Musculoskeletal Clinical Assessment Flashcards

1
Q

What are the GALS Screening Questions for MSK history as part of systematic enquiry?

A

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?

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2
Q

What are the orthopaedic symptoms that you should ask about in MSK history?

A

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)

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3
Q

What are the questions you would ask when taking an MSK history of a typical day, in order to assess the severity of symptoms?

A

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?

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4
Q

What are the components of MISTI THREAD in PMH?

A

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
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5
Q

What are the important allergies to ask about specifically in MSK?

A
Any known 
Penicillin
Iodine
General anaesthetic
Latex
Elastoplast/SAT
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6
Q

What are the important drugs to ask about in MSK?

A
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
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7
Q

What are the red flags for MSK symptoms?

A
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
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8
Q

What does GALS screen stand for?

A

Gait
Arms
Leg
Spine

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9
Q

What is the GALS screen?

A

Rapid screen for MSK and neurological deficits and functional ability
Used as part of systematic examination

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10
Q

What should you do when carrying out a regional examination of the MSK system?

A

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.

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11
Q

What are you looking for in a local MSK examination?

A

Look at any available x-rays first
Do not try to move a fresh fracture
Look, feel, move, x-ray

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12
Q

What are you looking for in MSK examination?

A

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

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13
Q

What is the real limb length?

A

Length from ASIS/greater trochanter/tibial tuberosity to the medial malleolus

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14
Q

What is the apparent limb length?

A

Midline marker e.g. xiphisternum or umbilicus to medial malleolus

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15
Q

What are you feeling for in MSK examination?

A

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

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16
Q

What movements should you carry out in MSK examination and what are you looking for?

A

Active and passive movements
Special tests for abnormal movements, joint laxity tests etc.
Range, rate and rhythm of movements
Range of movement - degrees or percentage vs normal side, comparison between sides
Whether movements are accompanied by pain, crepitus or stiffness
Rhythm/smoothness
Laxity/hypermobility, tenodesis
Muscle tone
Power/strength
Joint laxity/hypermobility

17
Q

What must you do in any joint examination?

A

You must examine the joint above and below e.g. examine hips if complaining of knee pain and examine spine for any limb symptoms
Do a neurovascular examination of the whole limb and consider other relevant systematic examination
Record findings, re-examine and compare

18
Q

What is the convention for describing an MSK deformity?

A

Valgus and varus for knee and hip
Anatomical position - should be 0 degrees for all joints
Name fingers, never number - small, ring, middle, index, thumb
In hand and forearm use ‘radial and ulnar, dorsal and volar’ rather than ‘lateral and medial, posterior and anterior’

19
Q

What is grade 5 of muscle power?

A

The muscle can move the joint it crosses through a full range of motion, against gravity, and against full resistance applied by the examiner

20
Q

What is grade 4 of muscle power?

A

The muscle can move the joint it crosses through a full range of motion against moderate resistance

21
Q

What is grade 3 of muscle power?

A

The muscle can move the joint it crosses through a full range of motion against gravity but without any resistance

22
Q

What is grade 2 of muscle power?

A

The muscle can move the joint it crosses through a full range of motion only if the part is properly positioned so that the force of gravity is eliminated

23
Q

What is grade 1 of muscle power?

A

Muscle contraction is seen or identified with palpation, but it is insufficient to produce joint motion even with elimination of gravity

24
Q

What is grade 0 of muscle power?

A

No muscle contraction is seen or identified with palpation; paralysis