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Chapter: Medicine Study Notes : Musculo-Skeletal

Exam - Musculo Skeletal

General inspection: observe them closely as the walk into the room – pain, gait, getting out of chair

Exam

 

·        General inspection: observe them closely as the walk into the room – pain, gait, getting out of chair

·        Joints: gait, look, feel, move

o   Gait

o   Inspection: 

§  Need to expose the patient (discretely watch them taking of their clothes – eg undoing buttons), including the joint above and below. Have sheets available to cover the patient. Ensure adequate lighting 

§  Compare left with right

§  Look from outside in:

·        Skin: scars, redness, swelling, hairs, rashes (eg psoriasis)

·        Soft tissue: swelling 

·        Muscle: wasting Þ chronic disuse, surrounding inflammation or nerve damage 

·        Bone and joint: deformities – usually a sign of destructive arthritis, also subluxation and dislocation

§  Other inspection: eg nails

o  Palpation:

§  Warmth

§  Tenderness (watch their face)

§  Evidence of:

·        Synovitis: soft and boggy swelling

·        Effusion: can shift within the joint 

·        Bony swelling (eg osteophyte formation or subchondral bone thickening): hard and immobile

o  Move Range of movement:

§  Better information from passive rather than active movement

§  Fixed Flexion Deformity = Limited extension

§  Fixed Extension Deformity = Limited flexion

§  Stability: attempt to move the joint in abnormal directions

§  Joint crepitus: grating sensation or noise from the joint 

§  Measure angles with a goniometer.  Anatomical position = 0°

o  To finish:

§  Special tests

§  Joint above and below

§  Distal pulses

§  Neurology

§  Xray and/or aspirate

·        Think: acute, chronic, impact on function, systemic effects

·        Is it broken?

o  Can they walk/use it at all?  If they can hobble, fracture less likely

o  Bony tenderness increases likelihood of fracture

 

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Medicine Study Notes : Musculo-Skeletal : Exam - Musculo Skeletal |


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