Musculoskeletal Clinical Skills Examination Flashcards

Vocabulary flashcards for Musculoskeletal Clinical Skills Examination lecture notes.

Chief Complaint (C/C)

The problem which makes the patient seek medical advice.

Fibromyalgia

A chronic pain syndrome causing widespread, constant pain with little diurnal variation.

Arthralgia

Pain originating from the joint itself.

Myalgia

Pain originating from the muscle.

Hemarthrosis

Bleeding into the joint.

Radicular Pain

Pain that radiates along a nerve root distribution.

Arthritis

Inflammation of a joint.

Monoarthritis

Involvement of only one joint.

Oligoarthritis

Involvement of 2-4 joints.

Polyarthritis

Involvement of more than 4 joints.

Migratory Pain

A condition where pain migrates from one joint to another over days.

Palindromic Rheumatism

Recurrent episodes of arthritis with periods of resolution between.

Compartment Syndrome

Increased pressure in a fascial compartment, compromising perfusion.

Charcot Joints

A condition where joints are grossly abnormal but pain-free due to neurological involvement.

Synovitis

Inflammation of the synovium.

Scoliosis

Lateral curvature of the spine.

Kyphosis

Curvature of the spine in the sagittal plane, apex posterior.

Lordosis

Curvature of the spine in the sagittal plane, apex anterior.

Gibbus

Spinal deformity with anterior wedge deformity of a single vertebra.

Vertebra Prominens

Most prominent spinous process.

Ulnar Deviation

Lateral deviation of the fingers at the MCP joints.

Swan Neck Deformity

Fixed flexion at the DIP and extension at the PIP joints.

Boutonniere Deformity

Fixed extension at the DIP and flexion at the PIP joints.

Z-shaped thumb

Z-shaped deformity with flexion at the MCP joint of the thumb and hyperextension at the interphalangeal joint.

Heberden’s Nodes

Hard, bony swellings at the DIP joints.

Bouchard’s Nodes

Similar to Heberden's nodes but at the PIP joints.

Clubbing

Increased curvature of the nails with loss of the angle at the base.

Schamroth's Sign

Loss of the diamond-shaped gap when nails are placed back-to-back (seen in clubbing).

Palmar Erythema

Reddening of palms, especially thenar/hypothenar eminences.

Dupuytren’s Contracture

Fixed flexion of the MCP and PIP joints of the little and ring fingers.

Elbow Joint Effusion

Swelling on either side of the olecranon.

Olecranon Bursitis

Inflammation of the olecranon bursa.

Lateral Epicondylitis (Tennis Elbow)

Inflammation of the common extensor origin at the lateral epicondyle.

Medial Epicondylitis (Golfer’s Elbow)

Inflammation of the common flexor origin at the medial epicondyle.

Most Common Shoulder Dislocation

Anterior dislocation of the shoulder joint.

Shoulder Muscle Wasting

Muscle wasting of the deltoid, supraspinatus, and infraspinatus muscles.

Winged Scapula

Paralysis of the serratus anterior muscle, causing the scapula to wing.

Valgus Deformity (Genu Valgum)

Deviation of the part of the body away from the midline (knock-kneed).

Varus Deformity (Genu Varum)

Deviation of the part of the body towards the midline (bow-legged).

Schober's Test

Test to detect any limitation of forward flexion in the lumbar spine.

Wrist Drop

Inability to extend the wrist and fingers, leading to a flexed, hanging wrist posture.

Claw Hand

Hyperextension at the MCP joints and flexion at the PIP and DIP joints of the 4th and 5th fingers.

Boutonnière Deformity (Finger)

A fixed flexion deformity at the PIP joint with hyperextension at the DIP joint.

Swan Neck Deformity (Finger)

Hyperextension at the PIP joint with flexion at the DIP joint.

Mallet Finger

Flexion deformity at the DIP joint that is passively correctable.

Thomas Test

Incomplete extension revealing fixed flexion deformity that may be masked by compensatory movement.

True Leg Length Discrepancy

Condition detected during measurement from anterior superior iliac spine to medial malleolus.

Trendelenburg's Sign

A test where the unsupported hemipelvis falls below the horizontal when standing on one leg, indicating gluteal weakness.

Genu Valgum (Knock Knee)

Frontal plane deformity in which the knees come together and touch while the ankles remain apart, due to inward angulation of the tibia relative to the femur.

Quadriceps Wasting

Muscle wasting that is almost invariable with inflammation, internal derangement, or chronic pain in the knee.

Genu Varum (Bow Legs)

A frontal plane deformity in which the knees remain apart when the medial malleoli (ankles) are together, due to outward angulation of the tibia relative to the femur.

Housemaid’s Knee

Enlarged prepatellar bursa.

Baker's Cyst

A bursa enlargement in the popliteal fossa.

Osgood-Schlatter Disease

Localised tibial tuberosity tenderness suggesting Osgood–Schlatter disease, a traction apophysitis.

Chondromalacia Patellae

Crepitus between the patella and femoral condyles, suggesting chondromalacia patellae or osteoarthritis.

Patellar Tap

A test useful in a moderate-sized knee effusion where a tapping sensation is felt as the patella strikes the femur.

'Bulge' or 'ripple' test (knee)

A test useful for detecting small amounts of fluid in the knee, but may produce a false negative if a tense effusion is present.

Medial Collateral Ligament (MCL)

The ligament on the medial side of the knee that resists valgus stress.

Lateral Collateral Ligament (LCL)

The ligament on the lateral side of the knee that resists varus stress.

Valgus Stress Test (Knee)

A knee test where a medially directed force is applied at the ankle while stabilizing the femur, creates valgus stress.

Varus Stress Test (Knee)

A knee test where a laterally directed force is applied at the ankle while stabilizing the femur, creates varus stress.

Anterior Cruciate Ligament (ACL)

Ligament that prevents anterior subluxation of the tibia on the femur.

Posterior Cruciate Ligament (PCL)

Ligament that resists posterior translation of the tibia.

Anterior Drawer Test

A test performed with knee flexed to 90 degrees, pulling the tibia anteriorly to check for anterior cruciate laxity.

Posterior Drawer Test

A test where posterior movement of the tibia relative to the femoral condyles suggests posterior cruciate ligament laxity.

Menisci (Knee)

Fibrocartilaginous structures that lie between the tibial articular surface and the femoral condyles to check for tears.

Medial Menisci

The menisci located on the medial or inner side of the knee.

Lateral Menisci

The menisci located on the lateral or outer side of the knee.

Meniscal Provocation Test (McMurray Test)

A test performed by gripping the heel and pressing on the cartilage while internally and externally rotating the foot, checking for tears.

McMurray Test Result for Lateral Meniscus Tear

Click or clunk felt with lateral meniscal tears.

Patellar apprehension test

Indicates previous patellar dislocation or instability.

Hallux Valgus

Medial deviation of the 1st metatarsal and lateral deviation and/or rotation of the great toe.

Hallux Rigidus

Loss of movement at the metatarsophalangeal (MTP) joints.

Hammer Toes

Dorsiflexion at MTP and DIP joints and plantar flexion at PIP joints.

Claw Toes

Dorsiflexion at MTP joints and plantar flexion at PIP and DIP joints.

Mallet Toes

Plantar flexion at DIP joints.

Pes Planus (Flat Foot)

A lack of the normal plantar arches.

Pes Cavus (High-Arched Foot)

Exaggeration of the plantar arches.

Splay Foot

Widening at the level of the metatarsal heads, often associated with MTP joint synovitis.

Abnormal Movement Accentuated by Walking

Increased height of step, indicating ‘foot drop’.

Abnormal Movement Accentuated by Walking on Tiptoes

Toes-to-toes or tiptoes (difficult or impossible with an S1 or tibial nerve lesion).

Ankle Synovitis

Anterior swelling ± lateral or medial extension of the Ankle.

Tenosynovitis

Tubular swelling oriented longitudinally along a tendon of the Ankle.

Positive Thomson’s (Simmond’s) Test

Failure of the foot to plantar-flex when the calf is squeezed

Thomson’s (Simmond’s) test

Test to Squeeze the calf just distal to the level of maximum circumference

Muscles Palpation During Tenderness Check of bony prominents

A good time to check for leg shortening.

Active movements (Compare both sides) for Hip Joint

Flexion, ask the patient to flex the hip until the knee meets the abdomen.

Active movements (Compare both sides) for Hip Joint

Abduction: with the patient’s leg held straight, ask them to move it away from the midline.

Active movements (Compare both sides) for Hip Joint

Knee (and hip) flexed at 90 degrees. Move the foot medially to test external rotation and laterally to test internal rotation.

Valgus Stress Test (MCL)

Place one hand against the lateral side of the knee.

Achilles tendon

Test used to Ask the patient to kneel with both knees on a chair. Palpate the gastrocnemius muscle and the Achilles tendon for focal tenderness and soft-tissue swelling.

Examination sequence During Anterior drawer test for ACL

Check that the hamstring muscles are relaxed and look for posterior sag (posterior subluxation of the tibia on the femur).

Passive movement (Compare both sides) for Hip Joint: Flexion adduction abduction

Internal and external rotation: with the patient’s leg in full extension, roll it on the couch and watch the foot to indicate the range of rotation.

Septic arthritis

A single hot, red swollen joint (acute monoarthritis)

Character of Pain

Bone pain can be described as a ‘deep ache’ or ‘penetrating’ and is characteristically worse at night.

Character of Pain as in SOCRATES

SHOOTING pain is often caused by impingement of a peripheral nerve or nerve root; for example, buttock pain, which ‘shoots down the back of the leg’, is caused by lumbar disc protrusion.

Timing/Duration of pain in History Taking

A history of several years of pain with a normal examination suggests fibromyalgia.

History Taking as reliving factors

Pain due to inflam. → worse first thing in the morning & eases with movement.

Causes of Sever pain of joint, but is disproportionately

Neurological involvement in diabetes mellitus, leprosy, syringomyelia and syphilis (tabes dorsalis) may impair joint sensation, reducing pain despite obvious pathology onexamination.

Socioeconomic Hx

Identify functional difficulties including: The ability to use pens, tools and cutlery.