MSK Rubric

Question 1

Intro

Answer 1

Name, PA-S, obtain consent, wash hands

Question 2

Inspection

Answer 2

All muscle groups for tone, symmetry, and atrophy

Joints for swelling, deformity, and erythema

Question 3

Palpate - Shoulder

Answer 3

I’m palpating for tenderness and deformity.
I’ll start with the scapula, clavicle to the AC joint, coracoid process, greater/less tubercle, bicipetal tendon grove.
Move down to the humerus, bicep, and tricep.

Question 4

Palpate - elbow

Answer 4

At the elbow, the medial and lateral epicondyle, the olceranon.
Tricep/bicep insertion and the flexor and extensor origins.

Question 5

Palpate- forearm

Answer 5

Radius, Ulna, flexors, and extensors

Question 6

Palpate - wrist

Answer 6

Palpate carpals, distal radius and ulna

Check radial pulses

Question 7

Palpate - hand

Answer 7

Metacarpals, interosseous muscles

Question 8

Palpate - fingers

Answer 8

MCP joints, phalanges, PIP joints, DIP joints, tendons and ligaments

Question 9

Palpate - Spine

Answer 9

Spinous processes, paravertebral musculature, for tenderness or spasms. Bilateral SIJ for tenderness
At this point I will also check the dermatomes of the BUE

Question 10

ROM - Shoulder

Answer 10

Flexion, extension, abduction, adduction, internal rotation, external rotation

Question 11

ROM - Elbow

Answer 11

Flexion, extension, pronation, supination

Question 12

ROM - Wrist

Answer 12

Flexion, extension, radial deviation, ulnar deviation

Question 13

ROM - Fingers

Answer 13

Flexion, extension, adduction, abduction, thumb opposition

Question 14

ROM - C Spine

Answer 14

Flexion, extension, R and L rotation, R and L lateral bend

Question 15

ROM- T spine/L spine

Answer 15

Flexion, extension, lateral bend, rotation

Question 16

Strength - Shoulder

Answer 16

Flexion, extension, abduction, adduction, internal rotation, external rotation

Question 17

Strength - Elbow

Answer 17

Flexion, extension, pronation, supination

Resisted pronation also tests for lateral epicondylitis

Question 18

Strength - Wrist

Answer 18

Flexion, extension, radial deviation, ulnar deviation

Question 19

Strength - Fingers

Answer 19

Flexion, extension, adduction, abduction, thumb opposition

Question 20

Strength - C spine

Answer 20

Flexion, extension, R and L rotation

Question 21

Special Tests - Shoulder

Answer 21

Speeds - Bicipital tendonitis
Empty Can - rotator cuff weakness
Neers - impingement
Drop arm - rotator cuff tear
Hawkins - impingement

Question 22

Special Tests - wrist

Answer 22

Tinels - tap for median nerve irritation
Phalens - wrist flexion for medial nerve entrapment
Finkelstein - 1st dorsal extensor compartment tendonitis

Question 23

Palpation - Pelvis

Answer 23

Again, palpating for tenderness or deformity.

Anterior sacroiliac spine, posterior sacroiliac spine, sacrum, and greater trochanter

Question 24

Palpation - Thigh

Answer 24

Femur, quadriceps, bicep femoris

Question 25

Palpation - Knee

Answer 25

Patella, femoral condyles, tibial plateau, tibial tuberosity, fibular head, and medial/lateral joint lines

Question 26

Palpation - leg

Answer 26

Tibia, fibula, gastrocnemius

Question 27

Palpation - ankle

Answer 27

Medial and lateral malleolus, tibial/talar joint, ATF ligament, deltoid ligament, achilles I will also check the PT and DP pulses while I'm here

Question 28

Palpation - foot

Answer 28

Calcaneus, tarsals, metatarsals, digits, flexor and extensor tendons. Now I will do a BLE dermatomal check

Question 29

ROM - Hip

Answer 29

Flexion, extension, abduction, adduction, internal rotation, external rotation

Question 30

ROM - Knee

Answer 30

Flexion, extension

Question 31

ROM - Ankle

Answer 31

Flexion, extension, inversion, eversion

Question 32

Strength - Hip

Answer 32

Flexion, extension, abduction, adduction

Question 33

Strength - Knee

Answer 33

Flexion, extension

Question 34

Strength - Ankle

Answer 34

Flexion, extension, inversion, eversion

Question 35

Special tests - Hip/pelvis

Answer 35

Thomas - tightness of the psoas

Question 36

Special tests - Knee

Answer 36

``` Bulge - Knee effusion Anterior/posterior drawer - for ACL laxity Lachmans - ACL laxity Varus/Valgus stress - MCL/LCL laxity McMurray - for meniscal cartilage tear ```

Question 37

Special tests - ankle

Answer 37

Anterior drawer - ligamentous stability Talar tilt - ankle stability Thompson - achilles tendon

Question 38

Special tests - Spine

Answer 38

Supine straight leg raise - pain at 60 degrees or below positive for L4 L5 S1 nerve root irritation Have patient sit up and do Hoffmans test for cervical stenosis Have patient stand and do Trendelenburg for hip abductor weakness Scoliosis check