MSK examinations

Question 1

What screening questions should be asked during a GALS exam?

Answer 1

Do you have any pain over any joints, muscles or back?

Can you dress yourself without any difficulties?

Question 2

What should be done to assess gait during GALS?

Answer 2

Ask to walk and turn back? (assess gait, ability to turn, symmetry)
Standing in anatomical position assess muscle bulk, symmetry, iliac crest heights, feet

Question 3

What should be done during assessment of arms during GALS?

Answer 3

Arms behind head (external rotation of shoulders)
Arms in front and look for any deformities
Flip hands over assess muscle bulk
Make a fist (ROM, power grip)
Squeeze your hands (strength of grip)
Make a pincer with each finger (precision pincer)
Squeeze MCPS (look for tenderness - watch face)

Question 4

What should be done during assessment of legs during GALS?

Answer 4

Bend and straighten knees (feel for crepitus)
Patellar tap
Internal rotation of hip (hip and knee bent)
Feet for calluses, and abnormalities
Squeeze MTPs

Question 5

What should be done during spine assessment of GALS?

Answer 5

Lateral flexion of cervical spine (ear to shoulder)
Rotate neck L/R
Lean forwards to touch toes (3 fingers on spine, should separate)

Question 6

What is assessed during inspection of hands?

Answer 6

Elbows and wrists (swellings?)
Skin
Nails (infarcts? psoriatic changes?)
Digits (deformities?)

Question 7

What is palpated during ‘feel’ of hand exam?

Answer 7

Warmth of wrists/MCPs
Bimanually palpate each joint 
Squeeze MCPs (look for signs of tenderness)

Question 8

What is done during ‘move’ of hand exam?

Answer 8

Make a fist (ROM, power)
Pincer (each finger to thumb)
Pick up a coin (fine movement)
Hold a pencil (tried grip)
Resist decoupling
Squeeze your hand (strength)

Question 9

What is assessed during ‘look’ of spine exam?

Answer 9

Side:

• cervical lordosis, thoracic kyphosis, lumbar lordosis
• scoliosis?

Behind:
-position of head, neck and shoulders

Question 10

What is assessed during ‘feel’ of spine exam?

Answer 10

Supraclavicular:

• cervical ribs
• enlarged lymph nodes

Mid-line:

• spinous processes
• para-spinal muscles

Iliac crest heights
Sacro-iliac joints

Question 11

What is assessed during ‘move’ of spine exam?

Answer 11

Cervical spine:

• Flexion/extension (forward/back)
• Lateral flex/extend (ear to shoulder)
• L/R rotation

Lumbar spine:

• flexion/extension (touch toes)
• lateral flexion (keep body and knees straight)

Question 12

What special tests are done during spine exam?

Answer 12

Schobers test:
Mark iliac crests and make a line between them,
Mark 10cm above and 5cm below
Using tape ask to touch toes (should increase to >20cm)

Question 13

What is assessed during inspection of knee exam?

Answer 13

Standing:

• Glut/hamstring muscle mass/bulk
• Popliteal fossase

Gait:

• Speed
• Symmetry
• Walking aid

Lying:

• Bruising
• Hair changes
• Erythema
• Scars

Question 14

What is assessed during ‘feel’ of knee exam?

Answer 14

• Temperature
• Tibial tuberosity
• Patella tendon
• Medial and lateral joint lines
• Medial/Lateral collateral ligaments
• Popliteal fossa

Question 15

What is assessed during ‘move’ of knee exam?

Answer 15

Active/passive flexion

Question 16

What special tests are done on the knee?

Answer 16

Straight leg raise (extensor mechanism)

Steinmanns (meniscus: knee at 90 degrees med/lat rotate)

Varus/valgus stress test (med/lat collateral ligaments - leg over side of bed move L/R)

Ant/Post drawer (ACL/PCL)

Lachman’s (thumb on tibial tuberosity pull forwards - ACL)

Patellar tap/medial gutter sweep (effusion)