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Clinical Exam > Musculoskeletal exam > Flashcards

Musculoskeletal exam Flashcards

1
Q

Athrogryposis multiplex congenita

A

clinical: contraction of multiple joints and degeneration of motor neurons

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2
Q

Inflammatory arthritis

A

associated findings:

  • eyes: blue sclera, uveitis
  • skin: striae, dermatomyositis rash, neurocutaneous stigmata, SLE rash, psoriatic lesions
  • nails: psoriatic changes
  • dactylitis
  • abdomen: HSM

investigations: check temperature, growth

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3
Q

Scoliosis

A

associated findings:

  • skin: neurocutaneous stigmata, scars
  • neurological examination
  • pubertal staging: worsens in puberty
  • respiratory compromise
  • evidence of Marfan’s if tall

investigations:

  • bloods: inflammatory markers, antinuclear Ab and AI Ab imaging
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4
Q

Wrist

A

palpate: localise tenderness

movements:

  • flexion 80 degrees
  • extension 70
  • radial deviation 20
  • ulnar deviation 30
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5
Q

Elbow

A

movements:

  • flexion 135 degrees
  • extension 0
  • supination 90
  • pronation 90

*supination/pronation test with elbow flexed

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6
Q

Shoulders

A

Range of movement

“Put your hands above your head”

  • flexion 90, abduction 180

“Give yourself a hug”

  • adduction 45

“Scratch your back”

  • internal rotation

“Hide your hands behind your back”

  • internal roation 55, extension 45
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7
Q

Jaw and C-spine

A

jaw

  • test movement TMJ opening and closing
  • feel for crepitus
  • look for micrognatihia and dental malocclusion

C-spine

  • flexion 45
  • extension 50
  • rotation 80
  • lateral flexion 40
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8
Q

Thoracolumbar spine

A

examine child standing and bending forward

  • look for kyphoscoliosis
  • feel for tenderenss
  • range or motion: flexion to toes, extension 30, lateral bending 50, lateral rotation 30
  • functional evaluation: shoes and socks
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9
Q

Lower limbs

A

Gait

Leg length discrepancy

Make child squat: Proximal weakness

Make child stand on each leg: Trendelenburg

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10
Q

Hips

A

Look for wasting

Note resting position

Feel for tenderness

Measure leg length between anterior superior iliac spine and medial malleolus

Movement:

  • flexion 120 degrees
  • extension 30
  • internal rotation 35
  • external rotation 45
  • abduction 50
  • adduction 30

*Internal and external rotation are measured with hips flexed

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11
Q

Ankles/feet

A

Ankle/feet ROM

sub-talar joints:

  • plantar flexion 50
  • dorsiflexion 20
  • inversion 5
  • eversion 5

mid-tarsal joints:

  • abduction 10
  • adduction 20

metatarsophalangeal:

  • plantar flexion 45
  • extension 70
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12
Q

Hand

A

Range of movement

  • MCP flexion 90, extension 30
  • PIP flexion 100
  • DIP flexion 90, extension 10

Assessment

“make a fist”: assesses median/ulnar

“make a star”: radial extends/adducts thumb, ulnar intrincic hand muscles

“make a circle”: medical opposes/flexes thumb

“touch fingers to your thumb”: dexterity, coordination

Function

  • grip
  • use utensils/cup/pencil
  • buttons
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13
Q

Median nerve palsy

A

sensory loss: thumb and lateral fingers

wasting: thenar eminence

motor: weakness thenar eminence, opponens pollicis, lateral 2 lumbicals, adductor pollicis brevis

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14
Q

Ulnar nerve palsy

A

sensory loss: medial 1.5 fingers

motor: claw hand, weakness and wasting of small muscles

  • sparing of thenar eminence
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15
Q

Radial nerve palsy

A

sensory loss: snuffbox

motor loss: wrist, finger and thumb extension

  • weakness of extensors of wrist, thumb, MCP joints
  • wrist drop
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16
Q

Erb’s palsy

A

causes: obstetric complications (shoulder dystocia)

deficit: C5/6 right>left but can be bilateral

features:

  • asymmetrical moro
  • adduction/internal rotation at shoulder
  • extension elbow
  • pronation of forearm
  • flexion of the wrist
  • hypotonic lumb
  • reduced bicep jerk

association: Horner’s

17
Q

Klumpke’s palsy

(less common)

A

deficit: C8, T1

clinical:

  • claw hand
18
Q

Osteogenesis imperfecta

A

genetics: AR/AD type 1 collagen

clinical:

  • blue sclera
  • short stature
  • bony deformities
  • decreased tone

investigations: skull XR (wormian bones)

19
Q

Beighton score

A

Score more than 4 is generalised hypermobility:

  1. Touch palms on the floor: spine hypermobility (1)
  2. Extend 5th MCP joint >90 degrees (1 each side)
  3. Oppose thumb to forearm (1 each side)
  4. Extend elbow >10 degrees (1 each side)
  5. Extend knee >10 degrees (1 each side)
20
Q

Joint hypermobility

A

arthralgia:

  • anterior knee pain
  • worse stopping/starting exercise

difficulty gripping:

  • grasping pens/pencils

delayed walking:

  • clumsiness
21
Q

Ehler danlos syndrome

A

clinical:

  • paper-like scars: forehead, LL
  • skin hyperelasticity
  • extreme joint hypermobility

types:

type 1. severe form: PROM, normal life expectancy, MV prolapse

type 3. hypermobility

type 4. vascular form: spontaneous rupture of arteries

22
Q

Juvenille Idiopathic Arthritis

A

clinical:

  • onset <16 years
  • arthritis in one or more joints with swelling/effusion, limited ROM, tenderness, pain on movement
  • duration > 6 weeks
  • polyarticular: 5 or more joints
  • oligoarticular: 4 or less joints
  • systemic: intermittent fevers
23
Q

Systemic JIA

A

clinical:

  • onset <5years
  • systemic: fevers precede by months, macular rash
  • polyarticular arthritis
  • other: anorexia, weight loss LN, HSM< pericarditis, pleural effusion, anaemia, uveitis, myalgia
  • ANA/RF negative
  • progresses to severe and long-term arthritis 1/3
24
Q

Oligoarticular JIA (40%)

A

clinical:

  • onset 2-5years
  • large joints: knees, ankle, wrists
  • joints warm, swollen, tender
  • chronic uveitis 30%
  • leg length discrepancy

prognosis:

  • most resolve in 6 months
  • polyarthritis in 20%
25
Q

Enthesitis related arthritis (15%)

A

clinical:

  • 90% males late childhood
  • few large joints: hip girdle, sacroilitis, spine
  • enthesitis: inflammation of tendon insertion
  • enthesitis in achilles, plantar fascia
  • sausage fingers (dactylitis)
  • acute eveitis 20%
  • HLA B27 positive 75%

*May develop ankylosing spondylitis

26
Q

Polyarticular JIA

A

clinical:

  • 90% females
  • more than 4 joints in first 6 months
  • symmetrical both large and small joints
  • NO sacroiliitis
  • uveitis if ANA positive
  • RF 100%, ANA 75%
  • prognosis worse if ANA positive: poor functional outcome in 50% cases
27
Q

Management arthritis

A

Non-drug:

  • physiotherapy: exercise, hydrotherapy
  • OT
  • spinting

Drug:

  • NSAIDs
  • corticosteroid injection (oligoarticular)
  • systemic steroids
  • DMARDs (MTX)
  • Anti-TNF monoclonal Ab (infliximab)
28
Q

Psoriatic arthritis

A

definition: chronic inflammatory arthritis < 16 years

Vancouver criteria:

  • arthritis with psoriatic rash
  • arthritis with 3 of 4: dactylitis, nail pitting/anycholysis, psoriasis-like rash, family hx psoriasis
29
Q

Juvenille dermatomyositis

A

onset: 20% childhood

clinical:

  • painful tender muscles with lethargy, rashes, proximal muscle weakness of shoulders or LL
  • asymmetrical
  • rash: upper eyelids/cheek, elbows, hyperaemic nail beds
  • dysphagia
  • skin calcification

investigations:

  • elevated ESR/CPK
  • muscle biopsy
30
Q

Hemihypertrophy

A

causes:

  • usually idiopathic
  • embryonal tumours: Wilm’s, hepatoblastoma
  • syndromic: BWS, NG, Klippel-Trenauney sx (failure of BV, lymph vessel formation, Proteus
31
Q

Short neck

A

causes:

  • Turner’s
  • skeletal dysplasia
  • Klippel-Feil syndrome (congenital fusion c-spine)
32
Q

Rickets

A

signs of rickets:

  • delayed dentition
  • delayed closure anterior fontanelle
  • bow legs
  • swelling epiphyses wrists/ankles
  • curving long bones
  • cranitabes
  • kyphoscoliosis
  • pathogical fractures
  • rickety rosary
  • myopathy

investigations:

  • calcium, phosphate, Ca:Cr, ALP, PTH, vitamin D, XR
33
Q

Intoeing

A

causes:

  • femoral anteversion
  • tibial torsion
  • metatarsus adductus
34
Q

Foot drop

A

clinical:

  • stepping gait
  • unable to walk on heels

causes:

  • lateral popliteal nerve palsy
  • peroneal muscle atrophy: hereditary motor/sensory neuropathy, CMT
  • poliomyelitis
35
Q

Perthe’s disease

A

definition: ischaemic necrosis of upper femoral epiphysis

clinical:

  • onset 4 to 9 years
  • bilateral 15%
  • limp
  • pain

investigations: XR

treatment: bracing, surgery

Clinical Exam (16 decks)

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