Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MF4 > MSK Physical Exams > Flashcards

MSK Physical Exams Flashcards

1
Q

Inspection Hip Exam

A
  • Gait Assessment
  • Swellings? Erythema? Skin changes/scarring?
  • Atrophy: Pelvic girdle, gluteal muscles, hamstrings, quadriceps, lower back.
  • Deformity:
    • Posture- scoliosis, exaggerated lumbar lordosis
    • Pelvic tilt - look at level of iliac crests.
    • Feet valgus or varus
  • Trendelenburg sign
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Palpation Hip Exam

A
  • With patient supine palpate along - pubic symphysis, inguinal ligament, femoral pulse, ASIS.
  • With patient sitting up - PSIS, dimples of venus, SI joint (superior to dimples), ischial tuberosity (lateral to dimples), greater trochanters, IT band.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ROM and Power Hip Exam

A

Perform active and then possive if active is limited.

  • Flexion (120o): Knee to chest
  • Extension (20o)
  • Internal rotation (30o)
  • External rotation (45o)
  • Abduction (45o)
  • Adduction (30o)

Do power assessment after for all of the above motions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Special Tests Hip Exam

A
  • Thomas Test - check for signs of hip contracture. Place one hand under patients lumbar spine and get patient to hold their knee to their chest. Look to see if contralateral thigh rises off the bed.
  • Ober test - check for signs of illiotibial band. Place patient in decubitus position with knees bent. Brace upper leg and extend it backwards. Knee should touch the bed.
  • FABER - check for sacroilliac joint of hip joint pathology. Make figure 4 position with leg and apply pressure stabilizing contralateral hemipelvis from other hand. See if their is pain.
  • Leg length discrepancy
    • True leg length - from ASIS to medial mallelous
    • Apparent leg lenth - from umbilicus to medial mallelous
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Gait Assessment

A
  • Gait Assessment
    • Stance phase/swing phase
    • Quailty of gait - smoothness, symmetry, ability to turn quickly.
    • Antalgic gait? (Painfult gait)
    • Trendelenburg gait (weak hip abductors on opposite side)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Inspection Knee Exam

A

Standing Position:

  • Swelling (bakers cysts)
  • Erythema
  • Atrophy -calves, quadriceps, hamstrings
  • Deformity - knee hyperextension, flexion deformity, varus, valgus
  • Skin changes and scarring

Supine:

  • Swelling - loss of parapatellar grooves/fossa, localized swelling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Palpation Knee exam

A

With knee extended:

  • Temperature
  • Patella palpation
  • Anterior from superior to inferior: quadriceps, suprapatellar tendon, patellar ligament, tibial tuberosity.
  • Posterior from superior to inferior: Popliteal fossa, popliteal pulse.
  • Palpate 4 bursa - pre-patellar, superficial and deep infra-patellar, anserine bursa

With knee flexed to 900

  • Palplate joint line: Medial and lateral tibial plateaus, femoral condyles, medial and lateral joint line, MCL
  • In figure 4 position palpate LCL

Palpation for effusion:

  • Fluid wave/milking: empty medial fossa by sweeping hand in superior lateral direction, then immediately sweep down.
  • Fluid ballottement test: Grasp knee just above patella and apply pressure while squeezing with one hand. With other hand, grasp medial and lateral parapatellar fossa to palpate for effusion.
  • Patellar trap: Grasp knee just above patella and apply ressure while squeezing with one hand. With other hand push patella down.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

ROM and Power Knee exam

A

ROM

  • Flexion (135o)
  • Extension (180o)
  • Internal rotation (30o)
  • External rotation (20o)
  • Patellar movement

Power

  • Just flexion and extension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Special Tests Knee Exam

A
  • Anterior and Posterior Drawer test (ACL and PCL tear)
  • Lachmans (ACL tear) - flex to 300. Stabilize femur with one hand, while you grasp the upper tibia with other hand. Try to pull tibia forward.
  • Medial and lateral collateral stress test - flex to 300. Stabilize knee posteriorly with one hand, and stabilize ipsilateral shin posteriorly with other hand. Apply varus force (MCL) and valgus force (LCL)
  • McMurray (menisca tear) - externally rotate foot with varus force (medial) while extending knee; internally rotate foot with calgus force (lateral) while extending knee.
  • Apley’s compression - with patient prone flex knee to 900. Push down while applying a varus and lateral force.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Shoulder Exam Inspection

A
  • Swelling (especially of joints) - sternoclavicular, acromioclavicular, and glenohumeral
  • Erythema
  • Atrophy - pectoralis major, deltoid, supraspinatus, infraspinatus, and trapezius
  • Deformities - alignment, step deformity of clavicle (prior fracture), wing of scapula (get patient to push against wall).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Palpation Shoulder Exam

A
  • Palpate sternoclavicular joint, acrominocalvicular joint, and gelnohumeral joint for warmth
  • Palpate SC joint, clavicle, coracoid process, AC joint, acromion, spine of scapula
  • Palpate - trapezius, supraspinatus, infraspinatus, deltoid, triceps, biceps
  • Palpate rotator cuff insertion on greater tuberosity of humerus - extend arm backwards to bring humerus out from under acromion. Also palpate for crepitus.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

ROM Shoulder Exam

A
  • Apley scratch test - have patient touch tip of their contralateral scapula.
  • Crepitus - With hand over shoulder, move shoulder in all directions around.
  • Shoulder abduction (1800)
    • Painful arch - tends to occur between 60-1200 during abduction, indicative of subacrominal impingement, subacrominal bursitings, or supraspinatus tendonitis.
    • Scapulothoracic rhythm - if abnormal, you would see kink in rhythm.
  • Shoulder adduction
  • Shoulder flexion (1800)
  • Shoulder extension (600)
  • Shoulder external rotation - rotate forearm away from body
  • Shoulder internal rotation - rotate forearm towards body and then behind the back.
  • Power - shoulder flexion, extension, abduction, adduction, internal and external rotation.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Special Testes Shoulder Exam

A

Supraspinatus tear

  • Drop arm test - have patient abduct arms to overhead position and bring arm back to side actively. If an arm suddenly drops to the side test is positive.

Subacrominal impingement syndrome

  • Painful arc - have patient abduct arms and look for signs of pain (between 60-1200)
  • Neer’s test - Stabilize shoulder and passively lift arm to the ear.
  • Hawkins Kennedy test - place arm as if it were holding a Hawk and internally rotate. Look for signs of pain.
  • Empty can test - Arms abducted 450 and flexed forward 450 with thumbs pointed down apply downward pressure.

Bicipital Tendonitis

  • Speed’s test - Patients elbow extended, arm supinated and forward at 450 apply downward pressure.
  • Yergasons test - with patients arm flexed to 900 pronate arm while patient is resisting.

Acromioclavicular joint pathology

  • Patient places their hand on contralateral shoulder. Stabilize ipsilateral shoulder. Apply a posterior force to push arm into body while stabilizing the ipsilateral joint.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Elbow exam General

A
  • Inspection:
    • Swelling (look at para-olecranon grooves (joint swelling); posterior aspect of olecranon (bursitis)).
    • Erythema
    • Atrophy - biceps, triceps, brachioradialis, wrist flexors (medial epicondyle), wrist extensors (lateral epicondyle).
    • Deformities - carrying angle, flexion contractures
    • Skin changes or scars
  • Palpation
    • Posteriorly - humerus, triceps, olecranon process, olecranon bursa, para-olecranon grooves, extensor surface of arm
    • Medially - medial triceps border, epitrochlear lumph nodes, medial epicondyle, common flexor tendon
    • Anteriorly - biceps, biceps tendon, brachial pulse
    • Laterally - lateral epicondyle, common extensor tendon, radial head
  • ROM: Flexion, extension, prontation, supination
  • Power: Flexion, extension, prontation, supination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Elbow Exam Special Tests

A
  • MCL (ulnar) an and LCL (radial) collateral ligaments - hold elbow to stabilize with on hand, and glex elbow at 300. Grasp foreamrm with other hand. Apply a valgus force (MCL) and a varus (LCL) force
  • Antero-posterior stability - elbow flexion to 900 and grasp at humerus. Push and pull humerus anteriorly and posteriorly, there should be no movement.
  • Tennis Elbow Test - Elbow extended with wrist extended. Palpate for tenderness at lateral epicondyle. Then apply a flexion force at wrist while patient resists. Look for signs of pain.
  • Golfers Elbow Test - Elbow extended with wrist flexion. Palpate for tenderness at medial epicondyle. The apply extension force at wrist while patient resists. Look for signs of pain.
  • Tinels Sign
  • Elbow flexion test - Have patient hold position with elbow flexed and wrists extended for 60seconds.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Back Examination General

A
  • Gait assessment - stance, swing, quality of gait, antalgic gait, trendelenburg gait, sitting to standing
  • Inspection - Swelling, erythemia, atrophy (sternocleidomasteroids, shoudler girdle, chest wall, intercostsals, paraspinal, gluteal, abdominal
  • Palpation - Palpate spinous processes and paravertebral muscles
  • ROM
    • Cervical Spine - flexion, extension, lateral flexion, rotation
    • Thoracolumbar spine - flexion (measure finger to floor distance), extension (get patient to lean against bed), lateral flexion, rotation (sitting on bed)
17
Q

Back Examination Special Tests

A
  • Adams forward bend test
  • Occiput wall distance
  • Chest expansion
  • Rib-pelvis distance
  • Schober test - measure 10cm above and 5cm below dimples of venus. Have patient bend over and remeasure - distance should now be 20cm or more
  • Straight leg raise and lasegue sign (sciatica) - raise leg that is symptomatic and look for pain radiating down leg. If pain occurs lower leg until pain stops and dorsiflex the ankle, if pain occurs lasegues is positive.
  • Crossed straight leg raise (sciatica) - Raise leg that is asymptomatic, and patient may experience pain radiating down symptomatic leg.
  • Femoral nerve stretch - Patient prone with knees extended. Passively flex the knee and extend the hip lifting thigh off the bed. Patient may experience pain in anterior thigh.
  • FABER
18
Q

Ankle exam general

A
  • Gait assessment - stance; swing; smoothness; symmetry; ability to turn quickly; antalgic gait; walk on toes, heels, medial border, lateral border
  • Inspection:
    • Splaying of toes
    • Too many toes sign
    • Sweeling
    • Erythemia
    • Atrophy
    • Deformity - valgus, bunions, hammer toes, claw toes, mallet toes
    • Skin changes
    • Shoe inspection
  • Palpation
    • Lateral, dorso-medially, medially, posteriorly
    • Planter fasciitis - medial calcanous tuberosity
    • Painful heel pad syndrome - centre of heel
    • True ankle joint swelling - cup hands around ankle, and palpate tibiotalaer joint space anteriorly for fullness, try to ballot fluid between thumbs
    • MTP squeeze
    • Palpate MTP, PIPs, and DIPs,
  • ROM
    • True ankle - dorsiflexion, plantarflexion
    • Subtalar - inversion, eversion
    • Midtarsal (stabilize heel, grasp and rotate mid and forefoot) - inversion, eversion, adduction, abduction
    • Toes - flexion, extension
19
Q

Special Tests

A
  • Stability testing - stabilize lower leg with one hand anteriorly and grasp the hindfoot
    • Deltoid ligaments - apply eversion force to foot
    • Lateral ligament - apply inversion force to foot
    • Anterior talofibular ligament - put foot in 200 plantarflexion, and then perform an anterior drawer test
  • Tinel’s sign - tape just posteriorly to medial malleolus for 30 seconds (first 3 toes)
  • Thompson calf-squeeze test (torn achilles tendon) - have patient supine or kneeling in a chair with foot handing off chair. Squeeze calf, calf should plantarflex
20
Q

Hands exam general

A
  • Inspection: swelling, erythemia, atrophy (thenar, hypothenar, interossei muscles, dupuytrens contractures), deformities (OA: bouchards (PIP), heberdens (DIP); RA: joint swelling MCPs, PIPs; prominent ulnar head, radial deviation of wrist, ulnar deviation of fingers, psoractic changes), prayer sign, scars and skin changes (psoriatic, gout, vasculities, scar).
  • Palpation: Warmth; MCP squeeze; snuffbox; carpal bones; metacarpals; wrist effusion; MCP, PIP, DIP effusion; flexor tendons
  • ROM
    • Wrist: flexion, extension, radial deviation, ulnar deviation, tuck sign
    • Thumb: Flexion, extension, adduction, abduction, opposition
    • PIPs and DIPs - finger tuck
  • Power: grip strength; wrist extension; wrist flexion; MCP flexion; finger adduction and abduction; thumb abduction, flexion, extension
  • Neurological - OK signs, thumbs up
21
Q

Special Tests Wrist

A
  • Wrist stability
  • Paino key sign
  • MCP stability
  • IP stability
  • Tinels
  • Phalens
  • Finkelsteins

MF4 (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions