Common OSCES for Muskuloskeletal system for finals. Shila Begum FY1 Orthopaedics. Outline . Check list of what to go through once before exams 3 OSCES that have come up in the past Full explanations and answers Extra Bits List of previous OSCES Questions.
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Schober's test: When the spine flexes, the distance between each pair of vertebral spines increases. Schober's test can be used to provide a quantitative evaluation of flexion of the lumbar spine A tape with a 15 cm mark is placed vertically in the midline upwards from the level of the dimples at the level of the posterior superior iliac spines). Mark the skin at 0 and at 15 cm and then ask the patient to flex as far forward as they can Record where the 15 cm mark on the skin strikes the tape. The increased distance along the tape is due only to flexion of the lumbar spine and is normally about 6-7 cm (less than 5 cm should be considered as abnormal)
This is a 45 year old man.
On general inspection he looks well and comfortable.
On examination of his back there is obvious scoliosis and scaring in the mid thoracic region with evidence of loss vertebral body space. On flexion there were prominent thoracic vertebral process.
On palpation there were no tenderness over the spinous processes or paraspinal areas
On movement there was limited forward flexion of approximately 50% expected, limited thoracic movements and normal lateral flexion.
These findings are consistent with …………
What else can cause this?
How could this be managed?
Just need to know the principles of management ie split into conservative and medical (non surgical) and surgical treatments.
General Inspection- pt well/unwell
Look- (Standing) symmetry, pelvic tilt, deformities,muscle wasting, scars, true and apparent leg length, get them to walk.
Feel- tenderness greater lesser trochanter, ischial tuberosities
Move- active and passive- flexion, extension, in and ex rotation, ab/aduction
Special Tests- Trendelenburgs, Thomas’
Please examine this patients’ hands and discuss investigations and management options.
General inspection-looks well,unwell
Look- color,swellings, deformity,wrist, muscle wasting,nails
Feel-wrist, MCP, PIP, DIP for tenderness(blanch skin), crepitus-open and close fist fully, feels tendon sheath.
Move-active and passive,make a fist,extension, flexion, ad/abduction
Other-median nerve-push against vertical thumb
radial nerve- push against extended fingers
ulnar nerve- froments test- grip paper between palm and thumb
Symmetrical deforming polyarthropathy.
There is MCP swelling and pip swelling, MCP deviation, volar displacemnt of the wrist, z from deformity of thumb and squaring of base of thumbs and both boutonniere and swan neck deformities. Small muscle wasting of both hands
On palpation there were no tenderness or pain found which means there is no active synovitis.
Movements were very limited
These findings are consistent with RA
I would also like to examine the joint above and do a full systemic examination for further manifestations of the disease.
ALCOGEL, INTRODUCTION, SOUND CONFIDENT
DIFFERENTIALS- GO THROUGH SURGICAL SEIVE (even if you have no idea!)