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Year 6 - Surgery > Ortho Examinations > Flashcards

Ortho Examinations Flashcards

1
Q

When someone px w joint pain what should you ask in S of SOCRATES?

A

Ask pt to point with one finger where it is

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2
Q

What order do you always perform movement in an ortho exam?

A

Active -> Passive

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3
Q

Why are passive movements performed?

A

To see if the loss of ROM is due to stiffness vs pain/weakness

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4
Q

How would you complete any ortho exam?

A

Full hx, assess NV status, examine the contralateral side and joints above/below, imaging

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5
Q

The Hip Examination

A

Intro, Consent, Pain

Gait + Trendelenburg’s Test

Look: aids, insoles, musc wasting, asymmetry, swelling, scars

Feel: greater trochanter, temp evenly down both legs, posterior tibial/dorsalis pedis pulses, cursory sensory exam

Move: active flexion + passive flexion, ad/abduction, int/ext rotation at 0° and 90° flexion, turn prone for extension

Special Tests: Thomas’s Test + measure for leg length discrepancy

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6
Q

What are the most common hip pathologies in the adult?

A
  1. OA
  2. Impingement
  3. Congenital Leg Length Discrepancy
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7
Q

Hip Pain Ddx

A

Ortho
Neuro
Gen Surg: hernia, vasc compromise, referred pain from back

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8
Q

% of Gait Cycle

A

Stance 60 + Swing 40

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9
Q

What are you looking for in the gait?

A

Front: symmetry, tredenelburg, antalgic

Side: heel strike, toe off, time spent in stance phase, fixed hip flexion, flexed knee, varus/valgus thrust, rotation of the feet

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10
Q

What is an antalgic gait?

A

The stance phase is reduced on the affected side

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11
Q

How do you correctly perform Trendelenburg’s test?

A

Find both ASIS working inf-sup, ask pt to put their hands on your forearms, look for lateral pelvic tilt and feel for weight on your forearms whilst the pt stands on each leg in turn

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12
Q

What does pain over the greater trochanter suggest?

A

Bursitis

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13
Q

Where can posterior tibialis be felt?

A

Behind the MEDIAL malleolus

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14
Q

Where can dorsalis pedis be felt?

A

Lateral to the extensor hallucis longus tendon on the dorsal aspect

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15
Q

How do you test ab/adduction of the hip?

A

You square off the hip, place fingers on one ASIS and olecranon on the other, the angle is at the point of pelvic shift

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16
Q

How do you correctly perform Thomas’ test?

A

Place your hand under the lumbar lordosis and ask the pt to fully flex both legs and then straighten each leg one at a time whilst holding the other knee

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17
Q

What does Thomas’ test look for?

A

Fixed flexion of the hip

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18
Q

What is a pos Thomas’ test?

A

The inability to straighten the leg past a point w/o losing lumbar lordosis

19
Q

How do you measure the apparent leg length?

A

Fixed point in the midline ie xiphisternum to medial malleolus

20
Q

How do you measure the real leg length?

A

ASIS to medial malleolus

21
Q

The Knee Examination

A

Intro, Consent, Pain

Gait + Crouch

Look: aids, insoles, foot arch, varus/valgus, musc wasting, asymmetry eg erythema, swelling eg bakers cyst, scars

Feel: diff part of quad, sweep test, patellar tap, cross fluctuance, plical folds, along joint line w bent thumb, posterior tibial/dorsalis pedis pulses, cursory sensory exam

Move: angle of active/passive extension and flexion

Special: inspect for posterior sag, ant/post drawer, Lachman test, collaterals at 0°/30° flexion w foot clamped tightly under your armpit, McMurray test, patella maltracking

22
Q

When is hindfoot valgus within normal physiology?

A

It corrects on tip toes

23
Q

How should you ask the pt to tense their quads to assess muscle bulk?

A

Ask them to push their knees into the coach and also observe how high the feet rise

24
Q

How do you correctly perform the sweep test?

A

You milk down the quad then sweep medial aspect distal to proximal then lateral aspect proximal to distal and observe the medial aspect

25
Q

How do you feel along the knee joint line?

A

Along tibial tubercle, patella tendon, inferior pole of patella, lateral joint line, head of fibula, medial joint line

26
Q

What is the normal ROM in degrees of a knee?

A

Ext-N-Flex: 10-0-140

27
Q

What should you check for before the ant/post draw test?

A

For any posterior sag and that the hamstrings are fully relaxed

28
Q

How do you perform Lachman’s test?

A

Stabilise the femur w thumb anteriorly fingers posteriorly OR for larger pts place your opposite thigh under theirs just above pop fossa and one hand over supracondylar region then move the tibial tuberosity up/down

29
Q

How do you test the lateral meniscus?

A

Rotate the tibia medially w the knee is full flexion and then extend at the knee

30
Q

How do you test the medial meniscus?

A

Rotate the tibia laterally w the knee is full flexion and then extend at the knee

31
Q

The Foot + Ankle Examination

A

Intro, Consent, Pain

Gait + Stand on Tip Toe/Heels

Look: aids, insoles, foot arch, asymmetry eg ulceration, swelling eg oedema, scars

Feel: down fibula, tibotalar joint, medial border of tibia, malleolus, navicular, calcaneus, midfoot joints, metatarsal heads, great toe, achilles tendon, base of heel, plantar fascia

Move: active/passive dorsi/plantarflexion, subtalar joint by pinching talus in place and rocking foot sideways, active eversion/inversion, passive great toe at MTP

Special: silfverskiold test, calf squeeze, test tendons against resistance

32
Q

What are the muscles of foot inversion?

A

Foot in dorsiflexion: tibialis anterior

Foot in plantarflexion: tibialis posterior

33
Q

What are the muscles of foot eversion?

A

Foot in dorsiflexion: peroneus tertius

Foot in plantarflexion: peroneus longus

34
Q

How do you perform the Silfverskiold test?

A

Ask the pt to sit, bring the ankle up as far as it goes, with a relaxed knee bring their knee up then back down

35
Q

The Shoulder Examination

A

Intro, Consent, Pain

Look: deformity, wasting, asymmetry, swelling, scars, deltoid contour, thoracic kyphosis, winging

Feel: muscle bulk, SCJ, along border of clavicle, ACJ, greater tuberosity, scapular spine medial border inf angle, temp

Move: active ab/aduction w palms out towards front, tuck elbows in then ext/int rotation, compound screening movements + passive/vs resistance

Special: hawkins-kennedy, empty can test, scarf test, sulcus sign and apprehension test, winging

36
Q

What does the shoulder girdle consist of?

A

Scapula, supraspinus fossa, infraspinus fossa, glenohumeral joint, clavicle, sternoclavicular joint

36
Q

What are the shoulder compound screening movements?

A

Hand behind head w elbow as far back as can go

Hand behind back w thumb as high up as can go

38
Q

How do you elicit the sulcus sign?

A

Pull down on the arm distal to elbow and look for inferior laxity and a sulcus to appear along the proximal humerus

39
Q

Px of Shoulder Examination

A

To summarise this pt had full ROM and was non-tender over the SCJ and ACJ

There was however right sided weakness of supraspinatus and Hawkin’s test was positive indicative of ACJ impingement or a rotator cuff issue

I would like to take a full hx, perform a NV exam and examine the spine and elbow joints before considering an MRI

40
Q

The Neck Examination

A

Intro, Consent, Pain

Look: deformity, wasting, asymmetry, swelling, scars, cervical lordosis

Feel: place one hand on pts forehead, feel for C7/T1/C6-2, trap spasm, wasting of deltoids, sensation and power of C5-T1, pulses

Move: flexion, extension, right, left, tilt

Special: spurling’s test, tone, reflexes

41
Q

How do you test the power of C5-T1?

A 
C5 - Arm aBduction
C6 - Wrist Extension
C7 - Elbow Extension
C8 - Finger Flexion
T1 - Finger aBduction
42
Q

What is spurling’s test?

A

Extend the neck, turn to one side and tilt down: pos if pain in neck shoulder arm

43
Q

The Back Examination

A

Intro, Consent, Pain

Gait + Walk on Tip Toe/Heels

Look: deformity, wasting, asymmetry, swelling, scars, normal kyphosis/lordosis, scoliosis/rib hump

Feel: find PSIS, mark 5cm below and 10cm above, ask pt to bend and measure excursion

Move: active extend backwards, slide hands down left/right side, turn to left/right + passive SLR and ask about any pain below knee + vs resistance hip knee ankle flex/ext and e/inversion

Special: tone, reflexes, cursory sensory exam, pulses

44
Q

How would you explain external fixation?

A

Favoured when there is extensive soft tissue injury

If circular where + how many rings

If monoplanar where + any underlying scars

Year 6 - Surgery (27 decks)

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