Musculoskeletal Summary Shoulder Exam Ask consent Look dislocation, AC joint, breaks Feel SC join, clavicle, AC join, acromion,

omion, scapula Move o Active; flex, extend, internal rot (across chest), external rot (hand on head, scratch high on back), abduction, adduction o Resisted as above Special tests painful arc , empty beer can test (supraspiatus) Common problems; o Swimmers shoulder (supraspinatus impingement) Sx painful arc, +ve empty beer can test Mx rest, NSAIDs (pain relief), physiotherapy, subacromial steroid injection (if no tear on u/s) o Adhesive capsulitis (frozen shoulder) Sx frozen shoulder, all movements limited and painful Common and worse in diabetics Mx Strong analgesia (paracetamol, codeine), subacromial injection Elbow Ask Look Feel medial epicondyle (golfers) & lateral epicondyle (tennis), olecranon, nodules, tophi Move flexion, extension, pronation, supination Special tests o Painful resisted flexion of wrist tennis elbow o Painful resisted extension of wrist - golfers elbow Common problems o Tennis elbow (lateral epicondylitis) exercises (wringing exercise, weighted wrist extension), corticosteroid injection, elbow brace for playing tennis o Golfers (medial) exercises (wringing, weighted wrist extension), steroid injections, surgery (for severe & chronic)

Hand/ wrist Ask Look (muscle wasting, deformities, osteoarthritis swellings, nodules) Feel Move flex, extend, abduct & adduct, rotation (wrist), opposition Special tests prayer, phalens (upside down prayer), tinels (tap carpal tunnel) Common problems o Carpal tunnel syndrome Pathognomonic sx awakening at night with pins and needs in fingers. +ve tinel test or phalen test. Mx Rest, lose weight, splinting, surgical release (gold), may try steroid injections

Cervical spine Ask, Look Feel C7 is most prominent process. C6 also big will disappear on neck extension. C2 big first one felt under occiput. Move flex, extend, lateral flexion, rotation Lumbar spine Ask Look posture (scoliosis, kyphosis), muscle wasting/ spasm Feel all spinous processes (landmark iliac crest L4/L5, dimples SIJ) Move gait/ walking, flex, extend, lateral flexion, rotation (limited) Special tests - straight leg raise (start with asymptomatic leg, dorsiflex foot for more effect) Functional tests sitting, bending, getting out of cars, tippy toes Knee Ask Look get to walk, observe gait. Get to squat Feel bakers cyst, patellar tap Move flex, extend, rotation Special tests collateral, anterior/ posterior draw, mcmurrays