LE MSK Exam

Question 1

Areas to be examined in LE MSK exam

Answer 1

• Gait/posture/stance
• Skin/musculature
• Spine
• Hip
• Knee
• Foot/ankle

Question 2

General LE MSK exam

Answer 2

 Perform a general inspection of the patient from the front, back and both sides.*
 Observe:
 Gait*
 Posture, stance*
 How patient transfers from chair to exam table*
 Inspect for:
 Skin color, rashes, masses, swelling
 Gross deformity, alignment, symmetry
 Muscle hypertrophy or atrophy, fasiculations, spasms

Question 3

Spine exam components

Answer 3

 Check alignment and symmetry [forward bending]
 Palpate surface features – SI joints, spinal processes, paravertebral muscles, sacrum
 Check Range of Motion (ROM) of spine: forward flexion, extension, lateral bend, rotation
 Check Range of Motion (ROM) of neck: forward flexion, extension, lateral bend, rotation
 Elicit deep tendon reflexes at the knee and ankle.
 Perform the straight leg raising test
 Check sensation in the distribution of the L4, L5 & S1 nerve roots*

Question 4

Hip exam components

Answer 4

 Palpate surface features (pt supine or on side)- pubic tubercle, anterior superior iliac spines, greater trochanters, and the ischial tuberosity
 Check hip ROM (pt supine)— internal & external rotation, flexion, adduction, abduction.
 Check hip ROM (pt standing or lying on opposite side) - extension

Question 5

Knee exam components

Answer 5

 Palpate surface features– patella, patella tendon, head of the fibula, medial & lateral joint lines
 ROM –flexion / extension, rotation (stabilize the ankle and rotate foot medially and laterally)
 Test the integrity of the anterior & posterior cruciate, and the medial & lateral collateral ligaments
 Test for meniscus integrity

Question 6

Foot/ankle exam components

Answer 6

Foot:
 Palpate surface features: plantar fascia, medial and lateral malleoli.
 Palpate the surface location of major tendons – Achilles, posterior & anterior tibial, peroneal, toe
extensors.
 Check ankle & hind foot ROM: dorsiflexion, plantarflexion, inversion and eversion

Question 7

Proper technique for checking lumbar nerve root sensation (L4, L5, S1)

Answer 7

a. L4 sensation: anterior knee
b. L5 sensation: anterior shin, dorsal surface of foot
c. S1 sensation: posterior and lateral calf, plantar surface of foot, posterior thigh

Question 8

Hip ROM

Answer 8

• Flexion – ask patient to bring flexed knee to chest
• Adduction – hand on opposite hip, support leg and swing over the other leg
• Abduction – hand on opposite hip, support leg and swing out to side
• Internal Rotation – flex leg to 90 at hip and knee, grasp ankle and swing leg LATERALLY
• External Rotation – flex leg to 90 at hip and knee, grasp ankle and swing leg MEDIALLY (it’s counterintuitive remember it is how the head of femur moves)

Question 9

Mcmurray test technique

Answer 9

• testing for meniscal integrity
• hand on knee joint line
• flex knee and rotate heel TOWARDs the meniscus being tested (i.e. heel towards lateral (foot inwards) to test lateral meniscus)
• extend knee
• (+) w/click and/or pain