Easy assessment of musculoskeletal system for GPsAspects of examining the musculoskeletal system

Revisiting the basicsGALSVideoSome bits and pieces / a personal view

HistoryHave 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 basicsInspectionLookPalpation FeelMovementMoveStabilityFunctionCompare with opposite side

InspectionSkin colour / rashesSwellingDeformityScarsMuscle wastingSurrounding structures - bursae, tendons

PalpationNature of swellingbonysynovialeffusionWarmthTenderness

MovementActive and passiveRange of movementCrepitusNote painInstability

StabilitySubluxation or dislocationMCPRadioulnarsubtalarMTP

FunctionLower limbs - gaitHandspincer grippower grip

G A L SDoherty, Dacre, Dieppe and Snaith (1992) The GALS locomotor screen, Annals of Rheumatic diseases 51: 1165-9GAITARMSLEGSSPINE

G A L Sprovide a valuable screening test for use in general practicethe 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

GALS recording

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Bits and piecesHandsWrists - CTS + de QShouldersBacksHipsFeet - biomechanicsHypermobilityFibromyalgia

Hand - RA

Early synovitisPIP - skin discolouration and tendernessClench fist - MCPs should be white with no infillingMCP squeeze to elicit tendernessInferior radio ulnar stress testBulge sign at kneeMTP squeeze test

Hand OA

Raynauds 1

Raynauds 2

Scleroderma early

Scleroderma

Sclerodactaly (acrosclerosis)

Carpal Tunnel SyndromePhalensTinels

De Quervains tenosynovitisAPL and EPB tendonstender over radial styloidsometimes nodule (thickened sheath)Finkelsteins testRest itInject it

ShouldersShoulder or notGlenohumeral or not - external rotationTenderness bicipital groovesubacromialPainful arc of abduction

Shoulder - abduction

Shoulder function related to abduction

BacksLumbar flexionModified Schobers - or use your fingersFingers to floor = misleadingLumbar extensionLumbar lateral flexionSacroiliac restriction

Backs - neurology

Root

Sensory loss

Motor weakness

Reflex

L4

Medial calf and ankle

Knee extension, foot inversion

Knee

L5

Medial foot and hallux

Dorsiflexion foot and hallux

None

S1

Outer foot and sole

Plantar flexion foot

Ankle

Sham backache

Hips

Internal rotation - can examine sitting

Trochanteric bursitis

Trendelenburg - to distinguish lumbosacral from hip pain

Trendelenburg test

Foot - biomechanicsSwing phase

Stance phaseContact (27%)Midstance (40%)Propulsive (33%)

Biomechanics - stance phaseContact outer border heel strikes thenPRONATION at subtalar joint shifts centre gravity mediallycauses tibia to internally rotatepurpose is shock absorption/adaption uneven ground

Biomechanics - stance phase (2)Midstanceforefoot loadedsubtalar joint supinatescauses tibia to externally rotatefoot is converted to rigid lever ready for propulsionends with heel lift

Biomechanics - stance phase (3)Propulsionapp 25% bodyweight on metatarsals and toes (esp 1st)ends with toes off

Abnormal pronation and supination

Over pronationSubtalar pronation uncheckedlongitudinal arch stretches and flattensexcess rotation of tibiaHallux valgusPlantar fasciitisAchilles tendonitisPost tibial tendonitisstress# navicularanterior knee painlow back pain

HypermobilityDorsiflexion of 5th MCP to 90 degreesApposition of thumb to volar aspect of forearmHyperextension of elbow by 10 degreesHyperextension of knee by 10 degreesHands flat on floor with knees extended

Fibromyalgia

The End