What are the 3 main MSK symptoms?
Pain, Stifness, Joint swelling
What are the first 3 Qs in a GALS screening?
- Any Pain, Swelling or Stiffness in your Muscles, Joints or Back?
- Can you dress yourself completely without difficulty?
- Can you walk up and down stairs without any difficulty?
Outline Gait analysis in GALS screening
- Walk a few steps, turn, walk back. Look for Symmetry, Smoothness and Ability to Turn Quickly
- Look for Limb Alignment, Spine Alignment, Equal Iliac crest level, Shoulder+Glute+Quad+Calf muscle Bulk and Symmetry, Ability to fully extend limbs, Popliteal Swelling, Feet abnormalities
Outline Arm analysis in GALS screening
- Put hands behind head. Straighten arms completely. Observe Dorsum: Joint swelling, Deformity, Nails, Skin
- Supinate hands. Observe Muscle Bulk.
- Make fist. Assess: Power grip, Hand and wrist function, RoM in fingers. Squeeze my fingers.
- Touch each finger to thumb. Squeegee across MTPJs (look for tenderness
Outline Legs analysis in GALS screening
- Assess F+E of knees and Internal Rotation.
- Patellar Tap or Sweep/Bulge Test. (Small effusions may not be seen with Patellar Tap)
- Inspect feet: Swelling, Deformity. Squeeze across MTPJs
Outline Spine analysis in GALS screening
- Scoliosis, Lordosis, Kyphosis. Aysmmetry.
- Assess Lateral neck flexion.
- Assess lumbar spine flexion: Ask to touch toes, Place fingers on Lumbar vertebrae. Fingers should move apart on flexion and together on extension
After GALS, you do Regional Examinations.
What are the 4 stages of these
- Look
- Feel
- Move
- Special tests
Outline the Hand+Wrist Regional Examination
- Look: Swell, Deformity, Wasting, Skin, Nails, Symmetry.
- Feel: Pulses, Eminences, Tendons, Sensation. Joint temps, Squeeze MCPJs. Nodes, Swellings, Palpate wrists, run hand up forearm to look for nodules/ plaques.
- Move: Straighten fingers against gravity, Make Fist. Assess Wrist F+E Actively and Passively. Phalen’s test if suspect Carpal Tunnel Syndrome. Assess muscle power.
- Function/ Special: Grip my 2 fingers, Pinch my finger, Pick up coin/ Undo button
Outline the Elbow Regional Examination
- Look: From front for Carrying Angle, From side for Flexion Deformity
- Feel: 4arm + Joint Temp. Swelling, Nodule, Plaque, Scars. Palpate M+L Epicondyles and Olecranon (Tenderness or evidence of Bursitis)
- Move: Full F+E Actively and Passively. Pronation+Supination Actively and Passively.
- Special: Put hand to mouth/ behind head
Outline the Shoulder Regional Examination
- Look: Symmetry, Posture, Wasting
- Feel: Front Joint temp. Palpate bony landmarks (tenderness), Glenohumeral joint line Ant and Post, Muscle bulk of Supraspiantus, Infraspinatus, Deltoids.
- Move: Put hands behind head then back. External rotation with elbow tucked to side. Raise arms behind and to front (F+E). Abduct arm Actively and Passively, looking from front and back
Outline the Spine Regional Examination
- Look: Wasting, Asymmetry, Scolisis, Posture.
- Feel: Feel down SPs for Alignment and Tenderness. Palpate Paraspinal muscles.
- Move: Run each hand down lateral leg (Lat Flexion). Cervical movements (Rotation, F+E, Lat Flexion). Sitting: Thoracic rotation with arms crossed. Supine: Straight leg raise with DFlexion.
- Special: U+L Limb Reflexes, Pulses, Full Neurovascular exam
Outline the Knee Regional Examination
- Look: Deformity,Alignment, Valgus/Varus, Wasting, Redness, Swelling, Psoriasis rash (extensor)
- Feel: Skin + Knee Temp, Tenderness around Patella, Baker’s Cyst, Effusion.
- Move: Full F+E Actively and Passively, Anterior Drawer Test (Pull upper tibia towards). Assess M+L Collateral Ligaments (with knee slightly flexed, apply force towards ligament)
- Special: Stand + walk, looking for Valgus/Varus deformity
Outline the Hip Regional Exam
- Look: Wasting, Deformity when Supine, Leg Lengths (Ant Sup Iliac Crest to Medial Malleosus)
- Feel: Palpate over Greater Trochanter (Tenderness-Trochanteric Bursitis) and Groin
- Move: Full flexion, Thomas Test, I+E Rotation with H+K flexed.
- Special: Trendelenburg Sign. Antalgic or Trendelenburg Gait (waddling
Outline Ankle+Foot Regional Exam
- Look: Sitting- Symmetry, Nails, Skin. Toe alignment/ subluxation/ Deformity/ Swelling/ Callus. Standing- Foot arch, Achilles’ tendon thickening or swelling, Hindfoot alignment.
- Feel: Forefoot, Midfoot, Ankle Temps. DP Pulse. Squeeze MTPJs. Palpate Midfoot, ankle and Subtalar Joints for tenderness.
- Move: Active + Passive Inversion+Eversion, D+PFlexion at the Ankle and Big Toe
What are 3 common causes of Synovitis
RA, OA, Gout
What is ‘Stiffness’?
Slowness or difficulty in moving a joint
Compare locations and origins of hip pain
- Anterior Hip Pain: “True” hip pain
- Lateral Hip Pain: Trochanteric Bursitis
- Posterior Hip Pain: Lumbosacral spine or Gluteal muscles
How does Plantar fasciitis pain present?
Pain worse with first few stops out bed/ towards end of day
What is Metatarsalgia?
Mid-foot pain
Morton’s Neuroma: Inter-digital tenderness wher Neuroma is
What is gout?
Inflammatory arthritis due to Uric acid Crystal deposition in Joint.
Often Recurrent and affects Hallux.
Rapid onset of severe pain, Swelling.
List some non-shoulder causes of shoulder pain
- Referred pain from neck
- Cardiac/ Lung problems
- Diaphragmatic pain
- Polymyalgia Rheumatica
Outline Ankylosing Spondylitis
Treatment: PT, Analgesia-Opioids, Immunotherapy
- Pain+Stiffness worse in Mornings+After inactivity
- HLA-B27 gene association
What is DeQuervain’s Tenosynovitis
How does it present
(Increased risk in those with repetitive thumb abduction: Office workers, musicians)
Inflammation of EPl and APL tendons at thumb base
Pain at thumb base Worse on;
- Thumb abduction, Gripping, Ulnar wrist deviation
May be;
- Tenderness of Anatomical snuffbox
- Hand weakness
How is DeQuervain’s Tenosynovitis managed
Analgesia, Splinting
If they fail, CS injections or Surgery
