartment

Question 12

Balloon sign-

Answer 12

compress suprapatellar pouch downward and feel for fluid wave around the patella (medially and laterally)

Question 13

Varus and Valgus

Answer 13

Valgus-slightly abducted. hand at the lateral aspect of the knee joint and the other hand at the medial aspect of the distal tibia. valgus stress is applied 0 (PCL and condlyles protects) and 30deg (MCL only)

Varus- hand at the medial aspect of the patient's knee and the other hand at the lateral aspect of the distal fibula. varus stress is applied 0 and 30deg. a soft or absent end point indicates 
complete rupture (third-degree tear) of the ligament.

Question 14

Lachman’s: ACL

Answer 14

effusions immediately 10-20m.following the injury. 15-30deg flx. Stablize Femur, then attempts to sublux the tibia anteriorly. Lack of a clear end point indicates a positive

Question 15

Anterior drawer: ACL

Answer 15

a supine position knee flexed to 90 degrees. slight external rotation (by sitting on the foot) and then places thumbs at the tibial tubercle and fingers at the posterior calf. pulls anteriorly and assesses anterior displacement of the tibia

Question 16

Posterior drawer: PCL

Answer 16

Inspect- (posterior sag sign).
a supine position knee flexed to 90 degrees. foot neutral (by sitting on the foot) and then places thumbs at the tibial tubercle and fingers at the posterior calf. pulls anteriorly and assesses anterior displacement of the tibia

Question 17

McMurray’s: meniscus

Answer 17

graps heel with one hand and the knee with the other hand. thumb is at the lateral joint line, and fingers are at the medial joint line. flexes the patient’s knee maximally.
To test lateral meniscus: the tibia is rotated internally, and the knee is extended from maximal flexion to about 90 degrees; added compression to the lateral meniscus can be produced by applying valgus stress across the knee joint while the knee is being extended.
To test the medial meniscus, the tibia is rotated externally,
A positive test produces a thud or a click, or causes pain in a reproducible portion of the range of motion.

Question 18

patellofemoral syndrome:

Answer 18

Patella grind test:
EXt knee. Pt contracts quads. +pain
nonspecific term for pain in front/center of knee, can be from chondromalacia patella, patellar tendonitis;

Question 19

Ankle Exam

Answer 19

Inspection: swelling, deformity(hallux valgus), callus or wound, redness

Palpation: malleoli, ligaments (medial and lateral), Achilles tendon, joints of ankle and toes. nodules, warmth, tenderness.

ROM,Strength: dorsiflexion, plantar flexion (toes and ankle), inversion and eversion; flexion, extension, abduction, adduction of the toes

Question 20

Thompson

Answer 20

Squeeze Achilles

Question 21

Anterior Drawer

Answer 21

ATFL stability
Stabilize Tibia
Anter shear of talocrual jt

Question 22

Cutanaeuos n

Answer 22

Dorsiflexion- deep fibular
Plantarfelxion- tibia n.
Inversion- Superfic fib
Eversion-Tibia