PACES - Musc Flashcards
Gottron’s Papules
Dermatomyositis
Nail Telangiectasia
Systemis Sclerosis
Onycholysis
PA
Pitting
PA
Longitudinal Ridging
PA
Nail Fold Infarct
Vasculitis
Subcutaenous Deposits
CREST
Dactylitis
DX?
PA with dactylitis
Heberden’s Nodes
Bouchard Nodes
How to conclude a hand exam
I would like to..
Examine other joints
Resp exam (fibrosis)
Abdo if RA (Felty’s Syndrome, splenomegaly)
Investigations:
FBC primarily to check for anaemia
U&Es, Vasculitic renal impairment and for drug dosing
LFT, baseline for meds
ESR/CRP, correlate with disease activity
TFT, Autoimmune concern
Immuno tests (Antibodies related to symptoms/signs identified)
Hand XR
Aspirate if effusion
What is a trendelenburg gait?
Waddling, body swings side to side due to hip abductor weakness, forcing the pt to use trunk muscles to lift the hip high enough to walk
What is an antalgic gait?
Hip pain = short stance phase on the painful side
How would you perform the trendelenburg test?
Ask the patient to stand facing you with hands out palms on top of yours
Stand on one leg then the other.
+ve test if pressure on contralateral palm, due to hip abductor weakness.
What is the modified thomas’s test
Hand under lumbar spine, ask pt to bring both knees up to chest
Passively push each hip into further flexion whilst watching pt’s face.
Ask pt to hold affected hip flexed whilst extending the other leg. Pressure should be felt on the examiner’s hand. Repeat on the other side whilst watching pt’s face. Fixed flexion deformity if pressure off hand lessens due to extension of lumbar spine as compensation.
What is reduced internal rotation of the hip a sign of?
Early OA
FAbER test
Hip pain & movement restriction = intraarticular dysfunction such as OA
FAdIR test
Femoroacetabular Impingement Syndrome
Anterior Labral Tear
How would you perform a hip exam
Intro
Inspect
Gait
Feel (Temperature, pulses,greater trochanter, leg length)
Move - Active hip flexion/extension with hand under lumbar spine
Passive extension, flexion, IR, ER, abduction, adduction
Special - Thomas’
Trendelenburg’s
How would you perform a knee exam?
Intro
Inspection
Gait
Feel - Temperature, measure quads size, palpate extended knee (joint lines, patella, offer patellar apprehension test, effusion, patellar tap), Palpate flexed knee and popilteal fossa
Move - Active flexion extension
Passive flexion extension
Posterior Sag
Anterior Drawer
Posterior Draw
LCL
MCL
McMurray’s
Hand exam
Intro
Inspection
Feel - temperature, radial/ulnar pulse,
Palms up - thenar/hypothenar bulk, palmar thickening,
Palms down - Radial Nerve (first dorsal webspace), bimanual joint palpation, snuffbox
Wrist palpation
Elbow - elbow palpation along ulnar
Active movement - Splay fingers
Make fist
Palms together and extend wrists
Back of hands together and flex wrists
Passive movement
Motor ->
Wrist/finger extension
Index finger abduction
Thumb abduction
Squeeze fingers, squeeze finger between thumb and index finger
Pick up coin
Tinel’s (Tap over the carpal tunnel)
Phalen’s (Hold wrist in maximum forced flexion for 60s, sx?)
What are the main principles of trauma management?
ATLS
Reduce Close -> Open
Repair
Rehab
Normal
Varus
Valgus
L = Volar
R = Dorsal