Practical skills

Question 1

Palpate tubercle of scaphoid, hook of hamate, pisiform, ridge of trapezium

Answer 1

Scaphoid - distal to wrist crease in line with base of thumb

Pisiform - distal to wrist crease medial side

Hamate - 1-1.5cm diagonal from pisiform

Trapezium - 1cm distal and diagonal from scaphoid, in line with index

Question 2

Surface mark SCJ or ACJ

Answer 2

SCJ - C shaped line at medial clavicle

ACJ - lateral end of clavicle and medial border of acromion

Question 3

End feel of shoulder flex/ext/ abduction?

Answer 3

Flexion - firm (shoulder extensors)
Extension - firm (shoulder flexors)
Abduction - Firm (shoulder adductors)

Question 4

Put supraspinatus or infraspinatus into action and palpate the contraction

Answer 4

Supraspinatus = first 30• abduction
Infraspinatus = lateral rotator

Question 5

Palpate head of humerus

Answer 5

Neutral arm, palpate rounded prominence anterior aspect of shoulder

Question 6

Surface mark superior RUJ or inferior RUJ

Answer 6

Superior = vertical line between head of radius (between lateral epicondylitis and olecranon) and ulna

Inferior = vertical line between head of ulna and distal end of radius

Question 7

Cervical flexion end feel?

Answer 7

Firm (ligamentum nuchae)

Question 8

PAM at wrist or Inferior RUJ

Answer 8

Wrist - AP, use both hands, one to stabilise wrist and one to push carpals from anterior to posterior

Inferior RUJ - PA, use thumb to push down on ulna head while stabilising radius

Question 9

Elbow joint line

Answer 9

2cm below medial epicondyle, 1cm below lateral

Question 10

End feel wrist ext/ flex

Answer 10

Flexion = firm (dorsal radiocarpal ligament)
Extension = firm (palmar radiocarpal ligament)

Question 11

Palpate greater/lesser tubercle/ corocoid process

Answer 11

Corocoid - 1 inch below lateral clavicle, protraction brings corocoid forward

Lesser tubercle - slightly down and laterally from corocoid

Greater tubercle - lateral border of acromion, move fingers laterally onto lateral aspect greater tubercle

Question 12

Surface mark GH

Answer 12

Just lateral of corocoid, joint line is a line 3km long down from this point

Question 13

Elbow end feel

Answer 13

Flex - soft (bicep on forearm)
Ext - hard (olecranon into olecranon fossa)

Question 14

demonstrate longitudinal caudad/ lateral distraction/ AP/PA at GH joint

Answer 14

Distraction - bend elbow, hand in armpit, other hand on lateral elbow, push with inner hand

Caudad - hold hand under elbow, lean backwards towards yourself

PA - Patient prone, hand on trap, lift shoulder, palm of hand, push head of humerus down

AP - Hand on shoulder joint line, palm of hand on head of humerus, downwards pressure

Question 15

Surface mark wrist joint

Answer 15

Between styloids of ulna and radius, concave proximally

Question 16

Test flexibility of flexor digi superficialis/ profundus

Answer 16

Superficialis - extend wrist and fingers expect DIP

Profundus - extend wrist and fingers including DIP

Question 17

Longitudinal caudad/ AP/ PA at elbow

Answer 17

Caudad - slight flex, stabilise proximal elbow, pull lower arm

AP - stabilise upper arm, apply downward force

PA, pull lower arm up

Question 18

Palpate spine of scap/ inferior angle

Answer 18

Spine = runs up/laterally from vertebral border to point of shoulder

Inferior angle = Easily visible, lies level with 7th rib when arm is by side

Question 19

Surface mark 1st CMC or MCPs

Answer 19

1st CMC = run down thumb lateral aspect, flex and extend thumb to check location

MCPs = Flex MCP, large bony prominence is head of metacarpal