Musculoskeletal Health Examinations Flashcards
1
Q
Overall Method
A
Look - alignment - symmetry - deformity - muscle wasting - swellings - colour - condition of skin - consider gait Feel - temperature - tenderness - swellings - joint line - tendons/ muscles Move - Function - Active and passive movements Special Tests - specific problems Joint above/ below Neurovascular exam
2
Q
GALS
A
Gait Arms Legs Spine
3
Q
GALS examination
A
EOB - walking aids - specialist shoes - signs of pain - systemically well - alignment - muscle bulk - symmetrical Spine - Inspection - lordosis, kyphosis etc - CS: Lateral flexion ear to shoulder - LS: flexion - Schober's Gait - Walk: smoothness, symmetry, ability to turn quickly Arms -Shoulder and elbow: hands behind head, adduction, external rotation, elbow flexion - Hands: swelling/ deformity, loss of muscle bulk, finger extension and abduction, grip strength, thumb to fingers, function (pick up coin/ button), MCP squeeze Legs - Knee: Patella tap for effusion, flexion and extension - Hip: Passive internal rotation -Foot: swelling/ deformity, MTP squeeze
4
Q
Ankle and Foot
A
Inspection Look: - Gait: antalgic, stiff ankle, foot drop (damage to common peroneal nerve) - Function: tip toes (observe ankles from behind) - Inspection: alignment, weight bear, symmetry, deformity, scars, wasting, scars, swelling, skin changes, nail changes Feel: - Temperature - Structures Move: - Toe flexion and extension - Ankle plantar and dorsiflexion - Subtalar joint inversion and eversion - Midfoot rotation Special tests - Simmond's achilles rupture tests Joint above - knee Neurovascular - power (toe extension= peroneal nerve, plantar flexion = tibial nerve, dorsum of the foot = common peroneal nerve, sole of foot = tibial nerve) - sensation (dorsum = common peroneal, sole = tibial nerve) -vascular (pulses)
5
Q
Foot drop
A
damage to common peroneal nerve
6
Q
Foot deformity
A
Varus/ valgus Claw toe Hammer toe Flat foot Subluxation of joints
7
Q
Foot/ ankle muscle wasting
A
Calves
8
Q
Foot ankle swelling
A
Effusion
Cysts
Inflammation
9
Q
Foot ankle skin changes
A
Thickening
Callus formation
Bunions
Ulcers
10
Q
Structures of the foot and ankle
A
MTP joint squeeze Mid tarsal joint squeeze Subtalar joint squeeze Achilles tendon Medial and lateral malleoli Anterior joint line Bimanual palpation of individual toes if indicated
11
Q
Simmond’s test
A
Achilles tendon rupture
Squeeze calf, lying on front with leg hanging of bed
Absence of plantar flexion = rupture
12
Q
Elbow Examination
A
EOB - Discarded sling - Pain Look - Alignment - Symmetry - Scars - Wasting - Swelling - Skin changes Feel - Temperature - Structures Move - Function - Extension - Flexion - Rotation Special Tests - Medial epicondylitis - Lateral epicondylitis Joint above - Shoulder Neurovascular - Power ( abduction little finger - ulnar, abductor pollicis brevis - median, wrist extension - radial) - Sensation (lateral aspect of little finger - ulnar, thumb- median, dorsum of hand at thumb base - radial) - Vascular
13
Q
Elbow Look
A
- Alignment
- Symmetry
- Scars: ulnar nerve surgery at medial epicondyle, olecranon surgery
- Wasting: muscles of forearm and upper arm
- Swelling: effusion (behind radial head), olecranon bursitis
- Skin changes: thickening, nodules, plaques, erythema, bruising
14
Q
Elbow Feel Structures
A
Effusion: boggy swelling behind radial head
Medial and lateral epicondyles
Olecranon process
Ulnar nerve
15
Q
Elbow Special Tests
A
Golfer’s elbow - resisted wrist flexion
- medial epicondylitis
Tennis elbow - resisted wrist extension
- lateral epicondylitis
16
Q
Hand and Wrist Examination
A
EOB Look - Nails - Skin changes - Wasting - Swelling - Deformity - Wrist - Elbow Feel - Temperature - Hand - Phalangeal - Wrist Move - Function - Fingers - Thumb - Wrist Special tests - Phalen's - Froment's test Neurovascular - Motor - Sensation - Pulses
17
Q
Hand and Wrist Look
A
Nails - Pitting and onycholysis: psoriatic - Nail fold infarcts: vasculitis Skin changes - Thinning and bruising: steroids - Palmar erythema: RA - Scars Wasting - 1st dorsal interossei - Thenar, hypothenar eminences Swelling - Herbeden's (DIPJ), Bouchard's (PIPJ): OA - Boggy swelling (synovitis): RA, trauma - Cystic swelling: ganglion Deformity - Swan neck, Boutonnieres, Z thumb, ulnar deviation, subluxation of MCPJs: RA - Dupuytren's contracture Wrist - Deformity (subluxation, deviation) - Swelling (RA nodules, ganglion, gouty tophi) - Scars (carpal tunnel release) Elbow - Psoriatic rashes - RA nodules - Gouty tophi
18
Q
Hand and Wrist Examination Feel
A
Temperature
Wasting of thenar and hypothenar eminences
Thickening of flexor tendons: Dupuytren’s
Anatomical Snuffbox: scaphoid
MCP squeeze: if painful then do individual
PIPs, DIPs, base of thumb
Palpate around
- Ulnar border
- Ulnar hear: extensor carpi ulnaris tendinitis: RA
- Radial styloid process: de Quervain’s tenosynovitis
19
Q
Hand and Wrist Move
A
Function - grip strength - finger and thumb taps - button/ coin Fingers - flexion - extension - abduction Thumb - flexion - extension - abduction - adduction - opposition Wrist - flexion - extension - pronation - supination
20
Q
Hand and Wrist Neurovascular Motor
A
Resisted wrist extension - radial nerve Resisted little finger abduction - ulnar nerve Resisted thumb opposition - median nerve
21
Q
Hand and Wrist Special Tests
A
Phalen's test - reverse prayer - carpal tunnel syndrome Froment's test - paper between thumb and index finger - ulnar nerve palsy
22
Q
Hip Examination
A
EOB Look - Gait - Inspection Feel - structures Move - Flexion - Rotation - Abduction - Adduction Special tests - leg length - Abductor weakness - Fixed flexion deformity Joint above - Spine Neurovascular
23
Q
Hip Look
A
Gait - Antalgic - Trendelenburg - Foot drop - Stiff hip Inspection - Overall alignment and weight bearing - Deformity: pelvis alignment, excessive lumbar lordosis (fixed flexion deformity), scoliosis, hip rotation, knee flexion Scars: arthroscopy, hip replacement Wasting: quadriceps and gluteal muscles Swelling: effusion, inflammation, bursitis Skin changes: erythema, bruising
24
Q
Hip Feel
A
Structure:
- Greater trochanter
- ASIS
- Midpoint of inguinal ligament
25
Hip Move
```
Flexion
- Active and passive (knee flexed)
Rotation
- Internal and external
Abduction and adduction
```
26
Hip Special Tests
```
Leg length
- Medial malleolus level?
- ASIS to medial malleolus
Abductor weakness
- Trendelenburg
- Side of raised leg drops
- Pain causing inhibition of muscles, muscle wasting disease, nerve damage
Fixed flexion deformity
- Thomas test
- Other thigh raises when hip flexed
- tightening/ shortening of the hip flexors, OA
```
27
Hip Neurovascular
```
Power
- Quadriceps: femoral nerve
- Extension of toes: common peroneal nerve
- Plantar flexion of foot: tibial
Sensation
- Anterolateral thigh: femoral
- Dorsum of foot: common peroneal nerve
- Sole of foot tibial nerve
```
28
Knee Examination
```
EOB
Look
- Gait
- Function
- Inspection
Feel
- Temperature
- Effusions
- Structures of the knee
Move
- Flexion
- Extension
Special Tests
- Cruciate ligaments
Collateral ligaments
Joint above
- Hip
Neurovascular
```
29
Knee Look
Gait
- Antalgic
- Thrusting: knee appears to give way
- Foot drop: damage to common peroneal nerve
Function
- Squat
Inspection
- Alignment
- DEformity: varus/ valgus, fixed flexion, hyperextension,
- Scars: arthroscopy, knee replacement
- Wasting: quadriceps and gastrocnemius muscles
- Swelling: effusion, (Bakers) cysts, inflammation, bursitis
Skin changes: erythema, bruising, nodules
30
Knee Feel
```
Temperature
Effusions
- Patellar tap: medium to large effusion
- Sweep/ bulge test: small effusion
Structures of the knee
- Swelling/ bogginess
- Quadriceps tendon
- Patellar margins
- Tibial tubercle
- Joint lines: tenderness = meniscal damage/ OA
- Collateral ligaments
- Tenderness of hamstrings
- Swelling behind the knee
```
31
Knee Move
Flexion
- Active and passve
Extension
- Fixed flexion deformity - inability to full extend knee: bone/ tissue in joing
- Knee extends too far: hypermobility syndrome
32
Knee special tests
```
Cruciate ligaments
- Posterior sag: PCL
- Anterior draw test: ACL
- Posterior draw test: PCL
Collateral Ligaments
- MCL
- LCL
```
33
Knee neurovascular
```
Power
- Extension of toes: common peroneal nerve
- Plantarflexion of foot: tibial nerve
Sensation
- Dorsum of foot: common peroneal nerve
- Sole of foot: tibial nerve
Vascular
- Pulses
```
34
Shoulder Examination
```
EOB
Look
- Inspection
Feel
- Temperature
- Structures
Move
- Passive then active!
- Function
- Flexion
- Extension
- Abduction: lower arc pain = supraspinatus infringement, high art pain = ACJ injury/ pathology
- External rotation
- Internal rotation
Special Tests
- Supraspinatus
- Infraspinatus
- Subscapularis
- Weakness: tear,
- Pain only
- Impingement tests
Joint above
Neurovascular
```
35
Shoulder Look
Alignment
Deformity: steps in clavicle, dislocation, winging of scapula (long thoracic nerve injury)
Scars: arthroscopy, shoulder surgery
Wasting: trapezius, deltoid, triceps, bceps, supraspinatus, infraspinatus
Swelling: inflammation, bursitis
Skin changes: erythema, bruising
Axilla
36
Shoulder Feel
```
Temperature
Structures
- SCJ
- Clavicle
- ACJ
- Acromion
- Borders of the scapula
- Greater tubercle of humerus
- Coracoid
- Biceps tendon
- Supraspinatus, infraspinatus and deltoid muscles
```
37
Shoulder Move
```
Function
- Hands behind head
- Hands behind back
- Touching opposite shoulder
Flexion
Extension
Abduction
- lower arc pain: supraspinatus impingement
- high arc pain: ACJ injury/ pathology
External rotation
- Frozen shoulder
Internal rotation
- How far up back
Passive movements
Adduction
```
38
Shoulder Special Test
Rotator Cuffs
- Supraspinatus: empty can
- Infraspiantus/ teres minor: external rotation against resistance
- Subscapularis: Lift off test
Impingement
- Hawkin's kennedy test: Supraspinatus impingement
- Scarf test: arm to opposite shoulder
39
Shoulder Neurovascular
```
Power:
- deltoid: axillary nerve
Sensation
- Regimental badge area: axillary nerve
Radial Pulse
```
40
Spine Examination
```
EOB
Look
- Gait
-Inspection
Feel
- Bones
- Muscles and soft tissues
Move
- Cervical
- Thoracic
- Lumbar
Special Tests
- Nerve root compression: straight leg raise, femoral stretch tests
- Reduced flexion: Schober's
- Increased kyphosis: wall tests
```
41
Spine Look
```
Gait
- Antalgic
- Trendelenberg
- Foot drop
- Stiff hip
Inspection
- Alignment
- Deformity: kyphosis/ lordosis, scoliosis
- Scars: spinal surgery
- Wasting: paraspinal and gluteal muscle
- Swelling
- Colour: erythema, bruising
```
42
Spine Feel
```
Bones
- Spinous process'ss
- Sacroiliac joints
Muscles and soft tissue
- Trapezius
- Interscapular
- Paraspinal muscles
```
43
Spine Move
```
Cervical
- Flexion
- Extension
- Lateral flexion
- Rotation
Thoracic
- Rotation: fix pelvis
- Chest expansion
Lumbar
- Flexion: Schober's
- Extension
- Lateral flexion
```
44
Spine Special Tests
Nerve root compression
- Straight leg raise: L4/5 S1, disc herniation
- Femoral stretch test: L2/3/4,
Reduced flexion
- Schober's
Increased kyphosis
- Wall test: back against wall, head unable to touch wall
45
Spine Neurovascular
```
Power
Reflexes
- Hip and ankle
Sensation
- Lower limb dermatomes
Vascular
- Posterior tibial
- Dorsalis pedis
```
