Musculoskeletal System Examination

Shoulder Joint Intense Consent comfort undress Explain 2Shirt chaperone mn Enthema colour Wasting Swelling Asymmetry Deformity lookfront side and Both back palpation a shoulder feeltemperature at compare surrounding areas o palpate Clavicle Aeromio clavi alar joint Coracoid process head of humans Greatertuberosity of humerus Repeaton other shoulder shoulders a palpate back spine scapula push wall in front Artin movement Handbehind head rearm son look for winging of scapula com me elbowspushedback back with both hands Active shoulder flexion 89 IIIImam qq.jpYitinnm the way up all Shoulder extension as far as possible Abduction all the way up Addictdown and across the body Elbows against sides arms forwards Is now internal now rotate externally rotate across body put handon their scapula they do shoulderabduction Mjminicament 2 hand on feel for they relax shoulder I guiding the Crepitus and clicking move arm them Empty can Arms out to side Resist painful impingement of supraspinates test me and furans thumbdown pushing down are move their arm abduction ask if there is pain Externalrotation up supraspinary against resistance Internal rotation against resistance Comm behind back push backagainst Shower Scarf test n f lift off 417 me subscapular Basicobservations bedsidetests and investigations wash hands neurovascular examination of upperlimb elbowjoint examination Cervical spine Imaging if required review existing imaging Kneeton ifmease Einstein Consent comfort movementdifficulties Explain Expose knee Greveralsnspect. u Swelling wasting Asymmetry Deformity Erythema color Staring 121 6 9 p bat gait cycle limp ftp.hce his feel around the Compare sides walking aids the Funrange of motion Any discomfort normal gait cycle own area fully extended palpate I quadriceps tendon patella tendon discomfort palpate patella borders femoral a tibial condyles poplitealfossa measure thigh circumference both less compare patella tap Extended position Slide handdown thigh to knee other hand tap thepatella if thid present you feel patella hit femur Streep fest extendedposition hameslidedown thigh Stroke medial knee stroke lateral bree rippleappear itfhi oiie.n.nu am extend knee to 1800 Passive flex passive extend passive hyperentention 10 abnormal Drawertesty kneeflexed 90 one hand stabilise ankle of I both hands grab leg pull and push to see if Cruciate ligaments are holding the lower leg inttTacnisg.hamaleganein below me EEI.hn pulltibia and slight external rotation Ivy Collateralligamentexame patient liesdown leg extenen hold their leg up try and bene leg to vans and n Basicobservations bedsidetests and investigations washhands neurovascular Hip exam of lower limb ankle examination Imaging if required valgus HIP Examination Intense consent comfort Explain Generduspection look at sides a of hip Shelling a wasting Asymmetry Deformity Colour Scarring Gait Assess Full range of motion Any discomfort normal gait cycle standing up anterior lateral posterior get patient to rotate700 palpitating liedown Feeltemperature of area Compare palpate trochanter measure leg length ASK to medial malleolus Tre length umbilicus to medial malleolus Apparent length movement Hip Ative flexion lie down passive FÑiexioTE orexin thb extension hip internalrotation external rotation bend the knee first Adduction Qa Abduction IhmdIt raised I hand flexes knee pt should actively push while other under their lumbar lordosis back on your hand under their D other thighshould stay flat Repeat otherleg normal raised is positive back Trendelenbursitest a put bothhandson sht med adductors and min each iliac crest Patient stand on I foot observe which side drops unsupported side windup in the test Iijima Magicobservations bedsidetests and investigations wash hang new insular exam of lower limbs Lumbar three Joint examination a furtherimaging if req for weakness spineExami natio .it look around the bed anterior lateral fftf.mn T posterior musclewasting Sears surgical posture Asymmetry pelvic tilt abnormal hair growths spina bifida occulta Bruising man walkup and down gait Cycle Tom discomfort FFLTIp.nu processes Sacro iliac joints paraspinal muscles tenderness alignment muscularspasms tenderness t.IE Iiei.ni look up Extension lateral flexion Rotation ear to shoulder each side look left htin thomai.rs right ptsitannamswsseeoerchest turn body left and right Lumbarspire Flexion bend forwards touch toes knees straight bend backwards Extension Lateral flexion mark 5cm bend left and below of midline of posterior Sacro iliac spine Mark to cm above midline of lumbarflexion measure right Psa level touch toes distance between should have gone from 15am s 20cm I sciatic stretch test aka straight leg raise sciatic nerve irritation Pt supine lie O down more EÉ pt leg up at hip to 80 then dorsiflex ankle no pain posterior thigh buttocks pain sciatic nerve irritation examiners may tellyou to skip this Femoral nerve stretch test pt Prone extend hip plantarflex Flex knee 90 ankle no pain pain anterior thigh femoral nerve irritation i neurovascular examination of hip shoulder examination imaging Further upperand lower limbs x ray MRI I I EEE.it Ee m Dupuyten's contractures Scars Swelling Color changes bouchards proximal Heberden's nodes distal Swan neck deformity Rheumatoid osteoarthritis arthritis muscle wasting Splinter haemorrhage _infective endocarditis sepsis vasculitis nail pitting razishing also check elbows Oster's nodes psoriatic plaques infective endocarditis palpate Emitter 1 Radial ulnar pulse 3 Thenar hypothenar eminence bulk 4 palmarthickening 5 median and dupaytren's contractures Vihar Thenareminence have sensation index finger Hypothenar eminence Y.in little finger aaan 1st dorsal 2 Temperature of all joints 3 MCP squeeze 4 Now feelfor webspace elbow sign of tenderness everysingle temperature same arthritis finger joint irregularities tenderness 5 Anatomical snuffbox 6 palpate wrists tenderness tenderness scaphoid fracture movements Thandsimultaneously E Flexion Wrist extension wrist flexion msn.LI i Finger flexion wrist extension extension flexion fTIhangerexensionasainst t.FI resistance arms out in front palmsfacingdown Radial nerve resisttheir wrist and fingerextension Index finger abduction against resistance fingers apart resist squishing fingers Thumb abduction together against resistance palm up try push their Ulnar nerve median thumbdown then resist nerve ftp.t tfIp squeeze my fingers with pincer grip squeeze my finger between have son thumb index Pick up small object manner Tap over man carpal tunnel Syndrome carpal tunnel with my if re thumb finger repeatedly tingling pain Phalen's Test Fhubhrist in max flexion ff the of both together for 00 see if burning tingling numb sensation on fingers median nerve carpal tunnel again Further to examination neurovascularexam examination of X ray or upper limb elbow MRI scans shoulder pornhub.examnah G.cn't TOO many toes test Extra flat feet passive movements subtale mid foot Chance positioning valgus posterior tiptoe view ankle when flat vans position ankle Simmond's test squeeze gastrocnemius Shoulder examination Instructions - “Examine the shoulder joint of this patient” 1 Washes hands 2 Introduces themselves & confirms patient details 3 Explains examination & gains consent 4 Exposes patient appropriately 5 Inspects patient's shoulders (anterior / lateral / posterior) 6 Assesses and compares joint temperature 7 Palpates shoulder girdle 8 External rotation & ABduction (active) 9 Internal rotation & ADduction (active) 10 Shoulder flexion (active) 11 Shoulder extension (active) 12 Shoulder ABduction (active) 13 Shoulder ADduction (active) 14 External rotation of the shoulder (active) 15 Internal rotation of the shoulder (active) 16 Assess flexion / extension / abduction / adduction / external & internal rotation PASSIVELY 17 Assess movements of the scapula 18 Supraspinatus assessment 19 Assess for painful arc 20 External rotation against resistance 21 Internal rotation against resistance 22 Thanks patient 23 Washes hands EXAMINER “Summarise your findings and suggest further investigations” 24 Accurately summarises salient findings 25 Suggests appropriate further investigations Read the full guide at GeekyMedics.com Download our OSCE App Knee examination Instructions - “Examine the knee of this patient” 1 Washes hands 2 Introduces themselves & confirms patient details 3 Explains examination & gains consent 4 Exposes patient appropriately 5 Assesses patient’s gait 6 Inspects patient’s knees from all angles 7 Assesses and compares knee joint temperature 8 Palpates quadriceps tendon 9 Palpates knee joint 10 Measures quadriceps circumference 11 Performs patellar tap 12 Sweep test 13 Active knee flexion 14 Active knee extension 15 Passive knee flexion 16 Passive knee extension 17 Passive knee hyperextension 18 Anterior / posterior drawer test 19 Assessment of collateral ligaments 20 Thanks patient & washes hands EXAMINER “Summarise your findings and suggest further investigations” 21 Accurately summarises salient findings 22 Suggests appropriate further investigations Read the full guide at GeekyMedics.com Download our OSCE App Hip examination Instructions - “Examine the hip joint of this patient” 1 Washes hands 2 Introduces themselves & confirms patient details 3 Explains examination & gains consent 4 Exposes patient appropriately 5 Inspects patient's hips (anterior / lateral / posterior) 6 Assesses patient’s gait 7 Palpates hip joint 8 Palpates greater trochanter 9 Measures apparent leg length 10 Measures true leg length 11 Active hip flexion 12 Passive hip flexion 13 Passive hip internal rotation 14 Passive hip external rotation 15 Passive hip ABduction 16 Passive hip ADduction 17 Passive hip extension (prone) 18 Thomas’s test 19 Trendelenburg’s test 20 Thanks patient 21 Washes hands EXAMINER “Summarise your findings and suggest further investigations” 22 Accurately summarises salient findings 23 Suggests appropriate further investigations Read the full guide at GeekyMedics.com Download our OSCE App Year 2 OSCE Examiner Information: Clinical Examination (MSK – Shoulder) The purpose of this station is for the student to perform a competent and complete examination. The student will perform the examination on a subject of clinical examination (SOCE), who is in the station with you. The SOCE is not expected to communicate with the student except to confirm name/consent. The student will have 10 minutes to complete their examination, including summarising their findings. Students may present this during their examination or summarise at the end. The Shoulder Examination A complete examination of the shoulder would be where the student: • Washes hands • Introduces themselves & confirms patient details • Explains examination & gains consent • Exposes patient appropriately • Inspects patient's shoulders (anterior / lateral / posterior) • Assesses and compares joint temperature • Palpates shoulder girdle • External rotation and ABduction (active) • Internal rotation and ADduction (active) • Shoulder flexion (active) • Shoulder extension (active) • Shoulder ABduction (active) • Shoulder ADduction (active) • External rotation of the shoulder (active) • Internal rotation of the shoulder (active) • Assess flexion/extension/abduction/adduction/external and internal rotation PASSIVELY • Assess movements of the scapula • Supraspinatus assessment • Assess for painful arc • External rotation against resistance • Internal rotation against resistance • Thanks patient & washes hands Year 2 OSCE Examiner Information: Clinical Examination (MSK – Hip) The purpose of this station is for the student to perform a competent and complete examination. The student will perform the examination on a subject of clinical examination (SOCE), who is in the station with you. The SOCE is not expected to communicate with the student except to confirm name/consent. The student will have 10 minutes to complete their examination, including summarising their findings. Students may present this during their examination or summarise at the end. The Hip Examination A complete examination of the hip would be where the student: • Washes hands • Introduces themselves & confirms patient details • Explains examination & gains consent • Exposes patient appropriately • Inspects patient's hips (anterior / lateral / posterior) • Assesses patient’s gait • Palpates hip joint • Palpates greater trochanter • Measures apparent leg length • Measures true leg length • Active hip flexion • Passive hip flexion • Passive hip internal rotation • Passive hip external rotation • Passive hip ABduction • Passive hip ADduction • Passive hip extension (prone) • Thomas’s test • Trendelenburg’s test • Thanks patient & washes hands Year 2 OSCE Examiner Information: Clinical Examination (MSK – Knee) The purpose of this station is for the student to perform a competent and complete examination. The student will perform the examination on a subject of clinical examination (SOCE), who is in the station with you. The SOCE is not expected to communicate with the student except to confirm name/consent. The student will have 10 minutes to complete their examination, including summarising their findings. Students may present this during their examination or summarise at the end. The knee Examination A complete examination of the knee would be where the student: • Washes hands • Introduces themselves & confirms patient details • Explains examination & gains consent • Exposes patient appropriately • Assesses patient’s gait • Inspects patient’s knees from all angles • Assesses and compares knee joint temperature • Palpates quadriceps tendon • Palpates knee joint • Measures quadriceps circumference • Performs patellar tap • Sweep test • Active knee flexion • Active knee extension • Passive knee flexion • Passive knee extension • Passive knee hyperextension • Anterior / posterior drawer test • Assessment of collateral ligaments • Thanks patient & washes hands