MSK-neuro assessment

Question 1

Subjective MSK

Answer 1

• joint pain
• inflammation
• limited movement
• past hx of musculoskeletal injury, trauma, or surgeries
• muscle pain
• spasms/twitching
• numbness
• tingling
• weakness
• family hx of arthritis, osteoporosis

Question 2

Subjective neuro

Answer 2

• headaches
• head injuries
• dizziness
• seizures
• tremors
• problems with swallowing
• speaking
• balance
• coordination
• falls
• hx of strokes, spinal cord injuries, meningitis, exposure to environmental toxins
• family hx of stroke, MS, fibromyalgia, parkinson’s disease

Question 3

Subjective function and self-care

Answer 3

• ADLs
• do they function like they want
• use of assistive devices
• exercise program

Question 4

Mental status

Answer 4

• LOC
• appearance
• mood/affect
• speech pattern
• continuity of thought (recent memory)

Question 5

Spinal assessment and cerebellar function (balance/coordination)

Answer 5

• Note gross symmetry and inspect spinal curvature (midline, no scoliosis, kyphosis)
• palpate spinal processes (note swelling, tenderness, heat, redness)
• Test spinal ROM (standing), note pain, limited movement
• Observe natural walk (note gait-smooth, rhythmic, effortless, not limping, no grimacing)
• Observe squatting (note range of motion, pain, balance)
• Perform Romberg’s sign test (+ or - for loss of balance)
• Tandem walk (heel/toe) note staggering, balance

Question 6

CN I-XII, TMJ

Answer 6

• Inspect face (note drooping, asymmetry, redness, swelling, ptosis)
• CN I- check sense of smell using extracts (intact)
• CN II- check visual acuity with hand held snellen (both eyes)
• CN III, IV, VI- PEERLA, extraocular movements (all 6 diagnostic positions)
• CN V and TMJ- test facial sensation with cotton ball. test mastication muscles (note muscle strength, pain limited movement- TMJ)
• CN VII- facial muscle tone and movement (raise eyebrows, close eyes tightly, smile, frown, puff out cheeks) Note symmetry, strong/smooth movement. Check taste
• CN IX,X,XII- swallowing, pharynx movement, gag reflex, speech, tongue movement
• CN XI and cervical spine- Test sternomastoid and trapezius muscles against resistance, test cervical spinal movement

Question 7

Shoulders

Answer 7

• inspect and palpate joints for swelling, redness, tenderness, heat, nodules
• test shoulder ROM and strength ( note full range of motion without pain)

Question 8

Elbows

Answer 8

• Inspect and palpate joints for swelling, redness, tenderness, heat, nodules
• Test elbow ROM and strength (note full range of motion without pain)
• Bicep DTR
• Tricep DTR

Question 9

Wrists and fingers

Answer 9

• Inspect and palpate wrist and finger joints for swelling, redness, tenderness, heat, nodules
• Test finger and wrist ROM
• Test finger/hand muscle strength (squeeze hands) note bilaterally equal strength

Question 10

Tests

Answer 10

• Check for Tinel’s sign, or phalen’s sign (median nerve)
• Test RAM (rapid alternating movements)
• Test Graphesthesia (number traced on hand) or Stereognosis (ID an object)

Question 11

Hips

Answer 11

• Verbalize need to visually inspect and palpate hip joints for swelling, redness, tenderness, heat, nodules
• Test hip ROM- flexion, rotation, abduction and adduction (note full ROM without pain)

Question 12

Knees

Answer 12

• Inspect and palpate knee joints for swelling, redness, tenderness, heat, nodules. Note the patella is freely moveable
• Test ROM and strength (note full ROM without pain)
• Achilles DTR

Question 13

Ankles

Answer 13

• Inspect and palpate ankle joints for swelling, redness, tenderness, heat, nodules
• Test ROM and strength (note full ROM without pain)
• Achilles DTR

Question 14

Feet

Answer 14

• Inspect and palpate toe joints for swelling, redness, tenderness, heat, and deformities
• Test ROM (ask patient to flex and extend toes)
• Perform vibration test (posterior column tract)
• Accurately perform monofilament test (9-10 locations)