MSK OSCE Flashcards
What do you look for in a lumbar spine exam
muscle wasting asymmetry scoliosis (from back) posture normal kyphosis and lordosis (from side)
what do you feel for in a lumbar spine exam
vertebrae and sacroiliac joint for tenderness
para-spinal muscles for tenderness
what do you move in a lumbar spine exam
3 fingers over spine- bend forward (flexion)
lateral flexion (run hand down side of leg)
thoracic rotation (sat down)
straight leg raise (flat on bed- pain= nerve root irritation)
DORSIFLEXION of big toe- L5 nerve root problem
what reflexes do you illicit in a lumbar spine exam
patella
ankle jerk
what end pieces would u discuss in a lumbar spine exam
if indicated:
peripheral nerve exam of the lower limb
peripheral vascular exam of the lower limb
what would you look for in a cervical spine exam
sitting and standing for:
posture
normal cervical lordosis
what do you feel for in a cervical spine exam
palpate the spine for alignment and tenderness
palpate paraspinal muscles, trapezius and upper back muscles for tenderness
what do you move in a cervical spine exam
flexion (tilt head down) and extension (tilt head back)
lateral flexion (ear to shoulder)
what reflexes would you elicit for a cervical spine exam
biceps
triceps
supinator
what end pieces would you discuss for a cervical spine exam
peripheral nerve exam of the upper limb
what would you look for in an elbow exam
in anatomical position
for carrying angle, flexion deformity
scars, rashes, muscle wasting, swelling
feel in elbow exam
temp
palpate elbow joint at 90 degrees flexion (note epidcondyles and olecranon process)
move elbow exam
full range of flexion and extension
pronation and supination
reflexes elbow exam
apparently none
function elbow exam
reach mouth
reach behind head
look foot and ankle exam
with feet overhanging couch:
forefoot for nail changes, rashes, alignment, swelling
footwear for insoles
with weight bearing:
forefoot for toe alignment
mid foot for foot arch position
from behind:
achilles tendon
alignment
feel foot and ankle exam
temp
pulses
squeeze MTP joints
palpate the whole foot including both malleoli, 5th metatarsal and navicular
move foot and ankle exam
inversion and eversion
dorsiflexion and plantar flexion
rotation of mid tarsal joint (fix the heel and invert the foot passively)
function foot and ankle exam
observe gait cycle
for heel strike, stance, toe-off
look hand and wrist exam
palms down for swelling, deformity, wasting, scars,
palms up for muscle wasting at the eminences (thenar wasting= carpal tunnel syndrome) , dupytrens contracture
check for scar at wrist (carpal tunnel surgery)
nails for pitting/ oncholysis (present in psoriasis), clubbing, splinter haemorrhages
feel hand and wrist exam
palms up for muscle wasting, median and ulnar nerve sensation (both eminences and index finger and little finger- should be the same)
palms down for radial nerve sensation (web between thumb and index finger), squeeze MCP joints
temperature of forearm
palpate wrist bimanually
radial pulse
run hand up ulnar border for plaques/ nodules (psoriasis)
move hand and wrist exam
wrist flexion and extension active and passive
finger flexion, extension, adduction and abduction
thumb abduction
function hand and wrist exam
grip 2 fingers with hand to assess grip strength
pinch 1 finger for pincer grip
look hip exam
standing for muscle wasting (note gluteal region bulk)
supine for leg length and deformity and scars
feel hip exam
palpate over greater trochanter for tenderness
move hip exam
with knee flexed assess full hip flexion
Thomas’ test= 1 hand on back- fully flex hip- other leg should stay on bed
Trendelenberg test= stand on one leg- positive= pelvis dipping on contralateral side (bad)
function hip exam
assess gait for limp
look knee exam
swelling, redness, inflammation
muscle wasting, scars
walking aids
feel knee exam
temp
palpate knee joint and behind for baker’s cyst
patellar tap test
move knee exam
active and passive flexion and extension
anterior and posterior drawer test (ACL and PCL)
medial and lateral collateral ligament stability (medial palm over knee, lateral fingers on knee joint to feel joint line)
function knee exam
assess gait
look for bakers cyst
look shoulder exam
front side and behind
for symmetry, posture, wasting, scara
feel shoulder exam
temperature
palpate from sternoclavicular joint all the way round on the clavicle to the scapula
palpate glenohumeral joint from front and back
palpate muscles: supraspinatus, infraspinatus, deltoid
move shoulder exam
hands behind head (External rotation)
hands behind back (internal rotation)
external rotation with elbow flexed at 90 degrees
flexion and extension
abduction (look from behind at scapula)
inspection GALS exam
in anatomical position- front side and back:
- muscle bulk/ wasting
- spine alignment
- limb alignment, carrying angle
- popliteal swelling
- foot abnormalities (arches, hallux valgus)
Gait GALS exam
observe: symmetry length of stride smoothness turning speed
Arms GALS exam
behind head and behind lower back
arms outstretched (palms down) look for swelling squeeze MCP joints
make a fist, squeeze hand, pinch finger
Legs GALS exam
supine inspect for bulk and deformity
knee flexion and extension
patellar tap test
flexion and internal rotation of hip joint
Spine GALS exam
cervical spine movement (up, down, ear to shoulder)
lumber flexion with 3 fingers on spine
