Musculoskeletal Clinical Assessment Flashcards
What are examples of orthopaedic symptoms and signs?
- Something feels wrong
- Pain
- Dysaesthesiae
- Weakness
- Something moves wrong
- Stiffness
- Reduced RoM
- Limp
- Instability
- Crepitus (feeling of grinding within joints)
- Something looks wrong
- Swelling
- Deformity
- Wasting
- Shortening
- Discolouration (such as redness, pallor, bruising)
- Wounds
What are examples of questions to ask to assess severity of symptoms?
- Wake at normal time or woken by pain
- How are they first thing in the morning
- Dressing
- Cut own toenails
- Can they get in and out of bath
- Walking distance on flat
- And stairs
- Driving
- Shopping
- Work/hobbies
What does red flags mean?
Suggests serious pathology such as infection or malignancy
What are examples of red flags?
- Severe and worsening pain
- Night pain disturbing sleep
- Non-mechanical pain
- General malaise, febrile, rigors
- Unexplained weight loss, anorexia, night sweats
- Past history of malignant disease
What are some important allergies to know about for orthopaedics?
- Any known allergies
- Iodine
- Penicillin
- Iodine
- General anaesthetic
- Latex
- Elestoplast
What screening is often part of MSK examination?
GALS screen is used:
- Gait, arms, legs and spine
- Rapid screen for MSK and neurological deficits and functional ability
What are the 4 aspects of GALS screen?
Gait, arms, legs and spine
Describe some of the principles of MSK examination?
- Private room
- Chaperone perhaps
- Space to observe gait
- Always compare right and left
- Always examine normal side first
- Convention for description of deformity
- Valgus = away from midline
- Varus = towards midline
- Anatomical position is 0o for all joints (extended elbow is 0 not 180)
Describe the convention for describing deformities?
- Convention for description of deformity
- Valgus = away from midline
- Varus = towards midline
What describes a deformity away from midline?
Valgus
What describes a deformity towards the midline?
Varus
In the anatomical position, what should be remembered about angles of joints?
- Anatomical position is 0o for all joints (extended elbow is 0 not 180)
How are fingers described?
Name fingers (never number)
In the hand, what is used instead of lateral/medial?
Radial and ulnar
In the hand, what is used instead of anterior/posterior?
Dorsal and volar/palmar
Describe the steps of introducing yourself in orthopaedics?
- Introduce your own full name and role
- Check patients name and age
- In orthopaedics we use formal address, so Mr Jones not Mike etc
- Explanation of proposed examination
- Consent
- Any painful/tender sites
In orthopaedics, how should patients be addressed?
Always formally, such as Mr Smith not David Smith
Why should process of examination be systematic?
So nothing is missed
Describe MSK examination in terms of look, feel and move?
- Look (observe)
- Posture
- Note any negatives such as amputations
- Gait
- Skin
- Scars, wounds, sinuses, ulcers
- Colour – redness, bruising, pallor, cyanosis, blae, black, shiny, hairless, atrophic, vascular markings
- Swelling
- Wasting
- Deformity
- Limb lengths
- Real and apparent
- Feel (palpate)
- Skin
- Temperature, sweating
- Tenderness
- Note than pain is a symptoms and tenderness is a sign, they are different
- Swelling
- Deformity
- Skin
- Move
- Active (“Would you bend you left elbow Mr Smith”)
- Passive (“Would you relax and let me bend your left elbow Mr Smith”)
- Special tests
- Abnormal movement
- Joint laxity tests
- When move a joint we are interested in
- Range, rate, rhythm
- RoM in degrees or % or vs normal side
- Accompanied by pain, crepitus, stiffness
- Rhythm/smoothness, laxity/hypermobility
- Muscle tone
- Power/strength
- Joint laxity/hypermobility
- X-ray
What things are observed in MSK examination?
- Posture
- Note any negatives such as amputations
- Gait
- Skin
- Scars, wounds, sinuses, ulcers
- Colour – redness, bruising, pallor, cyanosis, blae, black, shiny, hairless, atrophic, vascular markings
- Swelling
- Wasting
- Deformity
- Limb lengths
- Real and apparent
What are the different ways of assessing movement of a joint?
- Active (“Would you bend you left elbow Mr Smith”)
- Passive (“Would you relax and let me bend your left elbow Mr Smith”)
- Special tests
- Abnormal movement
- Joint laxity tests
What are some examples of tets to test joint movement?
- Abnormal movement
- Joint laxity tests
When we move a joint we are interested in what?
- Range, rate, rhythm
- RoM in degrees or % or vs normal side
- Accompanied by pain, crepitus, stiffness
- Rhythm/smoothness, laxity/hypermobility
- Muscle tone
- Power/strength
- Joint laxity/hypermobility
If you examine a joint, what else should be examined?
- In any joint examination, must examine joints above and below
