Easy assessment of

musculoskeletal system


GALS
REVISITING THE BASICS

joints or back? • Can you dress yourself completely without any difficulty? • Can you walk up and down stairs without any difficulty? .GALS GAIT. ARMS. LEGS AND SPINE Screening Questions • Do you have any pain or stiffness in your muscles.

Observe for : symmetry smoothness ability to turn quickly If abnormal gait. pain? . turning at the end.GAIT Ask the patient to walk up and down the room.

ABNORMAL GAIT Antalgic Gait Ataxic Gait :.sensory cerebellar Scissor Gait Waddling Gait Trendelenburg Gait Parkinsonian Gait (festinating gait) .

ARMS Ask the patient to :Put their hands behind their head. Turn hands over. . fingers outstretched. palms down. Make a fist. squeeze your fingers To bring each finger to the thumb in turn. You should gently squeeze across the metacarpophalangeal (mcp)joints testing for tenderness. Hold arms straight out.

LEGS With patient laid on a couch:Assess knee flexion and extension. Inspect feet. . Assess internal/external rotation of the hips. Perform patella tap. Squeeze the MTP’s.

Assess temporal mandibular joints. Assess lumbar spine movement. .SPINE With the patient standing:Inspect the spine from behind and side view. Assess lateral flexion of the neck (cervical spine).

Click icon to add picture REVISITING THE BASICS .

SPECIFICS HT Precipitating incident • trauma (macrotrauma) • repetitive stress (microtrauma) • is this a work related injury? • is there a lawsuit ongoing? For MVAs driver/passenger belted/non-belted location of impact and severity of crash (required jaws of life. thrown from the car. etc) speed at impact position of the patient and the limb in question at impact . if anyone died in the crash.

for pain or presenting problem • Onset • Duration • Character • Course • Aggravating and relieving factors • Location • Radition • Associated symptoms In addition to pain do they have: Clicking Snapping Catching Locking Sensation of giving way (including prior falls or dislocations) Swelling Weakness Is it worse when they wake up in the morning? Does it gradually get worse over the course of the day? Does the pain ever wake them up at night? .

RED FLAGS Pain at night or rest Associated weight loss and loss of appetite Hx. Of trauma Extreme age Bowel or bladder symptoms . Of cancer Steroids use Hx.

loss of function. and initial treatment When taking a history for a chronic problem always inquire about past injuries.GENERAL CONSIDERATIONS FOR EXAMINATION When taking a history for an acute problem always inquire about the mechanism of injury. effect on function. past treatments. and current symptoms. onset of swelling (< 24 hours). .

GENERAL CONSIDERATIONS FOR EXAMINATION The patient should be gowned and exposed as required for the examination Some portions of the examination may not be appropriate depending on the clinical situation (performing range of motion on a fractured leg for example) .

GENERAL CONSIDERATIONS FOR EXAMINATION The musculoskeletal exam is all about anatomy Think of the underlying anatomy as you obtain the history and examine the patient .

GENERAL CONSIDERATIONS FOR EXAMINATION The cardinal signs of musculoskeletal disease are: • Pain • Redness (erythema) • Swelling • Increased warmth • Deformity • Loss of function .

FEEL. regardless of the region you are examining (LOOK.GENERAL CONSIDERATIONS FOR EXAMINATION Always begin with inspection. MOVE) Specialized tests are often omitted unless a specific abnormality is suspected A complete evaluation will include a focused neurological exam of the effected area . palpation and range of motion.

INSPECTION Look for scars. rashes. or other lesions like abrasions/open wounds Look for asymmetry. deformity. or atrophy Always compare with the other side Look for swelling Look for erythema (redness) Posture/position of the joint or limb .

we don’t percuss things in orthopedics however the one exception is nerves If tapping over a nerve causes pain or electric shock sensations. this is called Tinel’s sign Present when nerves are compressed or irritated Also used to monitor nerve recovery after injury (in the form of an “advancing Tinel’s sign”) .PERCUSSION Typically.

AUSCULTATION We don’t really listen to anything in orthopedics .

PALPATION Examine each major joint and muscle group in turn Identify any areas of tenderness Joint line Tendinous insertions Palpate for any crepitus Identify any areas of deformity Always compare with the other side .

PALPATION Warm or cold including pulses Fluctuation/fluid collection Compartments – soft or firm and painful Sensation .

RANGE OF MOTION Active Passive .

) Note any increased range of motion or instability Always compare with the other side Proceed to passive range of motion if abnormalities are found . weakness.ACTIVE ROM Ask the patient to move each joint through a full range of motion Note the degree and type of any limitations (pain. etc.

PASSIVE ROM Ask the patient to relax and allow you to support the extremity to be examined Gently move each joint through its full range of motion Note the degree and type (pain or mechanical) of any limitation If increased range of motion is detected. perform special tests for instability as appropriate Always compare with the other side .

VASCULAR STATUS Pulses Upper extremity • Check the radial pulses on both sides • If the radial pulse is absent or weak. check the brachial pulses Lower extremity • Check the posterior tibial and dorsalis pedis pulses on both sides . check the popliteal and femoral pulses .if these pulses are absent or weak.

or shock . heart failure. arterial blockage.VASCULAR STATUS Capillary Refill • Press down firmly on the patient's finger or toe nail so it blanches • Release the pressure and observe how long it takes the nail bed to "pink" up • Capillary refill times greater than 2 to 3 seconds suggest peripheral vascular disease.