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Meddygaeth B > Orthopaedic Examinations > Flashcards

Orthopaedic Examinations Flashcards

1
Q

What are the main components of MSK examinations?

A

Look, feel, move, special tests, joint above/ below, neurovascular supplies

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2
Q

What are the components of the GALS examination?

A

Gait, arms, legs , spine

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3
Q

What do you look for when assessing gait?

A

Symmetry, smoothness and ability to turn quickly

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4
Q

What is the special test for foot and ankle exam?

A

Simmons test (for Achilles’ tendon rupture)

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5
Q

How is special test for foot and ankle performed?

A

Ask patient to lie prone and squeeze calf, look for plantar flexion on foot. If absent could be Achilles’ tendon rupture

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6
Q

What is the function test for ankle exam?

A

Ask patient to brace against wall and stand on tip toes

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7
Q

Where do you palpate on foot and ankle exam?

A

Metotarsalphalangeal, mid-tarsal and sub talar joints
Medical and lateral malleoli
Anterior joint line
Achilles tendon, palpation of individual toes of indicated

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8
Q

Define varus malformation

A

Medial angulation towards the midline

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9
Q

Define valgus malformation

A

Deformation angled laterally away from the midline

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10
Q

What movements need to be tested in foot and ankle examination?

A

Toe flexion and extension
Ankle dorsiflexion and plantar flexion
Inversion and eversion (sub Tamar joint)
Rotation (mid foot)

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11
Q

How does one test for common perineal nerve function in foot and ankle exam?

A

Toe extension and sensation on the dorsum of the foot

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12
Q

How does one test for tibial nerve function in a foot and ankle exam?

A

Plantar flexion and sensation on the sole of the foot

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13
Q

What vessels need to be palpated in foot and ankle exam?

A

Posterior tibial (behind medial malleolus) and dorsalis pedis

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14
Q

What structures need to be palpated in elbow exam

A

Olecranon process, medial and lateral epicondyles and radial head

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15
Q

What is the function test for elbow exam?

A

Move hand behind head and hands toward mouth

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16
Q

What are the special tests for elbow exam?

A

Medial epicondylitis palms up extend, and flex against resistance
Lateral epicondylitis pals down, flex and extend against resistance

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17
Q

How does one test for ulnar nerve function in an elbow exam?

A

Resisted abduction of little finger

Sensation on lateral side of little finger

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18
Q

How does one test for median nerve function in an elbow exam?

A

Abductor pollicis brevis and thumb sensation

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19
Q

How does one test for radial nerve function in an elbow exam?

A

Wrist extension and sensation of the dorsum of hand at base of thumb

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20
Q

What are heberdens nodes?

A

Firm knobbly swellings on the distal interphalangeal joints caused by osteophytes due to osteoarthritis

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21
Q

What are bouchard’s nodes?

A

Firm knobbly swellings on the proximal interphalangeal joints caused by osteophytes due to osteoarthritis

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22
Q

What does one need to feel in a hand and wrist exam?

A

Thenar eminences, flexor tendons, anatomical snuffbox, MCPs, DIPs, PIPsabd vase of thumb (using thumb and index finger). Styloid process of radius and ulnar head

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23
Q

What function tests do you need to do in hand examination?

A

Grip strength, touching thumb to tip of each finger, undoing or doing up a button.

24
Q

What are the movements of the thumb?

A

Extension, flexion, abduction, adduction and opposition

25
Q

What vascular tests need to be done in hand and wrist exam?

A

Cap refill, radial pulse, ulnar (Allen’s test)

26
Q

What special tests need to be done in hand and wrist exam?

A

Phalen’s test (carpel tunnel syndrome) hold wrists in reverse prayer sign for 60 seconds.
Froment’s test (ulnar nerve palsy) ask patient to hold paper with flat of thumb and index finger

27
Q

What structures do you need to feel in hip examination?

A

Greater trochanter if the femur, anterior superior iliac spine and and midpoint of the inguinal ligament

28
Q

What special test of the hip exam can be done during the Look, phase of examination?

A

Leg length, leg length (formal) and trendelenberg test

29
Q

How do you perform the leg length test?

A

Ask patient to stand with feet together, if medial malleolus touch all’s well if not do formal leg length test

30
Q

How does one do a formal leg length test?

A

Measure apparent length ( belly button to medial malleolus and compare)
Measure true length ( ASIS to medial malleolus and compare)
If both are different then bone deformity, if only apparent is different there is pelvic deformity

31
Q

How does one perform the trendelenberg test?

A

Stand in front of patient with hands on iliac crest, they may balance by holding onto your forearms. Ask them to raise effected leg and. Pelvis should rise on leg side. If it drops by it’s positive. This is due to either pain causing inhibition of muscles, muscle wasting disease or nerve damage

32
Q

What movements are done as part of hip exam?

A

Patient must be supine
Ask to bring knee to chest
Passively see if you can move it further
Then passively rotate in and out
Then hang non test leg over side of the bed
Holding test leg by ankle move outwards until you feel pelvis start to tilt (abduction) then move inwards until pelvis starts to tilt (adduction)

33
Q

What is Thomas test?

A

A special test for hip exam. Flex non-test hip with hand under lumbar spine. Positive if test leg raises as hip is flexed

34
Q

What is the function test for knee examinations?

A

Ask patient to squat. Not elderly or infirm!

35
Q

How do you check for effusions in the knee?

A

Patellar tap test. Press above the patella to move any fluid under it. Then press down on patella. If fluid there will be a ‘tap’.
Sweep test. Sweep finger over medial side then lateral side watching for bulge in medial side

36
Q

What structures do you feel for in a knee exam?

A

Quadriceps tendon, patellar margins, patella tendon tibial tubercle , joint lines, collateral ligaments, hamstrings , swelling in popliteal fossa

37
Q

What movements should be checked in knee exam?

A

Can you bring your heel to your bottom, then gently do it passively
Can you press the back of your knee into the bed? Then passively press down on thigh and lift by ankle

38
Q

What are the special tests for the knee exam?

A

Subluxation of the tibia, anterior draw test, posterior draw test, posterior sag, LCL, MCL, stress the ligaments

39
Q

What are the ligaments of the knee?

A

Posterior cruciate ligament, anterior cruciate ligaments, medial collateral ligament (tibia), lateral collateral ligament (fibula), patellar ligament

40
Q

How do you perform subluxation of the tibia test?

A

Flex knee at 90 degrees with feet flat. Pain is indicative of cruciate ligament tear

41
Q

What are the special tests for PCL tear?

A

Posterior sag-Knee appears to sag back, viewed anteriorly

Posterior draw test-Sit on foot, place hands on back of knee thumbs on tibia and press forward

42
Q

What are the special tests for ACL tear?

A

Anterior draw test. Sit on foot, place hands behind knee, thumbs on tibia and pull forwards

43
Q

What are the special tests for collateral ligament damage?

A

Stress ligaments by flexing knee to 30 degrees, pain or lack of end point suggests tear
MCL apply inward force to knee and outward force to ankle
LCL apply outwards force to knee and inward force to ankle

44
Q

What structures of the shoulder kneed to be felt?

A

SCJ, ACJ, clavicle, borders of the capfuls, acromion, greater tubercle of humerus, biceps tendon, coracoid, Supra spinatus, infraspinatus and deltoid muscles

45
Q

What function tests are required in the shoulder exam?

A

Bring right hand to left shoulder and vice versa
Hands behind head
Hands behind back

46
Q

What movements must be done in a shoulder exam?

A

Raise arms above head, raise thumbs up pain at 90 degrees is infra spinatus impingement pains at 120 degrees is ACJ joint, fix arms to side , flex elbows at 90degrees and rotate outwards, reach up back as high as possible

47
Q

What are rotator cuff special tests?

A

Empty can test (Supraspinatus), external rotation against resistance (infraspinatus/ trees minor), hand behind back, don’t let me push you back (subscapularis, any weakness suggest tear

48
Q

What are the special tests for impingement?

A

Hawkins-Kennedy test shoulder at 90 elbow at 90, palms down, rotate shoulder so palm goes down (supraspinatus impingement)
Scarf test, bring hand to shoulder, press down on elbow

49
Q

What are the neurovascular tests for shoulder issues?

A

Power deltoid -axillary nerve
Regimental badge are sensation -axillary nerve
Radial pulse

50
Q

What structures do you need to feel in a spinal exam?

A

All spinous process from c-spine to sacrum (check for tenderness and protuberance). Sacroiliac joints (tenderness indicates ligament issues)
Trapezius, paraspinal and interscapular muscles

51
Q

What movements need to be done in spinal examination (cervical)?

A

Put chin on chest (flexion) head back as far as it will go (extension) look left, look right ( rotation), put left ear on left shoulder and right ear on right shoulder (lateral flexion)

52
Q

What movement needs to be done in thoracic and lumbar spine examination?

A

Thoracic: Fix pelvis and rotate body left and right, chest expansion
Lumbar: Place two fingers on lumbar vertebrae, ask patient to flex, fingers should move apart. Lean back as far as possible (be ready to catch the patient). Slide left hand down left leg (lateral flexion)

53
Q

What are the special tests for the spine exam?

A

Nerve root compression: Straight leg raise, femoral stretch test.
Reduced flexion: schobers test and modified schobers test
Kyphosis: wall test

54
Q

What are the special tests for nerve root compression

A

Straight leg raise L4, L5, S1. Pain suggests disk herniation

Femoral stretch test L2, L3, L4. Patient pro on couch, leg flexed 90 degrees. Pain in lower back or buttocks is positive

55
Q

What is schobers’ test?

A

Have their back to you, identify superior posterior iliac spine, place dot on midline. Place a dot 10cm above, and 5cm below. Ask to touch toes, measure distance between dots, >5cm difference suggests reduced range of flexion

56
Q

What is wall test?

A

Patient stands flat against the wall.
If patients head can’t touch wall then it’s kyphosis
Measure wall to tragus difference

Meddygaeth B (9 decks)

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