1 / 42

Easy assessment of musculoskeletal system for GPs

Easy assessment of musculoskeletal system for GPs. Aspects of examining the musculoskeletal system. Revisiting the basics GALS Video Some bits and pieces / a personal view. History . “Have you any pain or stiffness in your muscles, joints or back?”

Download Presentation

Easy assessment of musculoskeletal system for GPs

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Easy assessment of musculoskeletal system for GPs Aspects of examining the musculoskeletal system

  2. Revisiting the basics • GALS • Video • Some bits and pieces / a personal view

  3. History • “Have you any pain or stiffness in your muscles, joints or back?” • “Do you have any trouble getting up or down stairs?” • “Do you have any difficulty getting dressed?”

  4. Revisiting the basics • Inspection Look • Palpation Feel • Movement Move • Stability • Function • Compare with opposite side

  5. Inspection • Skin colour / rashes • Swelling • Deformity • Scars • Muscle wasting • Surrounding structures - bursae, tendons

  6. Palpation • Nature of swelling • bony • synovial • effusion • Warmth • Tenderness

  7. Movement • Active and passive • Range of movement • Crepitus • Note pain • Instability

  8. Stability • Subluxation or dislocation • MCP • Radioulnar • subtalar • MTP

  9. Function • Lower limbs - gait • Hands • pincer grip • power grip

  10. Doherty, Dacre, Dieppe and Snaith (1992) The GALS locomotor screen, Annals of Rheumatic diseases 51: 1165-9 GAIT ARMS LEGS SPINE G A L S

  11. G A L S • “…provide a valuable screening test for use in general practice” • “the procedure can be viewed as a general functional (disability), as well as a basic musculoskeletal assessment” • “..be useful in selective situations as a rapid test of functional performance and to screen out regional locomotor abnormalities that merit closer scrutiny”

  12. GALS recording

  13. Hands Wrists - CTS + de Q Shoulders Backs Hips Feet - biomechanics Hypermobility Fibromyalgia Bits and pieces

  14. Hand - RA

  15. Early synovitis • PIP - skin discolouration and tenderness • Clench fist - MCPs should be white with no infilling • MCP squeeze to elicit tenderness • Inferior radio ulnar stress test • Bulge sign at knee • MTP squeeze test

  16. Hand OA

  17. Raynauds 1

  18. Raynauds 2

  19. Scleroderma early

  20. Scleroderma

  21. Sclerodactaly (acrosclerosis)

  22. Carpal Tunnel Syndrome • Phalen’s • Tinel’s

  23. De Quervains tenosynovitis • APL and EPB tendons • tender over radial styloid • sometimes nodule (thickened sheath) • Finkelsteins test • Rest it • Inject it

  24. Shoulders • Shoulder or not • Glenohumeral or not - external rotation • Tenderness • bicipital groove • subacromial • Painful arc of abduction

  25. Shoulder - abduction

  26. Shoulder function related to abduction

  27. Backs • Lumbar flexion • Modified Schobers - or use your fingers • Fingers to floor = misleading • Lumbar extension • Lumbar lateral flexion • “Sacroiliac restriction”

  28. Backs - neurology

  29. Hips • Internal rotation - can examine sitting • Trochanteric bursitis • Trendelenburg - to distinguish lumbosacral from hip pain

  30. Trendelenburg test

  31. Foot - biomechanics • Swing phase • Stance phase • Contact (27%) • Midstance (40%) • Propulsive (33%)

  32. Biomechanics - stance phase • Contact • outer border heel strikes then • PRONATION at subtalar joint shifts centre gravity medially • causes tibia to internally rotate • purpose is shock absorption/adaption uneven ground

  33. Biomechanics - stance phase (2) • Midstance • forefoot loaded • subtalar joint supinates • causes tibia to externally rotate • foot is converted to rigid lever ready for propulsion • ends with heel lift

  34. Biomechanics - stance phase (3) • Propulsion • app 25% bodyweight on metatarsals and toes (esp 1st) • ends with toes off

  35. Abnormal pronation and supination

  36. Subtalar pronation unchecked longitudinal arch stretches and flattens excess rotation of tibia Hallux valgus Plantar fasciitis Achilles tendonitis Post tibial tendonitis stress# navicular anterior knee pain low back pain Over pronation

  37. Hypermobility • Dorsiflexion of 5th MCP to 90 degrees • Apposition of thumb to volar aspect of forearm • Hyperextension of elbow by 10 degrees • Hyperextension of knee by 10 degrees • Hands flat on floor with knees extended

  38. Fibromyalgia

  39. The End

More Related