SCP2 MSI Flashcards
Nail fold infarcts are a sign of _________ such as SLE
vasculitis
_________ deformity – distal part of limb deviates away from midline
Valgus
_________ deformity – distal part of limb moves toward midline
Varus
increased anteroposterior flexion of the spine
Kyphosis
What is the screening tool used by non-specialists to assess MSK concerns?
GALS
What are the three GALS screening questions that should be incorporated into your systems review when history taking?
Have you any pain or stiffness in your muscles, joints or back?
Can you dress yourself completely without any difficulty?
Can you walk up AND down stairs without difficulty?
What are the 4 Phases of Gait?
Heel Strike Mid Stance Toe Off Swing phase
Supraspinatus hyperalgesia is part of the GALS screening test and is a sign of
fibromyalgia
A grating sensation or noise from the joint and indicates irregularity of the articular surfaces. Its presence suggests chronicity (eg OA)
Joint crepitus
Skin tightening/calcinosis can be a sign of
scleroderma
Inspection of hand joints: look for
Deformity, eg. Ulnar deviation/Swan neck/Boutonniere/Z shaped thumb
Swollen joints, wrists/MCPs/PIPs/DIPs
Rheumatoid nodules
OA Nodes, ___________(DIPs)/___________PIPs)
Tophi (gout)
Heberden’s, Bouchard’s
Nail fold infarcts/ Splinter Haemorrhages can be signs of
vasculitis
Boutnniere’s and swan neck deformaties both occur in __________ disease
rheumatoid
Bony protrusions around the DIP and PIP joints indicate
OA
To calculate a Disease Activity Score (DAS) for ___ we record the number of Swollen and the number of Tender joints and combine this with the ESR and Visual Analog Score
RA
The median nerve supplies sensation to the thenar eminence and motor supply to which two/three muscles?
Abductor pollicis brevis and opponens pollicis (also flexor pollicis brevis)
The radial nerve supplies motor supply to the finger, thumb, and wrist extensors as well as the brachioradialis muscle. Where does the radial nerve supply sensation?
The first dorsal web space
The ulnar nerve supplies motor function to the small mm of the hand (except abductor pollicis brevis) and the ulnar half of flexor digitorum profundus, and flexor carpi ulnaris. Where does the ulnar nerve supply sensation in the hand?
Hypothenar eminence and medial 1.5 fingers
Stability of the shoulder is maintained by: Supraspinatus – \_\_\_\_\_\_\_\_\_\_\_\_ Infraspinatus – external rotation Teres minor – external rotation Subscapularis – internal rotation
abduction
Winging of the scapula results from Pathology of the long thoracic nerve which innervates
serratus anterior
If a movement can be achieved passively but not actively – suggests pathology in the nerve, tendon or muscle but not the _______
joint
How do you test the function of subscapularis?
To test internal rotation against resistance, ask patient to put their hand on their back, place your hand on theirs and ask them to lift it off
What does a positive “Popeye sign” indicate?
If long head of biceps is ruptured – muscle bunches distally causing a bulge
One test for shoulder impingement is
Hawkins-Kennedy test
Abnormal hair tufts at the base of the spine could be a sign of
spina bifida occulta
Flexion and extension of the cervical spine mainly comes from which joint?
Atlanto-occipital (C1-occiput)
Rotation of the cervical spine mostly comes from which joint?
Atlanto-axial (C1 rotating on dens of C2)
Which special test measures forward flexion of the spine? What is a normal finding?
Schoeber’s test. On forward flexion, line drawn should lengthen to >20cm (more than 5cm of increase).
** Most important special test for neural irritation (query sciatica)?
Straight Leg raise
Tests for neural tension in lumbosacral roots by stretching the sciatic nerve (roots L4-S3)
Extension and forced-dorsiflexion further stretches the sciatic nerve increasing the pain of sciatica/nerve irritation in which special test?
Bragard’s test
What is a positive femoral stretch test?
If there is tension on the femoral nerve roots (L2-L4) pain will radiate down the anteromedial border of the thigh/groin
To measure true leg length, a measuring tape is extended from the medial malleolus to each __________
ASIS
To measure apparent leg length, a measuring tape is extended from the medial malleolus to the __________
xiphisternum
Palpation over the greater trochanter of the femur for pain from trochanteric
bursitis
To accurately assess the flexion we use Thomas’ Test. If the contralateral hip starts to rise during deep flexion it indicates the loss of ___________. This is referred to as a fixed flexion deformity (FFD) of the hip
extension
Trendelenburg’s test:
During the single-leg phases of gait (i.e. after toe off, swing, before heel strike) the ___________ abductors of the hip contract to keep the pelvis level.
This aids in stability of the trunk and allows the unsupported leg to clear the ground as it swings.
If the abductors are injured or deficient then they cannot stabilise the pelvis. During gait, the ___________ leg will drop when it is unsupported because of weakness of the ipsilateral abductors (abductor palsy)
contralateral, contralateral
remember, “the sound side sags”
A ffluid-filled mass in the posterior (esp. posteromedial) aspect of the knee could be due to a
Baker’s cyst
Burisitis of the knee:
Pre-patellar bursa – “___________” knee
Infrapatellar bursa – “__________” knee
housemaids
clergymans
The special test to check the integrity of the ACL is the
anterior draw test
A positive “J-sign” (special test in the knee) is a sign of
patellar maltracking
What bone is the “keystone” for the transverse arch of the foot?
The second metatarsal
Also remember that the talus is keystone for the Medial longitudinal arch of the foot
The “too many toes” sign on inspection of the foot indicates
pes planus- flat foot and collapse of the midfoot arches
Adult-acquired flat foot is due to a deficiency in which muscle?
Tibialis posterior
Special test for tibialis posterior function?
Heel raises- If the tibialis posterior tendon is functional then the hindfoot valgus will disappear during heel raise
History of ankle instability and laxity on anterior draw suggests ______ injury in high ankle sprains
ATFL
Special test for Achilles tendon integrity?
Simmonds test (gastroc squeeze)
Silfverskiold’s test
If dorsiflexion in full leg extension is limited, bend the knee to 90 and re-test.
Should be able to reach 15 deg dorsiflexion.
Mismatch suggests ________ contracture.
If the same = Achilles contracture
Gastroc
