Musculoskeletal

Question 0

Temporal Mandibular Joint

ROM

Answer 0

Open Mouth - 3-6cm or three fingers
Lateral Motion - 1-2cm
Stick out lower jaw, looking for protrusion without deviation

Question 1

Order of Examination for Musculoskeletal Exam

Answer 1

Inspection
Palpation
Range of Motion
Muscle Testing

Question 2

Cervical Spine

ROM

Answer 2

Chin to chest - 45
Lift chin to ceiling - 55
Ear to shoulder - 40
Turn chin to shoulder(shoulder check) - 70

Question 3

Shoulders

ROM

Answer 3

Forward flex action (move arm from side straight up above head) 0 at hip, 180 above head
Hyperextension (from hip pushed back) 50
Abduction from side to above head 0-180
Adduction from hip across 50
Internal rotation (hands Palm out, on small of back) 90
External rotation (hands behind head) 90

Question 4

Elbow

ROM

Answer 4

Bend and straighten elbow 160 flexion, 0 extension
Pronation 90
Supination 90

Question 5

Wrist and Fingers

ROM

Answer 5

Flexion of Wrist 90
Hyperextension of Wrist 70
Flexion of Fingers 90
Hyperextension of Fingers 30
Radial Deviation 20
Ulnar Deviation 55
Fist
Spread Fingers 20
Touch thumb to each finger and base of little finger

Question 6

Hip

ROM

Answer 6

Flexion with straight Knee 90
Flexion with bent Knee 120
Internal rotation 40
External rotation 45
Adduction 30
Abduction 45
Hyperextension 15

Question 7

Knee

ROM

Answer 7

Flexion 130

Hyperextension 0 - 15

Question 8

Foot and Toes

ROM

Answer 8

Plantar flexion 45
Dorsal flexion 20
Eversion 20
Inversion 30

Question 9

Spine

ROM

Answer 9

Flexion 90
Extension 30
Lateral bending 35 each side
Rotation 30 each side

Question 10

Cervical Spine

Answer 10

Inspect alignment of head, which should be held erect and on the midline. Musculature should be bilaterally symmetrical

Palpate spinous process

Palpate sternomastoid, trapezius, and paravertebral muscles. They should be firm and without spasm or tenderness

Range of motion: extension, flexion, lateral bending, and rotation

Repeat motions against resistance of your hand to test muscle strength

Question 11

Shoulders

Answer 11

Inspect and compare both shoulders prosteriorly and anteriorly. Look at size and contour of joint, colour, for swelling, masses or deformities. Look for muscular atrophy.

Palpate both shoulders noting muscle spasm, atrophy, swelling, heat, or tenderness. Start at clavical and methodically explore: acromioclavicular joint, scapula, greater tubercle or numerous, area of subacronomical bursa, biceps groove, and the anterior aspect of the glenhumoral join. Palpate the auxilla, no adenopathy or lumps should be present

Feel for crepitus during range of motion testing

Range of motion: forward flexion, hyperextension, internal rotation, abduction, adduction, external rotation

Have patient flex shoulder forward and up, then abduct them against your resistance.

Question 12

Elbow

Answer 12

Inspect area around joint expecting no swelling or discolouration, comparing bilaterally for symmetry and similar appearance. Looking at the shape and contour. There should be no masses or deformity

Support patients wrist and palpate elbow with arm at 70 degrees.

Palpate olecronin process, medial and lateral grooves of the epicondyles of the humerus. Thumb on lateral and fingers on medial groove. Note the temperature, any swelling, synovial thickening, tenderness, nodules or masses. Palpate the muscles, bony articulations and area of joint capsule.

Test range of motion: flexion, pronation and supination

Test strength by stabilizing patients arm at elbow and applying resistance to flexion and extension with your hand distal to their wrist

Question 13

Temporomandibular Joint Exam

Answer 13

Inspect area anterior to ear, there should be no swelling, discolouration, masses or deformity. Note size and contour of joint. It should be symmetrical bilaterally

Palpate the joint with first to fingers on sides of face in front of ears. Note the temperature, any swelling, tenderness, or masses. Palpate the muscles,crony articulations and area of joint capsule.

Have patient open mouth while you feel for crepitus. Should open 3-6 cm. patient should bite down while you palpate temporalis and masseter muscles. Compare bilaterally for evenness in size, firmness and strength. Have patient open mouth a little and move side to side, should move 1-2cm. Have patient move jaw forward. There should be no deviation.

Movements should be repeated against your resistance

Question 14

Hand and Wrist Exam

Answer 14

Inspect the hands and wrists on dorsal and palmar sides. Note position, contour and shape. Normally there is no swelling, redness, deformity,or nodules are present. Skin should look smooth with wrinkles over knuckles. There should be no lesions. Muscles are full, in particular at base of them and pinky

Palpate the wrist with thumbs on dorsal side. Joints should feel smooth, without swelling, boggyness, nodules or tenderness.

Palpate metacarphalangeal joint with thumbs. Use thumb and index finger to Palpate interphalangeal joints. Normally no thickening, tenderness, warmth or nodules are present.

ROM: extension of fingers and of wrist. Flexion of fingers and wrist, radial and ulnar deviation, abduction of fingers, fist, touch thumb to fingers and base of pinky.

Test strength by placing one hand on forearm and other in hand. Have them flex against resistance.

Phalen test and tinel’s sign

Question 15

Hip

Answer 15

Inspect while standing. Note iliac crests, gluteal folds and equal-sized buttocks. Have them take a few steps, gait should be smooth and even. Check hyper extension at this time!

With patient in supine position, Palpate joints. They should feel stable and symmetrical without tenderness or crepitation

Test ROM flexion with straight leg, flexion with bent knee, external and internal rotation, abduction, adduction and hyperextension

Question 16

Knee

Answer 16

Inspect standing and laying

Leg should extend on same axis as thigh. Inspect thought for atrophy. Inspect shape and contour. Noting swelling, colour.

Palpate in supine position starting 10cm up thigh. Explore supra patellar pouch. Muscle and soft tissue should feel solid, the joint smooth with no warmth, tenderness, thickening or nodularity. Inspect tibiofemoral joint, noting smooth margins and absence of pain. Palpate infra patellar fat pad and patella.

Check for crepitus by holding hand on patella as knee is flexed and extended.

ROM: flexion, extension, ambulation

While seated, ask patient to maintain flexion while you try to pull leg forward

Have patient rise from squat or low chair without using hands for support

Question 17

Ankle and Foot

Answer 17

Inspect while patient is sitting in a non weight bearing position, while standing and while walking. Compare both feet noting position of toes. Normally in line with long axis of lower leg. Note contour of joints

Weight bearing should be in the middle of foot from heel, along the mid foot, to between the second third toes.

Toes point straight forward and lie flat. Normally skin is smooth without lesions and with even colour

Palpate ankle by grasping heel with fingers while palpating with thumbs. Explore joint spaces, which should feel smooth and depressed, with no fullness, swelling or tenderness.

Question 18

Spine Examination

Answer 18

With patient standing, inspect back with gown open. Note if spine is straight from head through spinous process and down through the gluteal cleft. Note equal horizontal position of shoulders, scapulae, iliac crests, and gluteal folds. Space between lateral sides for thorax and arms should be symmetrical. Feel and knees should be aligned with trunk and be pointed forward.

Normally from side the is a convex thoracic and concave lumbar curve.

Palpate spinous process, normally straight and non tender. Paravertebral muscles should feel firm with no tenderness or spasm

Forward flexion, extension, lateral bends, rotation

Walk on toes, walk on heels