MF5 Clinical Skills

• Detect the difference between bony and soft tissue swelling.
• Elicit tenderness around a joint.
• Elicit temperature around a joint.
• Detect synovitis.
• Have an awareness of the difference between active and passive movements.
• Perform passive and active movements at all relevant joints.
• Detect a loss of full extension and a loss of full flexion.
• Assess gait.
• Correctly use the terms varus and valgus.
• Assess limb reflexes routinely when examining the spine and in other relevant circumstances.
• Have an understanding of the term subluxation.
• Where appropriate examine neurological and vascular systems when assessing a problematic joint (check for intact sensation and peripheral pulses).
• Assess leg length with a tape measure when assessing for a real leg length discrepancy.
• Make qualitative assessment of movement (not joint end feel but features such as cog-wheeling).
• Assess the median and ulnar nerves.
• Be able to localize tenderness within the joints of the hand (palpate each small joint of the hand if necessary).
• Assess power grip.
• Assess pincer grip in the hand.
• Make a functional assessment of the hand such as holding a cup.
• Correctly use the term "Heberden's nodes".
• Perform Phalen's test.
• Detect a painful arc* and frozen shoulder*
• Make a functional assessment of the shoulder (can they put their hands behind their head and back?).
• Perform external/internal rotation of the shoulder with the elbow flexed to 90 degrees and held in against the patient's side.
• Examine a patient's shoulder from behind for scapular movement.
• Assess the acromio-clavicular joint (by palpation alone).
• Palpate for tenderness over the epicondyles of the elbow.
• Palpate for tenderness over the greater trochanter of the hip.
• Perform internal and external rotation of the hip with it flexed to 90 degrees.
• Perform Trendelenberg's test.
• Perform Thomas' test.
• Detect an effusion at the knee.
• Perform a patellar tap.
• Demonstrate cross fluctuation or the bulge sign when looking for a knee effusion.
• Test for collateral ligament stability in the knee.
• Use the anterior draw test to assess anterior cruciate ligament stability in the knee.
• Examine the sole of a patient's feet.
• Recognise hallux valgus, claw and hammer toes.
• Assess a patient's feet with them standing.
• Assess for flat feet (including the patient standing on tip toes).
• Recognize hind foot/heel pathologies.
• Assess plantar and dorsi-flexion of the ankle.
• Assess movements of inversion and eversion of the foot.
• Assess the sub-talar joint.
• Perform a lateral squeeze across the metatarsophalangeal joints.
• Assess flexion/extension of the big toe.
• Examine a patient's footwear.
• Palpate the spinous processes.
• Assess lateral and forward flexion of the lumbar spine (using fingers not tape measure).
• Assess thoracic rotation with the patient sitting.