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musculoskeletal
system for GPs
Aspects of examining
the musculoskeletal
system
History
Inspection
Skin colour / rashes
Swelling
Deformity
Scars
Muscle wasting
Surrounding structures - bursae,
tendons
Palpation
Nature of swelling
bony
synovial
effusion
Warmth
Tenderness
Movement
Active and passive
Range of movement
Crepitus
Note pain
Instability
Stability
Subluxation or dislocation
MCP
Radioulnar
subtalar
MTP
Function
Lower limbs - gait
Hands
pincer grip
power grip
GALS
GAIT
ARMS
LEGS
SPINE
GALS
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
GALS recording
G
A
L
S
Hands
Wrists - CTS + de
Q
Shoulders
Backs
Hips
Feet biomechanics
Hypermobility
Fibromyalgia
Hand - RA
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
Hand OA
Raynauds 1
Raynauds 2
Scleroderma early
Scleroderma
Sclerodactaly
(acrosclerosis)
De Quervains
tenosynovitis
APL and EPB tendons
tender over radial styloid
sometimes nodule (thickened
sheath)
Finkelsteins test
Rest it
Inject it
Shoulders
Shoulder or not
Glenohumeral or not - external
rotation
Tenderness
bicipital groove
subacromial
Shoulder - abduction
Backs
Lumbar flexion
Modified Schobers - or
use your fingers
Fingers to floor =
misleading
Lumbar extension
Lumbar lateral flexion
Sacroiliac restriction
Backs - neurology
Root Sensory loss Motor weakness
Reflex
L4
Knee extension,
foot inversion
Knee
L5
Dorsiflexion foot
and hallux
None
S1
Ankle
Hips
Trochanteric bursitis
Trendelenburg test
Foot - biomechanics
Swing phase
Stance phase
Contact (27%)
Midstance (40%)
Propulsive (33%)
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
Midstance
forefoot loaded
subtalar joint supinates
causes tibia to externally rotate
foot is converted to rigid lever ready
for propulsion
ends with heel lift
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
Hypermobility
1
2
3
4
5
Fibromyalgia
The End