MSK examination

1. Wash your hands

2. introduce yourself

3. Check name and date of birth

4. Gain consent

5. Explain the process

6. Offer a chaperone

7. Expose the patient appropriately

General inspection

1. Observe the patient's general condition- Scars Obvious wasting of muscles

2. Observe around the bed- (walking aids/splints/analgesia)

Look

1. Examines dorsal aspect (palms down) of both hands

2. Inspects for following clinical signs

3. Inspect nails

4. Examines Palmar aspect (palms up) of both hands:

5. Looks specifically for

6. Insects the elbows

• Assesses hand posture (e.g. contractures/obvious deformity)

• Inspects for scars (previous surgery/trauma)

• Inspects for swelling (notes area of swelling and compares side to side)

• Inspects skin colour (e.g. erythema/ pigmentation changes)

• Bouchard's Nodes: occur at PIPJ (associated with osteoarthritis)

• Heberden's Nodes: occur at DIPJ (associated with osteoarthritis).

• Swan Neck Deformity: occurs at DIPJ with clinical features including - DIPJ flexion with PIPJ hyperextension (associated with Rheumatoid Arthritis)

• Z- Thumb: Hyperextension of the Interphalangeal joint and fixed flexion and subluxation of the metacarpophalangeal joint (MCPJ) (associated with Rheumatoid Arthritis).

• Boutonnieres Deformity: PIPJ flexion with DIPJ hyperextension (associated with Rheumatoid Arthritis)

• Skin Thinning/Bruising: associated with long term steroid use

• Psoriatic Plaques on hands/arms (associated with Psoriatic Arthritis)

• Muscle wasting of hands/arms

Looks for pitting/onycholysis

• Assesses hand posture (e.g., contractures/obvious deformity)

• Inspects for scars (previous surgery/trauma)

• Inspects for swelling (notes area of swelling and compares side to side)

• Dupuytren's contracture - thickening of the palmar fascia, which eventually causes contracture deformities of the fingers and thumb. - Thenar/Hypothenar Muscle Wasting

Looks for psoriatic plaques/rheumatoid nodules

Feel

1. Examines palmar aspect (palms up) of hands

2. Examines Dorsal Aspect (palms down) of hands

• Assesses temperature: Assesses hands/elbows temperature using back of their own hand, compares side to side

• Palpates radial and ulnar pulses bilaterally

• Assesses thenar/hypothenar muscle bulk

• Palpates palm for palmar thickening/Dupuytren's contracture

• Assesses median/ulnar nerve sensation - Median nerve sensation over the thenar eminence and index finger. - Ulnar nerve sensation over the hypothenar eminence and little finger

-Assesses temperature Assesses hands/elbows temperature using back of their own hand, compares side to side

• Assesses function of radial nerve: Checks first dorsal webspace

MCP joint squeeze: Gently squeezes across the metacarpophalangeal (MCP) joints and observes for signs of discomfort.

Bimanually palpates the joints of the hand and wrist, assesses and compares either side for tendemess/irregularities and warmth:

• Metacarpophalangeal joint (MCPJ)

• Proximal interphalangeal joint (PIPJ)

• Distal interphalangeal joint (DIPJ)

• Carpometacarpal joint (CMCJ) of the thumb wrists

Palpates anatomical snuffbox for tenderness. Palpates the patient's arm along the ulnar border to the elbow notes any tenderness, rheumatoid nodules or psoriatic plaques.