MSK hand, elbow and shoulder

Question 1

What do you ask before any of the examinations?

Answer 1

Whether they have any pain?

Question 2

what skin changes are you looking for in the hands?

Answer 2

Erythema –> cellulitis
Pallor–> PVD
Thinning –> long term steroid use
Rashes–> psoriatic plaque

Question 3

What abnormalities are you looking for in the nails?

Answer 3

pitting/ Oncholysis (psoriatic changes)

Nail vasculitis and infective endocarditis (ra)

Question 4

What are the abnormalities in the hand for RA?

Answer 4

Swan neck deformity
Z-thumb
Boutonnières deformity
Ulnar deviation

Question 5

What are the deformities you see in OA in the hand?

Answer 5

• Bouchard’s node

* Herbeden’s node

Question 6

What features are you looking for when the palm is facing up in inspection?

Answer 6

Muscle wasting in thenar and hypothenar eminence
Dupytren’s contracture
Elbows for psoriatic plaque and rheumatoid nodules
Scar for CPT

Question 7

What do you palpate with the palms facing up?

Answer 7

Hypothena and thenar area

temperature

Question 8

where do you feel for sensation for

a) median nerve
b) ulnar nerve
c) radial nerve

Answer 8

a) thenar and index finger
b) hypothenar and little finger
c) back of hand near thumb

Question 9

When assessing temperature what part of the arm are you palpating?

Answer 9

From elbow to the hands

Question 10

What joints do you squeeze for assessment of pain for RA?

Answer 10

Squeeze across row of MCP

Question 11

Why do you manually palpate all of the joints in the hand?

Answer 11

For signs of bone swelling or synovitis

Question 12

Why do you run your hands down the ulnar border of the forearm ?

Answer 12

For rheumatoid nodules or psoriatic plaques

Question 13

What test is done to assess the present of carpal tunnel syndrome?

Answer 13

Phalen’s test

Tinnel’s test

Question 14

What is Phalen’s test?

Answer 14

It is forced flexion of the wrist for 60 seconds

Question 15

Where do you palpate for fracture of scaphoid?

Answer 15

Anatomical snuff box

Question 16

What are the bones in the wrist from proximal to distal?

Answer 16

Proximal =Scaphiod, lunate, triquetrum, pisiform

Distal= Trapezium, trapeziod, capitate, hamate

Question 17

How do you test for radial nerve function?

Answer 17

wrist, hand extension against resistance

Question 18

What nerve are you testing when doing thumb abduction abduction resistance

Answer 18

median nerve

Question 19

How do you test for the function of ulnar nerve?

Answer 19

finger abduction against resistance

Question 20

What are the three function tests do you do?

Answer 20

Squeeze my hand
Pincer grip my hand
Pick a penny up

Question 21

What are the two special test?

Answer 21

Phanels test

Tinnels test

Question 22

How do you do Tinnel’s test?

Answer 22

Tap over the carpal tunnel and should cause symptoms of CPT

Question 23

When doing a hand msk examination should you rest the wrist on a pillow?

Answer 23

Yes

Question 24

When looking at the elbow directly what are you looking for?

Answer 24

Scar
Swelling/erythema
Carrying angle

Question 25

When looking at the elbow from the side what are you looking for?

Answer 25

Bursitis and hyperflexion and extension | Muscle wasting

Question 26

When looking at the elbow from behidn what are you looking for?

Answer 26

Rhuematic nodules Psoriatic plaques rashes/muscle wasting

Question 27

What is another name for a) medial epicondylitis b) lateral epicondylitis

Answer 27

a) golfers elbow | b) tennis elbow

Question 28

How do you test for the function of the elbow?

Answer 28

Can they touch their nose with their fingers | Can they touch the back of their hand

Question 29

What actions are done passively and actively in elbow examination?

Answer 29

Extension and flexion | Pronation and supination

Question 30

What is the name of the two test for tennis elbow?

Answer 30

Conzens test | Mills test

Question 31

How do you test for golfer elbow?

Answer 31

1) The patient should be seated or standing 2. Stabilise the elbow whilst palpating the medial epicondyle 3. Passively supinate the forearm 4. Extend the patient’s wrist 5. Extend the patient’s elbow fully

Question 32

How do you do the Mills test for tennis elbow?

Answer 32

1,Position the patient standing 2. Stabilise the elbow whilst also palpating the lateral epicondyle 3. Passively pronate the patient’s forearm 4. Flex the patient’s wrist 5. Extend the forearm fully

Question 33

How do you assess for frozen shoulder?

Answer 33

Ask patient to put flexed elbows next to their side then assess them to spread their arms

Question 34

How do you assess the movement of the scapula?

Answer 34

Ask the patient to abduction of their arm while you palpate their scapula

Question 35

What are the special test that you would do?

Answer 35

Supraspinator assessment Painful arc External rotation assessment Internal rotation assessment

Question 36

What muscle are you testing for when doing internal rotation against resistance?

Answer 36

Subscapularis muscle

Question 37

What muscle are you testing for in painful arc?

Answer 37

Deltiod and supraspinator