MSK Exams

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Knee Exam

Undress so legs and ankles are uncovered

Able to stand and weight bear

?

Assess gait -> symmetry, stride length, stepping height, turn, smooth heel strike toe off, pain (antalgic gait)

Patient standing inspection ->

1) Symmetry

2) Valgus or Varus deformity

3) Hyperextension or fixed flexion

4) Swellings in popliteal fossa

5) Muscle wasting

6) Brusing, erythema, skin changes

7) Rashes, scars

Patient now flat ->

Palpate for temperature

Feel for creptitus on movement

Palpate for tenderness when knee is flexed slightly:

1) Around margins of patella

2) Patella tendon

3) Medial and lateral joint lines

4) Tibial tuberosity

5) Head of fibula (lateral)

Palpate popliteal fossa for bakers cyst

Straighten leg to check for effusion ->

1) Patella tap - using left hand swipe down with thumb and index finger to the knee. Keep left hand there. With right hand gently push the patella down towards the femur, positive if you feel a rebound tap as the patella strikes the fumur.

2) Bulge test - Same left hand as before, then stroke firmly down the groove of the medial side of the patella, see if a bulge appears on the lateral side.

Active Movements ->

Flexion and extension along bed

Passive movements ->

Flexion and extension

Test for hyperextension - Lift heel up one hand on knee, gently pull upwards by heel. Look at angle between the thigh and lower leg.

Resisted movements ->

Flexion and extension

Lateral Collateral Ligament -> Hold lateral lower leg and medial knee. Varus stress, move lateral leg more medially. Pain?

Medial Collateral Ligament -> Hold medial lower leg and lateral knee. Valgus stress, move medial leg more laterally. Pain?

Patella apprhension test- push medially

Posterior cruciate ligament-> Posterior sag test

Posterior drawer test -> Anchor foot by sitting on it. Push tibia away from you , thumb on tibia and hamstring muscles felt by fingers.

Anterior cruciate ligament -> Anterior drawer test

Push tibia towards you

Mcmurray's Test ->

Varus to check lateral meniscus

Valgus to check medial meniscus

Apleys test ->

Patient prone, leg flex 90.

Stabilise upper leg with left hand, holds heel with right and rotates

Pain?

Check Hip, Ankle

Full neurovascular of lower limb

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Ankle Exam

Can patient stand up and weight bear?

Gait- symmtery, stride length, stepping height, turn, smooth heel strike toe off, pain? (antalgic gait)

Patient standing inspection->

1) Symmetry

2) Swelling

3) Bruising, erythema

4) Scars

Palpate for temperature

Feel ->

1) Achilles tendon

2) Peroneus Brevis (lateral foot)

3) Ankle ligaments : ATF, CF, PTF lateral. Medial is deltoid

4) Base of 5th metatarsal

5) Both maleoli

6) Head and shaft of fibula

7) Medial surface tibia

Active 4 movements

Passive 4 movements

Resisted 4 movements

Anterior drawer test ->

Lower leg freely over couch

Unjured ankle -> one hand under the heel, other over anterior surface of the lower leg above ankle.

0 degrees plantar flexion

Draw forward with some resistance

Then for injured

Most painful is complete tear, could be partial tear, just discomfort is simple sprain

Simmonds test ->

Patient kneels on chair

Affected leg foot is free

Widest part of calf is squeezeed

Look for plantar flexion which is normal

If achilles tendon is torn then won't move

Finish with knee and full neurovascular exam of the lower limb

Look for Charcot foot, , achilles tendon rupture, gout, hallux valgus, pes plantus (flat foot)

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Shoulder Exam

Undress waist up but keep bra on

Inspection standing up->

Symmetry, deformity

Muscle wasting of deltoids supraspinatus, infraspinatus

Colour

Scars

Feel ->

1) Sternoclavicular joint

2) Clavicle

3) Acromio-clavicular joint

4) Acromion

5) Subacromial bursa

6) Gleno humeral joint line

7) Greater and lesser tuberosity of humerus

8) Bicipital groove

9) Coracoid process

Active abduction and adduction -

Anatomical position to palm to palm and acrooss (separately adduction?) looking from behind

Active Flexion and Extension

Active Internal and External rotation ( More rotation = suprascapularis tear)

Passive abduction and Adduction

Passive ER and IR

Resisted Abduction and Adduction

Resisted ER and IR

1) Biceps tendon push up and down

2) Push up against wall

3) Can get hands to back of head / neck

4) Can you reach up between scapulae as if to scratch back/ fasten bra

Would check elbow, cervical spine, full neurovascular exam of the upper limb

Look for osteoarthritis, anterior shoulder instability (dislocation) , frozen shoulder, rotator cuff tears, Supraspinatus tendonitis

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