MSK OSCE Flashcards by Henry Marshall

What do you look for in a lumbar spine exam

muscle wasting
asymmetry
scoliosis (from back)
posture
normal kyphosis and lordosis (from side)

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what do you feel for in a lumbar spine exam

vertebrae and sacroiliac joint for tenderness

para-spinal muscles for tenderness

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what do you move in a lumbar spine exam

3 fingers over spine- bend forward (flexion)

lateral flexion (run hand down side of leg)

thoracic rotation (sat down)

straight leg raise (flat on bed- pain= nerve root irritation)

DORSIFLEXION of big toe- L5 nerve root problem

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what reflexes do you illicit in a lumbar spine exam

patella

ankle jerk

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what end pieces would u discuss in a lumbar spine exam

if indicated:

peripheral nerve exam of the lower limb

peripheral vascular exam of the lower limb

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what would you look for in a cervical spine exam

sitting and standing for:

posture
normal cervical lordosis

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what do you feel for in a cervical spine exam

palpate the spine for alignment and tenderness

palpate paraspinal muscles, trapezius and upper back muscles for tenderness

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what do you move in a cervical spine exam

flexion (tilt head down) and extension (tilt head back)

lateral flexion (ear to shoulder)

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what reflexes would you elicit for a cervical spine exam

biceps

triceps

supinator

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what end pieces would you discuss for a cervical spine exam

peripheral nerve exam of the upper limb

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what would you look for in an elbow exam

in anatomical position

for carrying angle, flexion deformity

scars, rashes, muscle wasting, swelling

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feel in elbow exam

temp

palpate elbow joint at 90 degrees flexion (note epidcondyles and olecranon process)

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move elbow exam

full range of flexion and extension

pronation and supination

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reflexes elbow exam

apparently none

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function elbow exam

reach mouth

reach behind head

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look foot and ankle exam

with feet overhanging couch:
forefoot for nail changes, rashes, alignment, swelling

footwear for insoles

with weight bearing:
forefoot for toe alignment
mid foot for foot arch position

from behind:
achilles tendon
alignment

feel foot and ankle exam

temp
pulses

squeeze MTP joints
palpate the whole foot including both malleoli, 5th metatarsal and navicular

move foot and ankle exam

inversion and eversion

dorsiflexion and plantar flexion

rotation of mid tarsal joint (fix the heel and invert the foot passively)

function foot and ankle exam

observe gait cycle

for heel strike, stance, toe-off

look hand and wrist exam

palms down for swelling, deformity, wasting, scars,

palms up for muscle wasting at the eminences (thenar wasting= carpal tunnel syndrome) , dupytrens contracture

check for scar at wrist (carpal tunnel surgery)

nails for pitting/ oncholysis (present in psoriasis), clubbing, splinter haemorrhages

feel hand and wrist exam

palms up for muscle wasting, median and ulnar nerve sensation (both eminences and index finger and little finger- should be the same)

palms down for radial nerve sensation (web between thumb and index finger), squeeze MCP joints

temperature of forearm

palpate wrist bimanually

radial pulse

run hand up ulnar border for plaques/ nodules (psoriasis)

move hand and wrist exam

wrist flexion and extension active and passive

finger flexion, extension, adduction and abduction

thumb abduction

function hand and wrist exam

grip 2 fingers with hand to assess grip strength

pinch 1 finger for pincer grip

look hip exam

standing for muscle wasting (note gluteal region bulk)

supine for leg length and deformity and scars

feel hip exam

palpate over greater trochanter for tenderness

move hip exam

with knee flexed assess full hip flexion Thomas' test= 1 hand on back- fully flex hip- other leg should stay on bed Trendelenberg test= stand on one leg- positive= pelvis dipping on contralateral side (bad)

function hip exam

assess gait for limp

look knee exam

swelling, redness, inflammation muscle wasting, scars walking aids

feel knee exam

temp palpate knee joint and behind for baker's cyst patellar tap test

move knee exam

active and passive flexion and extension anterior and posterior drawer test (ACL and PCL) medial and lateral collateral ligament stability (medial palm over knee, lateral fingers on knee joint to feel joint line)

function knee exam

assess gait look for bakers cyst

look shoulder exam

front side and behind for symmetry, posture, wasting, scara

feel shoulder exam

temperature palpate from sternoclavicular joint all the way round on the clavicle to the scapula palpate glenohumeral joint from front and back palpate muscles: supraspinatus, infraspinatus, deltoid

move shoulder exam

hands behind head (External rotation) hands behind back (internal rotation) external rotation with elbow flexed at 90 degrees flexion and extension abduction (look from behind at scapula)

inspection GALS exam

in anatomical position- front side and back: - muscle bulk/ wasting - spine alignment - limb alignment, carrying angle - popliteal swelling - foot abnormalities (arches, hallux valgus)

Gait GALS exam

``` observe: symmetry length of stride smoothness turning speed ```

Arms GALS exam

behind head and behind lower back ``` arms outstretched (palms down) look for swelling squeeze MCP joints ``` make a fist, squeeze hand, pinch finger

Legs GALS exam

supine inspect for bulk and deformity knee flexion and extension patellar tap test flexion and internal rotation of hip joint

Spine GALS exam

cervical spine movement (up, down, ear to shoulder) lumber flexion with 3 fingers on spine