Musculoskeletal Problems:

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Musculoskeletal Problems Examination of the
musculo-skeletal system Thursday 21 May,
2009 John Williams DM(Oxon) FRCS(Orth) Consultant
Surgeon, Trauma Orthopaedic Unit Newcastle
General Hospital Newcastle Upon Tyne
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Declaration of interests
I dont see private patients!
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Shoulder pain Frozen shoulder and sub-acromial
impingement (page 113) Knees Meniscal tears and
osteoarthritis (page 107) Hip Pain and Total Hip
Replacement (page 101) Lumbar Spine Pain (page
93)
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How to examine a Musculoskeletal Region

• How I do it
• What do the signs mean
• Questions

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How to examine a Musculoskeletal Region

• Look
• Feel
• Move
• Special Tests
• Region specific
• Pathology specific
• Neuro-vascular status
• Other sites of pain adjacent joints/abdomen

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HISTORY is still everything
History
History
History
History
History
History
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History

• Pain
• How long?/Nature?/Circumstances?
• Where?/Radiation?
• When?/Night-time?/Aggravating?
• Stiffness/loss of motion
• Loss of function
• Direct Gait
• Indirect Instability
• Neurological

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Shoulder - History

• Congenital/Adolescent problems
• Dislocations/Instability GH v ACJ
• Impingement
• Cuff tears Partial/Full, In/Competent
• ACJ problems
• Frozen Shoulder
• Arthritis

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Shoulder Examination

• Scapular position
• C- T-spine
• Muscle wasting
• (Scars and sinuses)
• Palpation ACJ/Acromion/Scapular/GHJ
• Movement active v passive
• Special tests

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Knee - history

• Meniscal injuries
• Acute injury
• Chronic - Locking/pseudo/swelling/giving way
• Instability
• Arthritis
• Pain/Swelling/Stiffness/Loss of function
• Bursitis

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Knee examination

• Gait
• Standing position
• Quads bulk
• Effusion/Synovitis/Bony swelling
• Extension (locked) / Extensor lag
• Palpation
• Range of motion
• Stability tests / Other tests

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Any questions
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Thank You