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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?”

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easy assessment of musculoskeletal system for gps

Easy assessment of musculoskeletal system for GPs

Aspects of examining the musculoskeletal system

slide2
Revisiting the basics
  • GALS
  • Video
  • Some bits and pieces / a personal view
history
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?”
revisiting the basics
Revisiting the basics
  • Inspection Look
  • Palpation Feel
  • Movement Move
  • Stability
  • Function
  • Compare with opposite side
inspection
Inspection
  • Skin colour / rashes
  • Swelling
  • Deformity
  • Scars
  • Muscle wasting
  • Surrounding structures - bursae, tendons
palpation
Palpation
  • Nature of swelling
        • bony
        • synovial
        • effusion
  • Warmth
  • Tenderness
movement
Movement
  • Active and passive
  • Range of movement
  • Crepitus
  • Note pain
  • Instability
stability
Stability
  • Subluxation or dislocation
    • MCP
    • Radioulnar
    • subtalar
    • MTP
function
Function
  • Lower limbs - gait
  • Hands
        • pincer grip
        • power grip
g a l s
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
g a l s13
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”
bits and pieces
Hands

Wrists - CTS + de Q

Shoulders

Backs

Hips

Feet - biomechanics

Hypermobility

Fibromyalgia

Bits and pieces
early synovitis
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
carpal tunnel syndrome
Carpal Tunnel Syndrome
  • Phalen’s
  • Tinel’s
de quervains tenosynovitis
De Quervains tenosynovitis
  • APL and EPB tendons
  • tender over radial styloid
  • sometimes nodule (thickened sheath)
  • Finkelsteins test
  • Rest it
  • Inject it
shoulders
Shoulders
  • Shoulder or not
  • Glenohumeral or not - external rotation
  • Tenderness
    • bicipital groove
    • subacromial
  • Painful arc of abduction
backs
Backs
  • Lumbar flexion
    • Modified Schobers - or use your fingers
    • Fingers to floor = misleading
  • Lumbar extension
  • Lumbar lateral flexion
  • “Sacroiliac restriction”
slide32
Hips
  • Internal rotation - can examine sitting
  • Trochanteric bursitis
  • Trendelenburg - to distinguish lumbosacral from hip pain
foot biomechanics
Foot - biomechanics
  • Swing phase
  • Stance phase
    • Contact (27%)
    • Midstance (40%)
    • Propulsive (33%)
biomechanics stance phase
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
biomechanics stance phase 2
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
biomechanics stance phase 3
Biomechanics - stance phase (3)
  • Propulsion
    • app 25% bodyweight on metatarsals and toes (esp 1st)
    • ends with toes off
over pronation
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
hypermobility
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