musculoskeletal assessment

Question 1

examples of subjective data

Answer 1

pain or discomfort, weakness, stiffness, limited movement, swelling/heat, deformity, lack of balance

Question 2

examples of past medical history

Answer 2

MSK trauma, surgery, skeletal anomalies, chronic illness

Question 3

how does chronic illness affect the bones

Answer 3

long term steroids can weaken the bones

Question 4

health history tips

Answer 4

always obtain mechanism of injury, timing of pain, popping/clicking/grating, joint instability, swelling, effect on ADLs

Question 5

what is the purpose of the MSK exam?

Answer 5

do assess function for ADLs and to screen for abnormalities

Question 6

how should the physical exam be performed

Answer 6

head to toe, proximal to distal, bilateral comparison

Question 7

what are the components of the MSK exam

Answer 7

inspection and palpation only

Question 8

what should you inspect/palpate for

Answer 8

• posture and gait
• muscle characteristics (tone/bulk)
• ROM
• strength
• joint exam

Question 9

what is the joint exam looking for

Answer 9

tenderness, swelling, redness, heat, crepitus, reduced ROM

Question 10

inspection of MSK includes…

Answer 10

size and contour of joint
inspection of skin and tissues for color change
swelling
any masses or deformity

Question 11

palpation of MSK includes…

Answer 11

palpate each joint, including skin for temperature, muscles, bony articulations, and area of capsule
- joints are normally not tender

Question 12

muscle strength testing

Answer 12

0/5- no muscle contraction
1/5- slight muscle contraction evident, no joint movement
2/5- full ROM with gravity eliminated (passive only)
3/5- full ROM with gravity
4/5- full ROM against gravity with some resistance
5/5- full ROM against gravity and full resistance

Question 13

normal spinal curvature

Answer 13

thoracic convexity, cervical and lumbar concavity

Question 14

abnormal spinal curvatures

Answer 14

scoliosis - lateral curve
kyphosis - hunchback
lordosis - exaggerated lumbar concavity
gait - smooth and rhythmic

Question 15

balance and coordination tests

Answer 15

walk on heels, toes, tandem walk, sit and stand
rapid alternating movements (ex fingers to thumb and heel to shin)

Question 16

what do balance abnormalities indicate?

Answer 16

neuro, MSK, or vestibular problems

Question 17

measuring extremities

Answer 17

muscle bulk and symmetry, strength and tone, range of motion

Question 18

expected extremities

Answer 18

symmetrical and even

Question 19

range of motion test

Answer 19

active and passive, if active ROM is full, no need to test passive
always ask patient to perform active first

Question 20

joint exam expected findings

Answer 20

bony structures aligned, full active and passive ROM, no swelling, tenderness, redness, warmth, or crepitus

Question 21

abnormalities that affect multiple joints

Answer 21

rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, osteoporosis

Question 22

shoulder abnormalities

Answer 22

atrophy, dislocated shoulder, joint effusion, tear of rotator cuff, frozen shoulder

Question 23

elbow abnormalities

Answer 23

olecranon bursitis, arthritis, rheumatoid nodules, epicondylitis

Question 24

spine abnormalities

Answer 24

scoliosis, herniated intervertebral disc

Question 25

wrist and hand abnormalities

Answer 25

ganglion cyst, colles’ fracture, carpal tunnel syndrome with atrophy of thenar eminence, ankylosis, dupuytren’s contracture

Question 26

knee abnormalities

Answer 26

osgood-schlatter disease
post-polio muscle atrophy
prepatellar bursitis
swelling of menisci

Question 27

ankle and foot abnormalitites

Answer 27

achilles tenosynovitis
tophi with chronic gout/acute gout
hallux vagus with bunion and hammer toes
plantar fascitis
ingrown toenail
plantar wart

Question 28

scoliosis exam

Answer 28

• stand before examiner
• anterior iliac symmetry
• shoulder symmetry
• bend at waist for spinal alignment and rib hump

Question 29

older adults MSK possibility

Answer 29

• decreased bone mass
• decreased height
• decreased joint flexibility
• sarcopenia
• decreaased nutritional intake
• osteoporosis - fractures
• decreased strength and muscle bulk
• decreased agility
• calcium/vitmain D deficiency

Question 30

osteoporosis risk factors

Answer 30

• female
• over 50
• thin
• smoker
• hypothyroid
• alcohol use
• calcium/vitamin D deficiency

Question 31

common diagnostic tests

Answer 31

• CK, AST, ALT enzymes elevated with muscle injury
• alkaline phosphatase elevated with bone injury
• uric acid - elevated in gouty arthritis
• x ray

Question 32

red flags in MSK assessment

Answer 32

• inability to bear weight on extremity
• joint out of alignment
• sensory change distal to MSK injury
• motor change distal to MSK injury
• delayed cap refill or loss of pulse distal to injury

Question 33

intervention of joint assessment

Answer 33

• PRICE
• splint as it lays
• do not remove protruding objects
• clean dressing if open skin
• monitor neurovascular status

Question 34

phalen’s and tinel’s tests test for what?

Answer 34

carpel tunnel syndrome

Question 35

phalen’s test

Answer 35

fingers falling, wrist flexion to maximum for 60 seconds
- abnormal finding; numb fingers

Question 36

tinel’s test

Answer 36

tapping over transverse carpal ligament, should not cause numbness

Question 37

symptoms of carpel tunnel syndrome

Answer 37

pain, anesthesia, paresthesia

Question 38

what to check for in neurovascular check

Answer 38

pain, sensation, skin temperature, cap refill, pulses, movement
6 P’s

Question 39

strain vs. sprain vs. fracture

Answer 39

strain - tendon and muscle
sprain - ligament
fracture - bone break