Musculoskeletal Clinical Assessment Flashcards
What are the GALS Screening Questions for MSK history as part of systematic enquiry?
Do you have any pain or stiffness in your muscles, joints or back?
Can you dress yourself completely without any difficulty?
Can you walk up and down stairs without any difficulty?
What are the orthopaedic symptoms that you should ask about in MSK history?
Pain, dysaesthesia, weakness (something feels wrong)
Stiffness, reduced range of movement e.g. locking, limp, instability/collapse, crepitus (something moves wrong)
Swelling, deformity, wasting, shortening, discolouration, wounds (something looks wrong)
What are the questions you would ask when taking an MSK history of a typical day, in order to assess the severity of symptoms?
Wake at normal time or woken by pain
How are they first thing in the morning? Is the pain/swelling/stiffness etc. at its worst?
How long does it take to get going/do they have to do exercises?
Dressing - ease of putting on socks and tying shoelaces
Can they cut their own toenails?
Can they get in and out of a bath?
How far can they walk on a flat surface? What stops them from walking e.g. pain?
Any use of walking aids, ability to go up and down stairs and walk on rough ground
Do they drive/do their own shopping?
Work and hobbies?
What are the components of MISTI THREAD in PMH?
MI - myocardial infarction
S - stroke
T - thrombosis (DVT/PE)
I - Icterus (jaundice)
T - TB H - hypertension R - rheumatic fever E - epilepsy A - asthma D - diabetes
What are the important allergies to ask about specifically in MSK?
Any known Penicillin Iodine General anaesthetic Latex Elastoplast/SAT
What are the important drugs to ask about in MSK?
Current and recent Any prescribed by doctor IVDA OCP Aspirin, warfarin, clopidogrel - why they are taking it and whether it is safe to stop NSAIDs - effectiveness and side effects Steroids - side effects
What are the red flags for MSK symptoms?
Severe and worsening pain Night pain disturbing sleep Non-mechanical pain General malaise, febrile, rigors Unexplained weight loss Anorexia Night sweats PMH of malignant disease
What does GALS screen stand for?
Gait
Arms
Leg
Spine
What is the GALS screen?
Rapid screen for MSK and neurological deficits and functional ability
Used as part of systematic examination
What should you do when carrying out a regional examination of the MSK system?
Ensure a quiet, private room, +/- chaperone, well lit and warm
Make sure you have space to observe gait as well as an examination bed
Adequate exposure and position
Always compare right and left, examine the normal side first
Expose and compare left and right when standing and when lying
When examining children, be careful not to overwhelm them e.g. examine them while sitting on parents lap, divert attention etc.
What are you looking for in a local MSK examination?
Look at any available x-rays first
Do not try to move a fresh fracture
Look, feel, move, x-ray
What are you looking for in MSK examination?
Posture - patient and limb, especially lower limb when weight bearing
Note relevant negatives and obvious positives e.g. amputation
Gait - any limp
Skin - scars, wounds, sinuses, ulcers, colour, shiny, hairless, thin, atrophic
Swelling
Wasting - for hip problems look at gluteal muscles, for knee problems look at thigh, for foot or ankle look at the calf; disuse, neurological, cachexia
Deformity - asymmetry, palpate for normal anatomical landmarks, are they in the right place?
Limb lengths - real and apparent
What is the real limb length?
Length from ASIS/greater trochanter/tibial tuberosity to the medial malleolus
What is the apparent limb length?
Midline marker e.g. xiphisternum or umbilicus to medial malleolus
What are you feeling for in MSK examination?
Systematic anatomical palpation, feeling for relationship of bony landmarks and surface anatomy
Start away from the painful area
Skin - temperature, sweating, capillary filling
Tenderness - localised or diffuse
Swelling
Deformity - palpate for normal anatomical landmarks, note whether in the right place and non-tender
