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Examination Findings > Musculoskeletal Health Examinations > Flashcards

Musculoskeletal Health Examinations Flashcards

1
Q

Overall Method

A 
Look
- alignment 
- symmetry
- deformity 
- muscle wasting 
- swellings 
- colour 
- condition of skin
- consider gait 
Feel 
- temperature 
- tenderness
- swellings
- joint line 
- tendons/ muscles 
Move 
- Function 
- Active and passive movements 
Special Tests 
- specific problems 
Joint above/ below
Neurovascular exam
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2
Q

GALS

A

Gait Arms Legs Spine

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3
Q

GALS examination

A 
EOB
- walking aids
- specialist shoes
- signs of pain
- systemically well 
- alignment 
- muscle bulk 
- symmetrical 
Spine 
- Inspection - lordosis, kyphosis etc
- CS: Lateral flexion ear to shoulder 
- LS: flexion - Schober's 
Gait
- Walk: smoothness, symmetry, ability to turn quickly 
Arms 
-Shoulder and elbow: hands behind head, adduction, external rotation, elbow flexion 
- Hands: swelling/ deformity, loss of muscle bulk, finger extension and abduction, grip strength, thumb to fingers, function (pick up coin/ button), MCP squeeze 
Legs
- Knee: Patella tap for effusion, flexion and extension 
- Hip: Passive internal rotation 
-Foot: swelling/ deformity, MTP squeeze
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4
Q

Ankle and Foot

A 
Inspection 
Look:
- Gait: antalgic, stiff ankle, foot drop (damage to common peroneal nerve) 
- Function: tip toes (observe ankles from behind) 
- Inspection: alignment, weight bear, symmetry, deformity, scars, wasting, scars, swelling, skin changes, nail changes 
Feel:
- Temperature 
- Structures 
Move:
- Toe flexion and extension 
- Ankle plantar and dorsiflexion 
- Subtalar joint inversion and eversion 
- Midfoot rotation 
Special tests 
- Simmond's achilles rupture tests 
Joint above
- knee 
Neurovascular 
- power (toe extension= peroneal nerve, plantar flexion = tibial nerve, dorsum of the foot = common peroneal nerve, sole of foot = tibial nerve)
- sensation (dorsum = common peroneal, sole = tibial nerve)
-vascular (pulses)
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5
Q

Foot drop

A

damage to common peroneal nerve

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6
Q

Foot deformity

A 
Varus/ valgus 
Claw toe
Hammer toe
Flat foot
Subluxation of joints
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7
Q

Foot/ ankle muscle wasting

A

Calves

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8
Q

Foot ankle swelling

A

Effusion
Cysts
Inflammation

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9
Q

Foot ankle skin changes

A

Thickening
Callus formation
Bunions
Ulcers

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10
Q

Structures of the foot and ankle

A 
MTP joint squeeze
Mid tarsal joint squeeze 
Subtalar joint squeeze 
Achilles tendon 
Medial and lateral malleoli 
Anterior joint line 
Bimanual palpation of individual toes if indicated
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11
Q

Simmond’s test

A

Achilles tendon rupture
Squeeze calf, lying on front with leg hanging of bed
Absence of plantar flexion = rupture

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12
Q

Elbow Examination

A 
EOB 
- Discarded sling 
- Pain 
Look 
- Alignment 
- Symmetry 
- Scars 
- Wasting 
- Swelling 
- Skin changes 
Feel 
- Temperature 
- Structures 
Move
- Function 
- Extension 
- Flexion 
- Rotation 
Special Tests 
- Medial epicondylitis 
- Lateral epicondylitis 
Joint above 
- Shoulder 
Neurovascular 
- Power ( abduction little finger - ulnar, abductor pollicis brevis - median, wrist extension - radial) 
- Sensation (lateral aspect of little finger - ulnar, thumb- median, dorsum of hand at thumb base - radial) 
- Vascular
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13
Q

Elbow Look

A
  • Alignment
  • Symmetry
  • Scars: ulnar nerve surgery at medial epicondyle, olecranon surgery
  • Wasting: muscles of forearm and upper arm
  • Swelling: effusion (behind radial head), olecranon bursitis
  • Skin changes: thickening, nodules, plaques, erythema, bruising
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14
Q

Elbow Feel Structures

A

Effusion: boggy swelling behind radial head
Medial and lateral epicondyles
Olecranon process
Ulnar nerve

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15
Q

Elbow Special Tests

A

Golfer’s elbow - resisted wrist flexion
- medial epicondylitis
Tennis elbow - resisted wrist extension
- lateral epicondylitis

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16
Q

Hand and Wrist Examination

A 
EOB
Look 
- Nails
- Skin changes 
- Wasting 
- Swelling 
- Deformity 
- Wrist 
- Elbow 
Feel 
- Temperature 
- Hand 
- Phalangeal 
- Wrist 
Move 
- Function 
- Fingers 
- Thumb 
- Wrist 
Special tests 
- Phalen's 
- Froment's test 
Neurovascular 
- Motor 
- Sensation 
- Pulses
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17
Q

Hand and Wrist Look

A 
Nails 
- Pitting and onycholysis: psoriatic 
- Nail fold infarcts: vasculitis 
Skin changes 
- Thinning and bruising: steroids 
- Palmar erythema: RA 
- Scars 
Wasting 
- 1st dorsal interossei 
- Thenar, hypothenar eminences 
Swelling 
- Herbeden's (DIPJ), Bouchard's (PIPJ): OA
- Boggy swelling (synovitis): RA, trauma 
- Cystic swelling: ganglion 
Deformity 
- Swan neck, Boutonnieres, Z thumb, ulnar deviation, subluxation of MCPJs: RA 
- Dupuytren's contracture 
Wrist 
- Deformity (subluxation, deviation) 
- Swelling (RA nodules, ganglion, gouty tophi) 
- Scars (carpal tunnel release) 
Elbow 
- Psoriatic rashes 
- RA nodules 
- Gouty tophi
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18
Q

Hand and Wrist Examination Feel

A

Temperature
Wasting of thenar and hypothenar eminences
Thickening of flexor tendons: Dupuytren’s
Anatomical Snuffbox: scaphoid
MCP squeeze: if painful then do individual
PIPs, DIPs, base of thumb
Palpate around
- Ulnar border
- Ulnar hear: extensor carpi ulnaris tendinitis: RA
- Radial styloid process: de Quervain’s tenosynovitis

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19
Q

Hand and Wrist Move

A 
Function 
- grip strength 
- finger and thumb taps 
- button/ coin 
Fingers
- flexion 
- extension 
- abduction 
Thumb 
- flexion 
- extension 
- abduction 
- adduction 
- opposition 
Wrist 
- flexion 
- extension 
- pronation 
- supination
20
Q

Hand and Wrist Neurovascular Motor

A 
Resisted wrist extension 
- radial nerve 
Resisted little finger abduction 
- ulnar nerve 
Resisted thumb opposition 
- median nerve
21
Q

Hand and Wrist Special Tests

A 
Phalen's test
- reverse prayer 
- carpal tunnel syndrome 
Froment's test 
- paper between thumb and index finger 
- ulnar nerve palsy
22
Q

Hip Examination

A 
EOB
Look 
- Gait 
- Inspection 
Feel 
- structures 
Move
- Flexion 
- Rotation 
- Abduction 
- Adduction 
Special tests
- leg length 
- Abductor weakness 
- Fixed flexion deformity 
Joint above
- Spine 
Neurovascular
23
Q

Hip Look

A 
Gait 
- Antalgic
- Trendelenburg 
- Foot drop 
- Stiff hip 
Inspection 
- Overall alignment and weight bearing 
- Deformity: pelvis alignment, excessive lumbar lordosis (fixed flexion deformity), scoliosis, hip rotation, knee flexion 
Scars: arthroscopy, hip replacement 
Wasting: quadriceps and gluteal muscles 
Swelling: effusion, inflammation, bursitis 
Skin changes: erythema, bruising
24
Q

Hip Feel

A

Structure:

  • Greater trochanter
  • ASIS
  • Midpoint of inguinal ligament
25
Q

Hip Move

A 
Flexion 
- Active and passive (knee flexed)
Rotation 
- Internal and external 
Abduction and adduction
26
Q

Hip Special Tests

A 
Leg length 
- Medial malleolus level? 
- ASIS to medial malleolus 
Abductor weakness 
- Trendelenburg 
- Side of raised leg drops 
- Pain causing inhibition of muscles, muscle wasting disease, nerve damage 
Fixed flexion deformity 
- Thomas test 
- Other thigh raises when hip flexed
- tightening/ shortening of the hip flexors, OA
27
Q

Hip Neurovascular

A 
Power 
- Quadriceps: femoral nerve 
- Extension of toes: common peroneal nerve 
- Plantar flexion of foot: tibial 
Sensation 
- Anterolateral thigh: femoral 
- Dorsum of foot: common peroneal nerve 
- Sole of foot tibial nerve
28
Q

Knee Examination

A 
EOB
Look 
- Gait 
- Function 
- Inspection 
Feel 
- Temperature 
- Effusions 
- Structures of the knee 
Move 
- Flexion 
- Extension 
Special Tests 
- Cruciate ligaments 
Collateral ligaments 
Joint above 
- Hip 
Neurovascular
29
Q

Knee Look

A

Gait
- Antalgic
- Thrusting: knee appears to give way
- Foot drop: damage to common peroneal nerve
Function
- Squat
Inspection
- Alignment
- DEformity: varus/ valgus, fixed flexion, hyperextension,
- Scars: arthroscopy, knee replacement
- Wasting: quadriceps and gastrocnemius muscles
- Swelling: effusion, (Bakers) cysts, inflammation, bursitis
Skin changes: erythema, bruising, nodules

30
Q

Knee Feel

A 
Temperature 
Effusions 
- Patellar tap: medium to large effusion 
- Sweep/ bulge test: small effusion 
Structures of the knee
- Swelling/ bogginess 
- Quadriceps tendon 
- Patellar margins 
- Tibial tubercle 
- Joint lines: tenderness = meniscal damage/ OA 
- Collateral ligaments 
- Tenderness of hamstrings 
- Swelling behind the knee
31
Q

Knee Move

A

Flexion
- Active and passve
Extension
- Fixed flexion deformity - inability to full extend knee: bone/ tissue in joing
- Knee extends too far: hypermobility syndrome

32
Q

Knee special tests

A 
Cruciate ligaments 
- Posterior sag: PCL 
- Anterior draw test: ACL 
- Posterior draw test: PCL 
Collateral Ligaments 
- MCL 
- LCL
33
Q

Knee neurovascular

A 
Power
- Extension of toes: common peroneal nerve 
- Plantarflexion of foot: tibial nerve 
Sensation
- Dorsum of foot: common peroneal nerve 
- Sole of foot: tibial nerve 
Vascular 
- Pulses
34
Q

Shoulder Examination

A 
EOB
Look 
- Inspection 
Feel 
- Temperature 
- Structures 
Move
- Passive then active!
- Function 
- Flexion
- Extension 
- Abduction: lower arc pain = supraspinatus infringement, high art pain = ACJ injury/ pathology 
- External rotation 
- Internal rotation 
Special Tests 
- Supraspinatus 
- Infraspinatus 
- Subscapularis 
- Weakness: tear, 
- Pain only 
- Impingement tests 
Joint above 
Neurovascular
35
Q

Shoulder Look

A

Alignment
Deformity: steps in clavicle, dislocation, winging of scapula (long thoracic nerve injury)
Scars: arthroscopy, shoulder surgery
Wasting: trapezius, deltoid, triceps, bceps, supraspinatus, infraspinatus
Swelling: inflammation, bursitis
Skin changes: erythema, bruising
Axilla

36
Q

Shoulder Feel

A 
Temperature 
Structures 
- SCJ
- Clavicle
- ACJ 
- Acromion
- Borders of the scapula 
- Greater tubercle of humerus 
- Coracoid 
- Biceps tendon 
- Supraspinatus, infraspinatus and deltoid muscles
37
Q

Shoulder Move

A 
Function
- Hands behind head
- Hands behind back 
- Touching opposite shoulder 
Flexion 
Extension 
Abduction 
- lower arc pain: supraspinatus impingement 
- high arc pain: ACJ injury/ pathology
External rotation 
- Frozen shoulder 
Internal rotation
- How far up back  
Passive movements 
Adduction
38
Q

Shoulder Special Test

A

Rotator Cuffs
- Supraspinatus: empty can
- Infraspiantus/ teres minor: external rotation against resistance
- Subscapularis: Lift off test
Impingement
- Hawkin’s kennedy test: Supraspinatus impingement
- Scarf test: arm to opposite shoulder

39
Q

Shoulder Neurovascular

A 
Power:
- deltoid: axillary nerve 
Sensation
- Regimental badge area: axillary nerve 
Radial Pulse
40
Q

Spine Examination

A 
EOB
Look
- Gait 
-Inspection 
Feel 
- Bones 
- Muscles and soft tissues 
Move 
- Cervical 
- Thoracic 
- Lumbar 
Special Tests 
- Nerve root compression: straight leg raise, femoral stretch tests 
- Reduced flexion: Schober's 
- Increased kyphosis: wall tests
41
Q

Spine Look

A 
Gait
- Antalgic
- Trendelenberg 
- Foot drop 
- Stiff hip 
Inspection 
- Alignment 
- Deformity: kyphosis/ lordosis, scoliosis 
- Scars: spinal surgery 
- Wasting: paraspinal and gluteal muscle 
- Swelling
- Colour: erythema, bruising
42
Q

Spine Feel

A 
Bones 
- Spinous process'ss 
- Sacroiliac joints 
Muscles and soft tissue
- Trapezius
- Interscapular
- Paraspinal muscles
43
Q

Spine Move

A 
Cervical 
- Flexion 
- Extension 
- Lateral flexion 
- Rotation 
Thoracic
- Rotation: fix pelvis
- Chest expansion 
Lumbar
- Flexion: Schober's 
- Extension 
- Lateral flexion
44
Q

Spine Special Tests

A

Nerve root compression
- Straight leg raise: L4/5 S1, disc herniation
- Femoral stretch test: L2/3/4,
Reduced flexion
- Schober’s
Increased kyphosis
- Wall test: back against wall, head unable to touch wall

45
Q

Spine Neurovascular

A 
Power 
Reflexes
- Hip and ankle 
Sensation 
- Lower limb dermatomes 
Vascular 
- Posterior tibial 
- Dorsalis pedis

Examination Findings (13 decks)

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