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MSK Exams for OSCEs

MSK Exams for OSCEs. Mark Cattermull. IT IS SIMPLE. Look Feel Move Special Test Joint Above/Below Neurovascular Supply. Intro. Usual spiel + Are you in any pain? Have you had previous operations?. Look. GENERAL INSPECTION – aids, slings/frames, pain etc then:

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MSK Exams for OSCEs

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  1. MSK Exams for OSCEs Mark Cattermull

  2. IT IS SIMPLE • Look • Feel • Move • Special Test • Joint Above/Below • Neurovascular Supply

  3. Intro • Usual spiel + • Are you in any pain? • Have you had previous operations?

  4. Look • GENERAL INSPECTION – aids, slings/frames, pain etc then: • Deformity / misalignment – Valgus vsVarus • Muscle bulk / wasting • Swelling • Erythema / redness

  5. Shoulder Pathologies • Impingement (supraspinatus tendonitis): impingement of tendon in subacromial space. Painful mid-arc 60-120. +veHawkin’s. Mx: Physio, analgesia, steroid inj, surgery –acromioplasty (arthroscopic) • Rotator Cuff Tear: assoc tendonitis and impingement. Supraspinatus wasting and trouble initiating abduction. Mx: incomplete – conservative, complete – surgery. • Adhesive Capsulitis (frozen shoulder): pain and then stiffness – loss of active and passive in all ranges. Mx: NSAIDs/inj when painful, physio when stiff. • OA: ?previous injury/scar. Painful movement and loss of range in all directions – less than frozen shoulder. Mx: analgaesia, inj, surgery • Dislocation/instability: apprehension test.

  6. Spine Pathologies • OA/facet joint degeneration: pain and decreased range of movement. Stiffness (<30mins), movement -> pain, no neurosx. Mx: lifestyle, paracetamol, NSAIDs/opioids, other eg TENS, capsaicin cream. • Ankylosing Spondylitis: pain and decreased range of movement (particularly lower back). Stiffness (>30mins). Schober’s test (10 above 5 below, <5cm), SIJ pain. Mx: physio and exercise (swimming), NSAIDs, anti-TNFa if bad. • Sciatica: shooting pains down back of leg particularly on sciatic stretch test (straight leg raise). Nerve root impingement (L4/5 or L5/S1). Mx: amitriptyline, duloxetine, gadapentin or pregabalin. • CaudaEquina(won’t get): lower back pain, sciatica (bilateral)/leg pain, saddle anaesthesia, urinary retention. Before may have neurogenic claudication. Mx: emergency MRI and surgical decompression

  7. Hip Patholgies • OA: pain and reduced range of movement (int. rotation first), +ve Thomas and Trendelenburg test later. Stiffness <30mins. Mx: lifestyle, paracetamol, NSAIDs/opioids, inj, surgery. • IA: pain esp. w/ morning stiffness >30mins. Systemic features. • Trochanteric Bursitis: pain, warmth and tenderness over greater trochanter of femur. (Women 50-70yrs).

  8. Knee Pathologies • ACL tear: twisting injury, pop and immediate swelling (haemarthrosis). Pain and laxity /+ve ant. draw test. Mx: physio, surgical reconstruction. • PCL tear: high energy trauma eg w/ hip dislocation, #. Laxity / +ve post. draw. Mx: physio, surgical reconstruction. • Meniscal tear: twisting injury, swelling in few hours. Locking, pain over joint line. +ve McMurray’s. MRI/arthroscopy to confirm. Mx: surgery if locking. • Collateral Ligament tears: effusion, pain over affected area. +ve valgus/varus laxity. Mx: rest, physio, brace. • OA: pain and stiffness, reduced range of movement and crepitus. • (Pre)patellar bursitis: swelling, redness, pain on palpation. Hx of kneeling (oioi). Mx: rest, analgaesia (NSAIDs), inj, aspiration.

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