MSK Examinations

Question 1

Shoulder examination inspection

Answer 1

scars - previous surgery/trauma
asymmetry/deformity - winged scapula, scoliosis
muscle bulk of trapezius and deltoids - symmetry, wasting
paravertebral muscles - swelling, wasting
muscle wasting in the supra and infraspinatus fossa - nerve injury, chronic rotator cuff tear

Question 2

Shoulder examination palpation

Answer 2

Temperature - inflammatory arthropathy/infection

sternoclavicular joint > clavicle > acromioclavicular joint > coracoid process > head of humerus > greater tuberosity of humerus > spine of scapula

Question 3

Shoulder examinations active movements

Answer 3

Flexion (forwards)
Extension (backwards)
ABduction
Adduction
External rotations
Internal rotation

Question 4

Shoulder examination passive movements

Answer 4

Flexion
Extension
Adduction
Abduction
External rotation
Internal rotation

Feel for crepitus

Question 5

Shoulder examination resisted movements

Answer 5

Abduction
Adduction
External rotation (infraspinatus)
Internal rotation (subscapularis)

Question 6

Shoulder examination special tests

Answer 6

Jobe’s test - supraspinatus impingement/weakness

Painful arc - supraspinatus impingement

Gerber lift-off test - test of subscapularis muscle function

Question 7

Elbow join general inspection

Answer 7

Scars - injury, surgery
Swelling/erythema of joint - acute injury, inflammatory arthritis, septic arthritis, cellulitis
Carrying angel - cubits valgus/varus deformity ( trauma/childhood fracture)
Fixed flexion deformity - often post traumatic
Olecranon bursitis - swelling
Rheumatoid nodules - systemic rheumatoid disease
Psoriatic plaques - well defined pink/red lesions wth silvery scale

Question 8

Elbow passive and active movements

Answer 8

Flexion
Extension
Pronation
Supination

Question 9

Elbow exam special tests

Answer 9

Medial Epicondylitis (aka Golfer’s elbow) - resisted FLEXION

Lateral epicondylitis (aka Tennis elbow) - resisted EXTENSION

Question 10

Biceps tendon tenderness

Answer 10

Biceps tendonitis

Question 11

Hand examination inspection

Answer 11

inspect hand posture
scars or swellings
erythema - cellulitis, palmar erythema
pallor - peripheral vascular disease, anaemia
deformities - bouchards, heberdens, swan neck, z thumb, boutonnieres
skin changes
muscle wasting
nail changes
thenar/hypothenar wasting
elbows - psoriatic plaques or rheumatoid nodules

Question 12

Palms - palpation

Answer 12

temperature (forearm, wrist, MCP joints) - inflammatory/septic arthritis
radial and ulnar pulse
thenar/hypothenar eminence bulk
palmar thickening
median and ulnar nerve sensation (thenar eminence/index finger - median nerve) (hypothenar eminence/little finger - ulnar nerve)
assess radial nerve sensation (first dorsal web space)
gently squeeze MCP joints - inflammatory arthropathy
bimanually palpate hand joints
palpate anatomical snuffbox
wrists
along ulnar border from elbow

Question 13

Hand examination passive and active movements

Answer 13

finger extension
finger flexion
wrist extension
finger flexion

Question 14

Hand examination motor assessment

Answer 14

wrist/finger extension against resistance (radial nerve)
finger abduction against resistance - ulnar nerve
thumb abduction against resistance (median nerve)

power grip
pincer grip
pick up small object/do up a button

Question 15

Hand examination special tests

Answer 15

Tine’s test (tap over carpal tunnel)
Phalen’s test (inverted prayer)

both for carpal tunnel syndrome

Question 16

Hip examination inspection

Answer 16

scars
pelvic tilt
quadriceps wasting
foot deformity
scoliosis
gluteal wasting
gait
unequal sole wearing

Question 17

Hip examination palpation

Answer 17

tenderness/warmth - inflammation, infection
greater trochanter - tenderness = greater trochanteric bursitis
assess leg length (apparent and actual)

Question 18

Hip examinait active movements

Answer 18

flexion (with hand under lumbar spine)

Question 19

Hip examination passive movements

Answer 19

flexion
internal rotation
external rotation
abduction
adduction
hip extension (prone)

Question 20

Hip examination special tests

Answer 20

Thomas’s test - see if not flexed thigh raises off bed - FIXED FLEXION DEFORMITY (do not perform on patients with hip replacements)

Trendelenburg’s sign - weak hip abductors on the contralateral side of the pelvis

Question 21

Knee examination inspection

Answer 21

gait
scars
swellings
asymmetry/leg length discrepancy
valgus or varus deformity
quadriceps wasting
asymmetry
popliteal swellings - baker's cyst, popliteal aneurysm

Question 22

Knee examination palpation

Answer 22

knee and surrounding structures
quadriceps tendon
patella
patella tendon
tibial tuberosity
joint line
head of fibula
collateral ligaments
popliteal fossa

patella tap
sweep test

Question 23

Knee examination active and passive movements

Answer 23

extension
flexion
?hyperextension

Question 24

Knee examinations special tests

Answer 24

anterior/posterior drawer test - posterior/anterior cruciate laxity/rupture

medial collateral ligament test - laxity/rupture

Question 25

Foot and ankle examination inspection

Answer 25

``` gait symmetry toe alignment - hallux valgus bunions deformities of the toes - claw, mallet, hammer scars - previous injury/surgery calluses - foot/gait deformity or poorly fitting footwear swelling or erythema - injury/inflammatory arthritis/septic arthritis/cellulitis foot arches - pes planus, pes cavus stand on tip toes symmetry achilles tendon ```

Question 26

Ankle and foot examination palpation

Answer 26

temperature pulses - posterior tibial and dorsalis pedis achilles tendon squeeze MTP joints > tarsal and metatarsal bones > tarsal joint > ankle joint > subtalar joint > calcaneum > medial/lateral malleoli > distal fibula

Question 27

Ankle and foot examination active and passive movement

Answer 27

``` plantar flexion dorsiflexion to flexion toe extension ankle/foot inversion ankle/foot eversion ``` PASSIVE ONLY: ankle joint subtler joint mid tarsal joint

Question 28

Ankle and foot examination special tests

Answer 28

Simmond's test - squeeze calf for achilles tendon rupture

Question 29

GALS examination screening questions

Answer 29

do you have any pain in your muscles, joints or back? are you able to dress yourself completely without any difficulties? are you able to walk up and down the stairs without any difficulty?

Question 30

GALS examination inspection

Answer 30

``` Gait shoulders - bulk and symmetry elbow extension - carrying angle quadriceps - bulk and symmetry knees - swelling, deformity, asymmetry feet - deformity, asymmetry cervical spine, thoracic spine, lumbar sine knee joints - hyperextension foot arches - low or high tow clawing shoulder muscles spinal alignment iliac crest alignment popliteal swellings kind foot abnormalities ```

Question 31

GALS arm assessment

Answer 31

``` hand behind head hands out in front of them supination fist power grip precision grip squeeze MCP joints ```

Question 32

GALS leg assessment

Answer 32

passive full knee flexion and extension passive internal rotation of the hip patellar tap squeeze MTP joints

Question 33

GALS spine assessment

Answer 33

inspect lateral flexion of cervical spine (ear to shoulder) lumbar flexion

Question 34

Spine examination - inspection

Answer 34

``` posture of head and neck symmetry of shoulders cervical lordosis thoracic kyphosis lumbar lordosis scars wasting scoliosis abnormal hair growth (spina bifida) ``` assess gait

Question 35

Spine examination - feel

Answer 35

palpate spinal processes and sacroiliac joints | Palpate paraspinal muscles

Question 36

Spine examination - movement

Answer 36

cervical spine - flexion, extension, lateral flexion, rotation lumbar spine - flexion, extension, lateral flexion thoracic spine - rotation (sit down, arms across chest, twist)

Question 37

Spine examination - special tests

Answer 37

Schooner's test - marking lumbar spine and touch toes and should increase by 5cm Sciatic stretch test - sciatica Femoral nerve stretch test - femoral nerve impingement