MSK OSCE

Question 1

What to look for on low back inspection

Answer 1

Swelling
Erythema
Bruising
Atrophy

Lordosis/kyphosis
scoliosis (lower back)

Question 2

Palpation for lower back

Answer 2

Spinous process
Paraspinous muscles
SI joint

Question 3

Lower back ROM

Answer 3

Flexion

Extension

Question 4

Lower back Strength

Answer 4

L4 – dorsiflexion
L5 – big toe dorsiflexion
S1 – eversion

Question 5

Lower back Reflexes

Answer 5

L4 – patellar
L5 – NONE
S1 – achilles
(ask about and check SADDLE ANESTHESIA)

Question 6

Low back red flags

Answer 6

Bowel or bladder changes
Saddle anesthesia
Constitutional symptoms (fever, wt loss, night sweats, etc)
Hx of cancer
Hx of trauma
Numbness or sensation change
Nocturnal pain
Age -- under 18 or over 50

Question 7

Low back sensation

Answer 7

L4 – medial leg/ankle
L5 – dorsum of foot
S1 – lateral leg/ankle

Question 8

Low back special test

Answer 8

DO ALL BILATERAL

Straight leg raise (for lumbar disc herniation)
FABER (for SI joint or hip dysfunction)
Single leg stork (for spondylolysis)

Question 9

Knee inspection

Answer 9

Swelling
Erythema
Bruising
Atrophy

Limping gait; weight-bearing
Varus/valgus

Question 10

Ankle inspection

Answer 10

Swelling
Erythema
Bruising
Atrophy

Limping gait; weight-bearing
Arches

Question 11

What to look for on shoulder inspection

Answer 11

Swelling
Erythema
Bruising
Atrophy

Deformity (squared shoulder = anterior dislocation)

Question 12

Palpation for shoulder

Answer 12

Sternoclavicular joint
Clavicle
Acromioclavicular joint

Question 13

ROM shoulder

Answer 13

ACTIVE AND PASSIVE
 Flexion
 Abduction
 External/internal rotation

Question 14

Strength for shoulder

Answer 14

 External rotation (infraspinatus) – anchor elbows inside
 Empty can test (supraspinatus)
 Lift-off test/parade rest (subscapularis)

Question 15

Neurovascular for shoulder

Answer 15

Sensation

Radial pulse

Question 16

Special tests for shoulder

Answer 16

Impingement
 Neer’s (Neer the ear! – pronate, passively flex at shoulder)
 Hawkin’s (flap like a Hawk – shoulder 90°, elbow 90°, internally rotate)

Instability
 Apprehension (pt laying down, externally rotate)
 Relocation (cont. from above, press on humeral head)

AC Joint
 Scarf (push down on elbow – pt resists)

Question 17

Palpation for knee

Answer 17

	Medial joint tenderness, MCL
	Lateral joint tenderness, LCL
	Tibial tuberosity/patellar tendon
	IT band
	Pes Anserine Bursa
	Semimembranosus/tendinosis
	Biceps femoris

Question 18

ROM for knee

Answer 18

Flexion

Extension

Question 19

Strength for knee

Answer 19

ACTIVE AND PASSIVE

Flexion
Extension

Question 20

Neurovascular for knee

Answer 20

Sensation

Dorsalis pedis and posterior tibial pulses

Question 21

Special tests for knee

Answer 21

Effusion
 Warm/cold/warm

Patellar testing
	compression
	shrug
	apprehension
	Tenderness facets

Meniscal tear
 McMurray’s
 Thessaly (joint line pain)

Ligamentous tests
	Anterior drawer (ACL)
	Posterior drawer (PCL)
	Lachman’s (ACL)
	Varus (LCL)/Valgus (MCL)

Question 22

Ankle palpation

Answer 22

	Achilles tendon
	Medial malleolus
	Lateral malleolus
	Peroneal tendons
	Base of 5th metatarsal
	ATFL
	PTFL
	CFL
	Deltoid ligament
	Navicular (near dorsalis pedis)
	Tibiofibular syndesmosis

Question 23

Ankle ROM

Answer 23

 Plantarflexion

 dorsiflexion

Question 24

Ankle strength

Answer 24

 Dorsiflexion/plantarflexion

 Inversion/eversion

Question 25

Ankle neurovascular

Answer 25

 Sensation
 Dorsalis pedis
 Posterior tibial pulse

Question 26

Ankle Special tests

Answer 26

 Thompson’s squeeze (squeeze calf, compare sides - Achilles Rupture) – BILATERALLY
 Anterior drawer (stabilize tib, pull calcaneus anterior - ATFL integrity)
 Talar tilt (Varus Stress – CFL integrity)

Question 27

History questions to ask for all

Answer 27

Mechanism of injury (acute or overuse)
Functional disability (how it affects daily life, sleep, etc)
Quantify on 1-10 scale
PMH/PSH
Meds/Allergies