MSK Exam: History/UE

Pain Hx

myalgia→muscle pain

arthralgia→joint pain

articular vs extra-articular

mono vs polyarticular

swelling

weakness

activity level

Pain HPI

trauma

radiation+what radiates
-pain vs radicular sxs (paresthesias)

morning vs night→waking pain

Pain ROS

fever/chills
-systemic
-IV mx use
-immunocompromised

recent infxns

wt loss

rashes/lesions

travel

trauma

metabolic dxs

Inflammation

check if really swelling
-check body habitus
-compare to other side
-need palpation

check if really erythema

what is warm

PE List

inspection

palpation
-innervation/vascular
-strength

range of motion

special tests

Anatomy vs Morphology

anatomy→MSK structure
-pt has 2 arms

morphology→MSK form
-how arms are shaped/formed/deformed

Inspection

watch

• walk

• sit

• get up from chair

• get on exam table

• etc.

I: skin
ecchymosis
erythema
rashes
lesions
lymphangitis
etc.

look for gross deformities

look for alignment+symmetry

I: musculature
tone
symmetry
fasciculations
spasms

Palpation (General)

remember anatomy→know difference between

• muscles

• tendons

• ligments

• bones

• articulations

palapate bony landmarks

note

• tenderness

• warmth

• edema

• effusion

• crepitus

• deformities

• resistance to mvmnt
  -active+passive

Palpation: Neurovascular (Innervation+Vascular)

check

• before+after injury

• before+after reduction of fracture

• may not be orthopedic

sensation to light touch

deep tendon reflexes

• biceps

• triceps

• patellar

• achilles

P: vascular
skin color
skin temperature→compare to other areas
palpable pulses
capillary refill

Palpation: Strength

Myotomes

Active ROM

pt moves joint themselves through maximum ROM

compare BL

note

• pain

• deformities/asymmetry

• limitations

• fasciculations

• spasticity

• rigidity/contractures

Passive ROM

pt relaxes+lets clinician move joint through an arc of motion

compare BL

note

• pain

• deformities/asymmetry

• limitaitons

• fasciculations

• spasticity

• rigidity/contractures

• crepitation

• instability

Temporomandibular Joint (TMJ) MSK Function

open→external pterygoid

close

• masseter

• teporalis

• internal pterygoid

dysfxn→jaw moves forward→TMJ dislocated→mouth remains open

Temporomandibular Joint (TMJ) Palpation

1. tips of index fingers→just anterior to tragus

2. pt open+close mouth

3. finger should fall into joint space

note

• tenderness

• swelling

• snapping/clicking

Temporomandibular Joint (TMJ) Muscle Palpation

masseters→angle of mandible

temporal→clench+relax jae

pterygoids→difficult to palpate

Temporomandibular Joint (TMJ) Gliding+Hinging Palpation

open+close

protrude+retract

side-to-side
-laterotrusion

note→smoothness of ROM

Rotator Cuff Muscles

SITS

• supraspinatus

• infraspinatus

• teres minor

• subscapularis

Shoulder Palpation+ROM

P→subacromial bursa

ROM

• flexion

• extension

• abduction

• adduciton

• internal rotation (IR)

• external rotation (ER)

Painful Arc Test

pain from 60-120° of abduction→impingement/tendinitis

Crossover/Crossed-Body Adduction Test

adduction of arm→pain at AC joint

Neer Impingement Sign

pain→subacromial impingement of rotator cuff

stabilize scapula during maneuver
-”i’m bringing the arm near the body”

Hawkins Test

pain→subacromial impingement of rotator cuff

shoulder flexed to 90°+palm down+internal rotation
-”flapping like a hawk”

External Rotation Lag

palm up→external rotation→let go

can’t maintain external rotation→supraspinatus/infraspinatus pathology
-ex: tear

Internal Rotation Lag

palm out→internal rotation→let go

can’t maintain internal rotation→subscapularis pathology

Lift-Off Test

palm out+dorsum of hand against pack→pt pushes against provider→”lift off” their own back

fail→subscapularis pathology

Drop Arm Test

1. abduct arm up to 90°
   -you or pt sets up

2. ask pt to hold

3. slowly lower arm

pain/weakness→supraspinatus RCT/bicipital tendinitis

Empty Can Test

1. forward flex arm to 90°
   -shoulder level

2. thumb down→internal rotation
   -”emptying a can”

3. provider pushes down+pt resisits

pain/weakness→positive

External Resistance Test

1. adduct+flex arm to 90°
   -at elbow

2. thumbs up

3. pt external rotation against provider resistance
   -pt moves arms out

pain/weakness→infraspinatus PP

Speed’s Test

1. elbow fully extended+hand fully supinated+arm flexed at shoulder to 90°

2. provider applies downward pressure+pt resists

pain/weakness→biceps tendinopathy
-usually felt in bicipital groove

Elbow ROM

palm up→flexion+extension

palm neutral→pronation+supination

Cozen Test

usually from repeated grip+wrist movements

process

1. pt makes a fist

2. pt attempts to extend/dorsiflex fist against resistance

pain in lateral epicondyle→lateral epicondylitis/”tennis elbow”

Swan Neck Deformity

PIP joints→hyperextension

DIP joints→fixed flexion

E: injuries
RA

Boutonniere Deformity

“button hole”

PIP joint→persistent flexion

DIP joint→hyperextension

E: injuries
RA

Bouchard’s vs Herberden’s Nodes

bony bumps/deformities on finger joints

E→OA

bouchad’s nodes→PIP joint

herberden’s nodes→DIP joint

Wrist ROM

flexion/volarflexion

dorsiflexion/extension

Fingers ROM

flexion→make a fist

extension→open the hand

adduction→bring fingers together

abduction→spread fingers apart

Thumb ROM

flexion→medial

extension→lateral

abduction→in

adduction→out

opposition→touch pinky

Hand Grip Test

test BL→can do at same time

weakness→flexor/intrinsics PP

E: not very specific
infalmmation
OA
cervical
etc.

Finkelstein Test

1. thumb inside fingers/fist

2. ulnarly deviate wrist
   -move down

pain→tenosynovitis

• de Quervain

• EPB/APL

• repeated stress

Nerve Entrapment Neuropathy Tests (General)

2 tests

can happen in different areas

cause paresthesias

• numbness

• tingling

• pins+needles

• weakness

Tinel Sign Test

tap over affected nerve→looking for reproduction of sxs

I: carpal tunnel syndrome

Phalen Sign

pt holds position→compresses median nerve
-can hold hands in position

pain x u60 secs→positive test

E: carpal tunnel sydnrome