Musculoskeletal examination

Question 1

What exposure is required for a musculoskeletal examination?

Answer 1

From the thigh downwards

Question 2

What position is required for a musculoskeletal examination?

Answer 2

Supine position with no elevation

Question 3

What does one inspect in general inspection of the musculoskeletal examination?

Answer 3

• Scars
  
  • Down the middle → Likely indication of knee replacement surgery
  • Other → Likely indication of other surgery / trauma to joint (eg fall)
• Muscle atrophy
  
  • Due to disuse → Likely indication of arthritis (patient has antalgic gait)
  • Due to Lower Motor Neuron Injury → Likely indication of peripheral neuropathy or other lesion
• Knee Deformity
  
  • Genu Valgum → Usually genetic
  • Genu Varum → Likely indication of osteomalacia

Question 4

What does warm knee indicate (2)?

Answer 4

• Septic arthritis
• Flare up of osteoarthritis or rheumatoid arthritis

Question 5

What does pain during palpatation indicate?

Answer 5

• Meniscal damage

Question 6

What does swelling in popliteal fossa indicate?

Answer 6

• Baker’s cyst

Question 7

What does effusion during swipe test or patellar test may indicate (2)?

Answer 7

• Effusion present (Small or Large)
  
  • Arthritis
  • Damage to internal structure eg meniscus

Question 8

What does pain during knee flexion and extension (active or passive) may indicate?

Answer 8

• Damage to meniscus or fracture

Question 9

What does reduced range of motion may indicate?

Answer 9

• Arthritis

Question 10

What does inability to straight leg raise may indicate?

Answer 10

• Damage to knee extensors

Question 11

What does posterior sag sign indicate?

Answer 11

• Posterior Cruciate Ligament Tear

Question 12

What does anterior draw >1.5 cm (in absence of posterior sag sign) indicate?

Answer 12

• Anterior Cruciate Ligament Rupture

Question 13

What does anterior draw >1.5cm (in presence of posterior sag sign) indicate?

Answer 13

• Clinically Inconclusive

Question 14

What does open medial joint line indicate?

Answer 14

• Medial Collateral Ligament Laxity/Rupture

Question 15

What does open lateral joint line indicate?

Answer 15

• Lateral Collateral Ligament Laxity/Rupture

Question 16

What are the common clinical presentations of osteoarthritis (Movement 2 / Investigations 3)?

Answer 16

• Movement:
  
  • Reduced Range of Motion
  • Pain worse on movement, better on rest
• Investigations:
  
  • X-ray shows LOSS (loss of joint space, osteophytes, subchondral sclerosis, subchondral cysts)
  • Possible muscle atrophy due to antalgic gait
  • In flare up, may detect warm temperature

Question 17

What are the common clinical presentations of septic arthritis?

Answer 17

• Warm temperature
• Effusion
• Tenderness
• Reduced Range of Motion

Question 18

What are the common clinical presentations of rheumatoid arthritis (3)?

Answer 18

• Pain better with movement
• May have other features such as ulnar deviation of hands
• History of autoimmune disease

Question 19

What are the common clinical presentations of a torn ACL?

Answer 19

• Positive Anterior Draw (without posterior sag)
• Pain on passive and active flexion and extension