MSK week: hx & ex (REMS)

Question 1

Cardinal symptoms in MSK history

Answer 1

• injury
• pain
• stiffness
• locking and triggering
• swelling, redness
• deformity and instability
• weakness, loss of function
• loss of sensation

Question 2

What does dysesthesia mean

Answer 2

Abnormal pain

Question 3

What does allodynia mean

Answer 3

Pain produced by normally non-painful stimuli

Question 4

What does GALS stand for

Answer 4

• gait
• arms
• legs
• spine

Question 5

3 screening questions to ask in GALS

Answer 5

1. Pain/stiffness in muscles, joints, back
2. Ability to dress without difficulty
3. Ability to walk up & down stairs without difficulty

Question 6

What arms assessment to do in GALS

Answer 6

LOOK
-hands palm up & down

FEEL
-squeeze MCP for tenderness

MOVE

• hands behind head
• make fist
• squeeze your fingers (grip strength)
• fine precision pinch

Question 7

What leg assessment to do in GALS

Answer 7

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

Question 8

What spine assessment to do in GALS

Answer 8

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)

Question 9

Describe Thomas test

Answer 9

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

Question 10

Describe Trendelenberg test

Answer 10

TEST ABDUCTION MUSCLE WEAKNESS

-ask pt to balance on 1 leg

POSITIVE
-pelvis dips to contralateral side of muscle weakness

Question 11

Purpose of palpating greater trochanter in hip REMS

Answer 11

Feel for bursitis

Question 12

Describe antalgic gait

Answer 12

Waddling gait, due to hip pain

Question 13

Describe Trendelenberg gait. Which side does spine bend towards?

Answer 13

Sign of muscle weakness.

Spine bends towards affected side

Question 14

Purpose of doing straight leg raise in knee REMS

Answer 14

Check for damaged quads tendon/ patella tendon

Question 15

Where to feel for radial, medial, ulnar nerves in hand REMS

Answer 15

Radial: web space of thumb and index

Medial: Index finger pad

Ulnar: Little finger pad

Question 16

Which nerve is tested when asking pt to fully extend their fingers against gravity

Answer 16

Radial N

Question 17

Which nerve is tested when opposing pt thumb abduction

Answer 17

Median N

Question 18

Which nerve is tested when asking pt not to let you break the ring formed by their thumb and little finger

Answer 18

Median N

Question 19

Which nerve is tested when asking pt to spread their fingers apart

Answer 19

Ulnar N (innervates interosseus)

Question 20

What is lordosis

Answer 20

Convex to front

Question 21

What is kyphosis

Answer 21

Concave to front (eg sacrum, thoracic spine)

Question 22

Until what time period is back pain considered acute

Answer 22

Acute: up to 6 weeks

Question 23

Back pain red flags

Answer 23

• 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