OSCE - MSK

Question 1

Summarise the special tests involved in a shoulder MSK examination?

Answer 1

1. Empty can test
   - supraspinatus test
   - positive if pain or weakness with resistance
2. The painful arc (impingement syndrome)
   - abduction of right shoulder painful between 60-120 degrees
3. External rotation against resistance
   - infraspinatus and teres minor
4. External rotation in abduction
   - teres minor
5. Gerber’s lift off test
   - internal rotation against resistance
6. Scarf test
   - testing acromioclavicular joint

Question 2

Give 3 differential diagnoses for the following findings:

• reduced and painful right shoulder abduction
• painful arc test positive between 60-120 degrees

Answer 2

1. Subacromial impingement
2. rotator cuff tear
3. adhesive capsulitis

Question 3

Appropriate management for subacromial impingement?

Answer 3

Conservative
- physiotherapy

Medical
- corticosteroid injections
- NSAIDs

Surgical
- arthroscopic repair
- removal of cause of impingement

Question 3

Appropriate management for subacromial impingement?

Answer 3

Conservative
- physiotherapy

Medical
- corticosteroid injections
- NSAIDs

Surgical
- arthroscopic repair
- removal of cause of impingement

Question 4

Special tests in hip examination?

Answer 4

1. Thomas test
   - testing hip flexors
   - patient on edge of table, patient lies down hugging knees
   - patient holds one leg but lets other leg dangle over edge of table
   - leg dangling of table is test leg
   - if patient has no muscular tightness then thigh should be in contact with table (good sign)
   - abnormal: thigh does not lie on table
2. Trendelenburg test
   - tests hip abductors
   - ask patient to stand on one leg
   - looking for sign of dropping of the other leg
   - weakness of gluteus medius

Question 5

The following clinical features suggest what:
- true leg length shortening
- inability to weight bear

Answer 5

Neck of femur fracture

Question 6

Management of neck of femur fracture if patient can mobilise with zimmer frame

Answer 6

hemiarthroplasty

Question 7

When looking at a lumbar spine x-ray, what are you commenting on?

Answer 7

1. Confirm patient details and adequacy
2. Alignment
   - look at vertebral bodies
   - look at spinous processes
3. Vertebral height
4. Vertebral space
5. Vertebral endplates
6. Posterior elements
   - traces pedicles
   - laminae
   - spinous processes

Question 8

Special tests for elbow

Answer 8

Check for Tennis Elbow
- pain on wrist extension against resistance
- lateral epicondyle

Check for Golfers Elbow
- pain on wrist flexion against resistance
- medial epicondyle

Question 9

Special tests in hand and wrist examination

Answer 9

1. Tinel’s
   - lightly tap over median nerve to see if there is pins and needles
   - carpal tunnel
2. Phalen’s test
   - maintained wrist flexion at 90 degrees reproduces symptoms of carpal tunnel syndrome such as tingling or pain
   - reverse prayer position

Question 10

Medical treatment of carpal tunnel syndrome?

Answer 10

• analgesia (NSAIDs)
• corticosteroid injections

Question 11

Special tests associated with knee exam

Answer 11

1. Inspect for posterior sag sign
2. Anterior drawer test
3. Collateral ligament assessment
4. Lachman’s test
5. Meniscal assessment