MSK week: hx & ex (REMS) Flashcards
Cardinal symptoms in MSK history
- injury
- pain
- stiffness
- locking and triggering
- swelling, redness
- deformity and instability
- weakness, loss of function
- loss of sensation
What does dysesthesia mean
Abnormal pain
What does allodynia mean
Pain produced by normally non-painful stimuli
What does GALS stand for
- gait
- arms
- legs
- spine
3 screening questions to ask in GALS
- Pain/stiffness in muscles, joints, back
- Ability to dress without difficulty
- Ability to walk up & down stairs without difficulty
What arms assessment to do in GALS
LOOK
-hands palm up & down
FEEL
-squeeze MCP for tenderness
MOVE
- hands behind head
- make fist
- squeeze your fingers (grip strength)
- fine precision pinch
What leg assessment to do in GALS
LOOK
-feet soles (for ulcers, callouses)
FEEL
- temperature for whole leg, on and below knee
- MTP for tenderness
- Patella tap
MOVE
- flex and extend knees (feel for crepitus)
- hip internal rotation
What spine assessment to do in GALS
LOOK
- behind (scoliosis)
- side (lordosis, kyphosis)
FEEL
-spine alignment
MOVE
- move ears towards shoulder
- move jaw from side to side
- touch toes (place fingers on lumbar spine)
Describe Thomas test
TEST FOR FIXED FLEXION DEFORMITY
- lie pt flat
- keep 1 hand under pt’s back to remove lumbar lordosis
- ask pt to flex their opposite knee and pull it back with their hands (fix pelvis in place)
POSITIVE
-other leg lifts off couch
Describe Trendelenberg test
TEST ABDUCTION MUSCLE WEAKNESS
-ask pt to balance on 1 leg
POSITIVE
-pelvis dips to contralateral side of muscle weakness
Purpose of palpating greater trochanter in hip REMS
Feel for bursitis
Describe antalgic gait
Waddling gait, due to hip pain
Describe Trendelenberg gait. Which side does spine bend towards?
Sign of muscle weakness.
Spine bends towards affected side
Purpose of doing straight leg raise in knee REMS
Check for damaged quads tendon/ patella tendon
Where to feel for radial, medial, ulnar nerves in hand REMS
Radial: web space of thumb and index
Medial: Index finger pad
Ulnar: Little finger pad
Which nerve is tested when asking pt to fully extend their fingers against gravity
Radial N
Which nerve is tested when opposing pt thumb abduction
Median N
Which nerve is tested when asking pt not to let you break the ring formed by their thumb and little finger
Median N
Which nerve is tested when asking pt to spread their fingers apart
Ulnar N (innervates interosseus)
What is lordosis
Convex to front
What is kyphosis
Concave to front (eg sacrum, thoracic spine)
Until what time period is back pain considered acute
Acute: up to 6 weeks
Back pain red flags
- Extremes of age
- Thoracic location
- Night pain
- Fever, sweats, weight loss
- Hx of cancer, recent infection
- Hx of immunosuppression
- Neurological deficit eg loss of bladder and bowel control
