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- Arthritis Research UK Professionals Resources
- AR Hands On and Synovium Topical Reviews
- British Society for Rheumatology (BSR)
- British Society for Paediatric and Adolescent Rheumatology (BSPAR)
- Arthritis and Musculoskeletal Alliance (ARMA)
- European League Against Rheumatism (EULAR)
- British Association of Sport and Exercise Sciences
- British Association of Sports and Medicine BASEM
- National Sports Medicine Institute NSMI (now a patient information portal)
- Sports Med – Doctors providing medical care at sporting events Revised Aug 2011
- Musculoskeletal disorders: time for joint action in primary care Tom Margham BJGP Nov 2011
MSK Examination Routines
- hacking-medschool/msk-examination-gals
- ARUK MSK Clinical assessment
- ARUK Regional examination of the musculoskeletal system + GALS
- ARUK PGALs video
- youtu.be/xa1dnWrdVZM
- youtu.be/17rvkifyylc
Myotomes (msk)
Each muscle in the body is supplied by a particular level or segment of the spinal cord and by its corresponding spinal nerve. The muscle, and its nerve make up a myotome.
Myotomes — not quite right
C345 diaphragm
C5 deltoid
C6 wrist extension
C7 elbow extension
C5 shoulder abduction & lateral rotation
C7 shoulder adduction & Medial rotation
C6-7: wrist flexion/extension
C5-6 elbow flexion
C7-8: elbow extension
C6: Pronation/Supination
C8 finger flexion
T1 fingers abduction
C7-8: finger Flexion/Extension
T1: Abduction/Adduction (small muscles of the hand)
T1 –T12 the chest wall & abdominal muscles
L123 hip flexion – iliopsoas (+adduction and medial rotation)
L45 hip Extension glutei (+abduction and lateral rotation)
L34 knee extension quadriceps
L5S1 knee flexion
L4-5 ankle and foot dorsiflexion
S1-2 ankle and foot plantarflexion (gastrocnemius)
L4 ankle inversion (tibialis anterior and posterior)
L45 ankle dorsiflexion
L5-S1 ankle eversion (peronei)
L5S1 toe extension
S1 S2 toe flexion
S3 4 5 bladder bowel genitalia and the anal and other pelvic muscles.
Tendon Reflexes
biceps C5/6
triceps C6/C7
supinator C5/C6
knee L3/L4
ankle L5/S1
Test for clonus if hyperreflexia present/suspected
Hyperreflexia – UMN, thyrotoxicosis, uraemia, hepatic coma
Hyporeflexia – LMN, myopathies, acute UMN damage
Reinforcement – ask patient to clench teeth ( for upper limb reflexes) or clench hands and pull in opposite directions (lower limb reflexes)
Plantar Reflex L5/S1 – elicited by stroning lateral border of sole of foot. Flexor in normal patients, extensor (Babinski) in UMN
Delayed relaxation – hypothyroisism.
Pendular jerks – cerebellar lesions.
hacking-medschoolmrc-scales-muscle-power-reflexes-myotomes
MRC MSK Scales (msk)
hacking-medschool/mrc-scales-2
| MRC scale for strength of muscle contraction | ||
|---|---|---|
| 5/5 | normal | FROM against gravity with full resistance |
| 4/5 | good | FROM against gravity with moderate resistance |
| 3/5 | fair | FROM against gravity only |
| 2/5 | poor | FRO passive movement (gravity eliminated) |
| 1/5 | trace | of muscle contraction (palpable) but without joint movement |
| 0/5 | zero | no evidence of muscle contraction |