Clinical Skills: MSK Examination

Question 1

Outline the relevant parts of MSK exam. (8)

Answer 1

General inspection
Set of basic observations
Look
Feel
Movement (active/passive/resistance/function)

Question 2

Define flexion. (1)

Answer 2

Joint bending from neutral position (reduces angle)

Question 3

Define extension. (1)

Answer 3

Straightening a joint back to the neutral position and into a reversed position.

Question 4

Define hyper extension. (1)

Answer 4

Movement beyond the anatomical position.

Question 5

Define adduction. (1)

Answer 5

Movement towards midline of body.

Question 6

Define abduction. (1)

Answer 6

Movement away from midline.

Question 7

Define supination. (1)

Answer 7

Facing upwards.

Question 8

Define pronation. (1)

Answer 8

Facing down/backwards.

Question 9

Define inversion. (1)

Answer 9

Supination of foot (raised medial edge)

Question 10

Define eversion. (1)

Answer 10

Protonation of foot (raised lateral edge).

Question 11

Define ulnar deviation. (1)

Answer 11

Movement towards ulnar

Question 12

Define radial deviation. (1)

Answer 12

Movement towards radius.

Question 13

Define dorsi-flexion. (1)

Answer 13

Foot towards shin.

Question 14

Define plantarflexion. (1)

Answer 14

Pointing toes down.

Question 15

Define opposition. (1)

Answer 15

Tip of thumb to touch tips of other fingers.

Question 16

Define internal rotation. (1)

Answer 16

Rotation towards midline.

Question 17

Define external flexion. (1)

Answer 17

Rotation away from midline.

Question 18

What are the possible MSK diagnosis? (2)

Answer 18

Soft tissue injury
Fracture

Question 19

State the management of soft tissue injury. (3)

Answer 19

PRICE + HARM
Analgesia
Safety netting advice

Question 20

State the management of fracture. (3)

Answer 20

X-ray referral
Don’t use affected limb.
Take analgesia.

Question 21

What factors is considered for look in MSK examination? (7)

Answer 21

Swelling
Inflammation
Deformities
Differences in sizes
Bruising/wounds
Colour/Pallor

Question 22

What factors is considered for feel in MSK examination? (3)

Answer 22

Skin temperature:
- Hot/warm = inflammation/infection
- Cold = Poor circulation.

Area of tenderness: General/Bony
Check for swellings/mobility
Sensation (NVD)

Question 23

What factors is considered for move in MSK examination? (5)

Answer 23

ROM
Actively (1st) and passively (2nd)
Active = px moves with instruction
Passive = practitioner moves limb/joint.
During passive movements one hand to remain on joint for crepitations.

Question 24

What factors is considered for function in MSK examination? (2)

Answer 24

Functional assessment on affected joint/limb.
Movement against resistance (caution)

Question 25

Perform the Hand/Wrist in MSK examination. (4)

Answer 25

Look : Swelling, inflammation, deformities (wrist/metacarpal) differences in size, bruising/wounds, colour/pallor. Feel: skin temperature, tenderness, check for swellings, sensation (NVD), ASB for tenderness. Move: active then passive. Wrist (flexion, extension, ulnar/radial deviation), Hand (fingers flexion, extension, abduction, adduction, thumb opposition Function: hand function/grip test, power/resistance

Question 26

Perform the Elbow in MSK examination. (4)

Answer 26

Look : Swelling, inflammation (olecranon bursitis/infection) , deformities, differences in size, bruising/wounds, colour/pallor. Feel: skin temperature, general/bony (lateral/medial epicondyle, olecranon) tenderness, check for swellings. Move: active then passive. Elbow: Flexion, Extension, Pronation, Supination Function: hand function/grip test, power/resistance

Question 27

What are the OTTAWA rules for knee examination? (5)

Answer 27

< 18 yrs. If injury occurred < 7 days. Inability to bear weight both immediately and in emergency department Isolated tenderness of patella/fibula Inability to flex to 90 degrees.

Question 28

Perform the Knee in MSK examination. (4)

Answer 28

Look : > 55 yrs, Swelling, inflammation, deformities, differences in size, bruising/wounds. Feel: skin temperature, tenderness (patella/head of fibula), check for swellings and mobility. Move: active then passive. Knee (flexion, extension, straight leg raise, anterior crucuate lag test, posterior cruciate laf test, lateral/medial stress test. Function: power/resistance, walk 4 steps at time of incident and consultation.

Question 29

What are the OTTAWA rules of ankle in MSK examination? (2)

Answer 29

> 18 years Injury occurred < 10 days ago.

Question 30

Perform the ankle/foot in MSK examination. (4)

Answer 30

Look : Swelling, inflammation, deformities (ankle/metatarsals) differences in size, bruising/wounds. Feel: skin temperature, tenderness (navicular, base of 5th metatarsals, medial + lateral Malle plus 6cm, check for swellings, pain and fluctuation, sensation (NVD). Move: active then passive. Ankle (Dorsiflexion, Plantarflexion, inversion, eversion, rotation). Foot (Toe dorsiflexion/plantarflexion). Function: power/resistance. Walk 4-5 steps at time of incident and consultation.

Question 31

What is PRICE? (5)

Answer 31

Protect Rest Ice Compression Elevation

Question 32

What is HARM? (7)

Answer 32

Heat Alcohol Running Massage Analgesia Gently mobilisation Recover period

Question 33

What analgesics advice is given for px with soft tissue injury? (5)

Answer 33

Paracetamol Topical NSAIDs (Ibuprofen gel) Codeine Medical review after 5-7 days: - No signs of improvement - Worsening condition - Can take several weeks to fully heal.