Musculoskeletal Clinical Assessment

Question 1

What are examples of orthopaedic symptoms and signs?

Answer 1

• Something feels wrong
  
  • Pain
  • Dysaesthesiae
  • Weakness
• Something moves wrong
  
  • Stiffness
  • Reduced RoM
  • Limp
  • Instability
  • Crepitus (feeling of grinding within joints)
• Something looks wrong
  
  • Swelling
  • Deformity
  • Wasting
  • Shortening
  • Discolouration (such as redness, pallor, bruising)
  • Wounds

Question 2

What are examples of questions to ask to assess severity of symptoms?

Answer 2

• Wake at normal time or woken by pain
• How are they first thing in the morning
• Dressing
• Cut own toenails
• Can they get in and out of bath
• Walking distance on flat
  
  • And stairs
• Driving
• Shopping
• Work/hobbies

Question 3

What does red flags mean?

Answer 3

Suggests serious pathology such as infection or malignancy

Question 4

What are examples of red flags?

Answer 4

• Severe and worsening pain
• Night pain disturbing sleep
• Non-mechanical pain
• General malaise, febrile, rigors
• Unexplained weight loss, anorexia, night sweats
• Past history of malignant disease

Question 5

What are some important allergies to know about for orthopaedics?

Answer 5

• Any known allergies
• Iodine
• Penicillin
• Iodine
• General anaesthetic
• Latex
• Elestoplast

Question 6

What screening is often part of MSK examination?

Answer 6

GALS screen is used:

• Gait, arms, legs and spine
• Rapid screen for MSK and neurological deficits and functional ability

Question 7

What are the 4 aspects of GALS screen?

Answer 7

Gait, arms, legs and spine

Question 8

Describe some of the principles of MSK examination?

Answer 8

• Private room
• Chaperone perhaps
• Space to observe gait
• Always compare right and left
  
  • Always examine normal side first
• Convention for description of deformity
  
  • Valgus = away from midline
  • Varus = towards midline
• Anatomical position is 0^o for all joints (extended elbow is 0 not 180)

Question 9

Describe the convention for describing deformities?

Answer 9

• Convention for description of deformity
  
  • Valgus = away from midline
  • Varus = towards midline

Question 10

What describes a deformity away from midline?

Answer 10

Valgus

Question 11

What describes a deformity towards the midline?

Answer 11

Varus

Question 12

In the anatomical position, what should be remembered about angles of joints?

Answer 12

• Anatomical position is 0^o for all joints (extended elbow is 0 not 180)

Question 13

How are fingers described?

Answer 13

Name fingers (never number)

Question 14

In the hand, what is used instead of lateral/medial?

Answer 14

Radial and ulnar

Question 15

In the hand, what is used instead of anterior/posterior?

Answer 15

Dorsal and volar/palmar

Question 16

Describe the steps of introducing yourself in orthopaedics?

Answer 16

1. Introduce your own full name and role
2. Check patients name and age
   
   1. In orthopaedics we use formal address, so Mr Jones not Mike etc
3. Explanation of proposed examination
4. Consent
5. Any painful/tender sites

Question 17

In orthopaedics, how should patients be addressed?

Answer 17

Always formally, such as Mr Smith not David Smith

Question 18

Why should process of examination be systematic?

Answer 18

So nothing is missed

Question 19

Describe MSK examination in terms of look, feel and move?

Answer 19

• Look (observe)
  
  • Posture
  • Note any negatives such as amputations
  • Gait
  • Skin
    
    • Scars, wounds, sinuses, ulcers
    • Colour – redness, bruising, pallor, cyanosis, blae, black, shiny, hairless, atrophic, vascular markings
  • Swelling
  • Wasting
  • Deformity
  • Limb lengths
    
    • Real and apparent
• Feel (palpate)
  
  • Skin
    
    • Temperature, sweating
  • Tenderness
    
    • Note than pain is a symptoms and tenderness is a sign, they are different
  • Swelling
  • Deformity
• Move
  
  • Active (“Would you bend you left elbow Mr Smith”)
  • Passive (“Would you relax and let me bend your left elbow Mr Smith”)
  • Special tests
    
    • Abnormal movement
    • Joint laxity tests
  • When move a joint we are interested in
    
    • Range, rate, rhythm
    • RoM in degrees or % or vs normal side
    • Accompanied by pain, crepitus, stiffness
    • Rhythm/smoothness, laxity/hypermobility
    • Muscle tone
    • Power/strength
    • Joint laxity/hypermobility
• X-ray

Question 20

What things are observed in MSK examination?

Answer 20

• Posture
• Note any negatives such as amputations
• Gait
• Skin
  
  • Scars, wounds, sinuses, ulcers
  • Colour – redness, bruising, pallor, cyanosis, blae, black, shiny, hairless, atrophic, vascular markings
• Swelling
• Wasting
• Deformity
• Limb lengths
  
  • Real and apparent

Question 21

What are the different ways of assessing movement of a joint?

Answer 21

• Active (“Would you bend you left elbow Mr Smith”)
• Passive (“Would you relax and let me bend your left elbow Mr Smith”)
• Special tests
  
  • Abnormal movement
  • Joint laxity tests

Question 22

What are some examples of tets to test joint movement?

Answer 22

• Abnormal movement
• Joint laxity tests

Question 23

When we move a joint we are interested in what?

Answer 23

• Range, rate, rhythm
• RoM in degrees or % or vs normal side
• Accompanied by pain, crepitus, stiffness
• Rhythm/smoothness, laxity/hypermobility
• Muscle tone
• Power/strength
• Joint laxity/hypermobility

Question 24

If you examine a joint, what else should be examined?

Answer 24

• In any joint examination, must examine joints above and below