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Health Assesment > 6.1 Musculoskeletal Assessment > Flashcards

6.1 Musculoskeletal Assessment Flashcards

1
Q

Nonsynovial Joints

A

Nonsynovial Joints - Bones united by fibrous tissue or cartilage. Immovable such as sutures in the skull or can be slightly moveable

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2
Q

Synovial Joints

A
  • Freely Moveable (separated and enclosed by joint cavity)
  • Temporal-Mandible Joint
  • Spine
  • Shoulder
  • Elbow
  • Wrist/Hand
  • Hip
  • Knee
  • Ankle/Foot
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3
Q

Muscle

A

Muscles include skeletal, smooth, and cardiac types

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4
Q

Key Terms

A

Flexion - Bending limb at the joint
Extension - Straightening limb at the joint
Abduction - Move limb away from midline of body
Adduction - Move limb towards midline of body
Pronation - Hand with palm facing down
Supination - Hand with palm facing up
Circumduction - Moving arm in circle around shoulder
Inversion - Moving sole of foot inward at the ankle
Eversion - Moving sole of foot outward at ankle
Rotation - Moving head around central axis

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5
Q

Key Terms (cont)

A

Protraction - Moving body part forward, parallel to ground
Retraction - Moving body part backwards, parallel to ground
Elevation - Raising body part
Depression - Lowering body part

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6
Q

Joints ROS

A
  • Pain in the joints (when is it better or worse)
  • Rheumatoid Arthritis (RA) is generally worse in the morning, osteoarthritis is worse at night
    Type of pain
    Sharp - Fracture
    Popping Sound - Indicates a Tear
    Myalgia-Type Pain - Viral Infection
  • Is there stiffness or swelling
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7
Q

Bone and Muscle ROS

A
  • Trauma to bones?

- Pain or weakness in the muscles?

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8
Q

Functional ADL’s

A
  • Can the patient preform ADL’s Independently?
  • Is the patient taking any dietary supplements?
  • Is there a history of smoking? (Causes bone loss)
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9
Q

Infant Data

A
  • Trauma to infant during labor/delivery
    Did infants head come first
    Was there need for forceps (used for grasping)
    Did infant need resuscitation
    (Periods of anoxia - complete loss of oxygen - could mean hypotonia - decreased muscle tone)
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10
Q

Infant Data (cont)

A
  • Were motor milestones achieved at the same time as siblings
  • Any broken bones/dislocations (how were they treated)
  • Bone deformities
    Spinal Curvature
    Unusual shape of toes or feet
    Trauma increasing risk of fractures
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11
Q

Adolescent Data

A
  • Is patient involved in sports
    How frequently
    What does patient do if they get hurt
  • How does sports fit in with other school demands and activities
    It is necessary to assess safety measures for adolescents because they are less likely to report injuries
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12
Q

Older Adult Data

A
  • History of weakness in the past few months
  • Increase in falls or stumbling in the past few months
  • Does patient use mobility aids such as cane or walker
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13
Q

Physical Assessment

A
  • Purpose to assess function of ADL’s and screen abnormalities
  • Supporting each joint at rest
    (Muscles should be soft and relaxed to assess joints accurately)
  • Take care when examining inflamed areas where rough manipulation can cause pain and muscle spasms
  • Comparing Corresponding Joints
    (Expect symmetry of structure and function and normal parameters of each joint)
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14
Q

Head to toe approach

A
  • Begin with inspection of TMJ (Temporomandibular joint) and work your way down to the ankles.
  • Assessment technique is same for each joint but may be different movements to assess
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15
Q

Inspection

A
  • Size and contour of each joint
  • Inspect skin for color, swelling, masses/deformities
    Deformities
    Dislocation - Loss of contact between 2 bones and joint
    Subluxation - Misalignment
    Contracture - Shortening of Muscle
    Ankylosis - Stiffness/Fixation of Joint

Swelling may cause joint irritation and could mean effusion, inflammation, bony enlargement

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16
Q

Palpation

A

Palpate each joint
- Assess temperature, muscles, bony articulations, area of joint capsule.
(Warmth can indicate inflammation)
- Joints should not be tender to palpate
(If there is tenderness, localize it to specific anatomic structure - Skin, Muscle, Bursae, Ligament, Tendon, Fat Pads, Joint Capsule)

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17
Q

Palpation

A

Note presence of articular disease which is swelling and tenderness (arthritis)
- This limits active and passive ROM
- Extra-articular disease affects active movement and may be a ligament or tendon injury
Note whether the synovial joint membrane is palpable
- Usually not palpable, membrane is doughy and boggy when thickened

18
Q

(ROM) and Muscle Strength

A

Ask for active voluntary ROM

  • Limitations in voluntary ROM attempt passive movement
  • Note pain/tenderness/crepitation (audible crunching or grading with movement)
19
Q

Assess Muscle Strength

A

Assess Muscle Strength

  • Test strength of prime mover muscle groups for each joint
  • Repeat motions for active ROM
  • Ask patient to flex as you apply opposing force
  • Muscle strength should be equal bilaterally
20
Q

Muscle Strength Grade

A

Grade 5 - Normal
Grade 4 - Active movement against gravity with resistance
Grade 3 - Active movement against gravity without resistance
Grade 2 - Active movement with gravity eliminated
Grade 1 - Only trace or flicker of movement
Grade 0 - No movement

21
Q

Temporomandibular Joint

A
  • When palpating audible and palpable snap is normal when people open their mouth
  • Ask patient to move jaw forward and laterally against resistance
  • Ask patient to open mouth against your resistance
    (Tests integrity of Cranial Nerve 5 - Trigeminal Nerve)
  • Note swelling or crepitus
22
Q

Cervical Spine

A
  • Inspect alignment of head and neck
    (Should be straight and head should be erect)
  • Palpate spinous process and sternomastoid, trapezius, paravertebral muscles
  • They should feel firm with no muscle spasms or tenderness
  • Repeat motions while applying opposing force
  • Maintain Flexion against full resistance is normal
    (Tests cranial nerve 6 - spinal nerve)
23
Q

Shoulder

A

Test strength of shoulder muscles
- Shrug shoulders, flex forward and up, abduct against resistance.
- Shoulder shrug tests cranial nerve 6 (spinal accessory nerve)
- Inspect/Palpate comparing both shoulders posteriorly and anteriorly.
DO NOT ATTEMPT IF YOU SUSPECT NECK TRAUMA

24
Q

Elbow

A

Inspect size and contour of elbow in both flexed and extended positions
- Effusion and Synovial Thickening shows as a bulge in the groove of the sides of olecranon process.
(Occurs with gouty arthritis)
- Epicondyles, head of radius, and tendons are common sites of inflammation and tenderness
(Example - tennis elbow)

25
Q

Hand and Wrist

A
  • Inspect hands on both palmar and dorsal sides.
  • Note position, contour, shape
    (No swelling, redness, deformities, or nodules should be present)
    (Skin should appear smooth with knuckle wrinkles present)
    (Muscles should appear full)
26
Q

Hand and Wrists

A

Palpate each joint in wrist and hands
- This tests for carpal tunnel syndrome with Phalen Test and Tinel’s Sign
Phalen Test - Patient places back of hands together and presses (if painful could mean carpal tunnel syndrome)
Tinel’s Sign - Apply direct percussion to median nerve
(Pain/Tingling can mean carpal tunnel syndrome)

27
Q

Hip

A
  • Lay patient in Supine Position
  • Check for no crepitus, asymmetry or tenderness
    Assess ROM
  • Hip flexion should be assessed with knee straight forward and flexed
  • Preform external and internal rotation, adduction, abduction.
  • Limited abduction while supine in the most common motion dysfunction of hip disease.
28
Q

Hip (cont)

A
  • Smooth, even gait reflects equal leg length and functional hip motion.
  • Hip joint will be inspected later together with spine
29
Q

Knee

A
  • Patient supine with legs extended
  • Inspect lower leg alignment, shape, and contour
    (Hollows should be present on sides of patella)
  • Check quadriceps muscles in anterior thigh for atrophy
    (Important because quadriceps is prime mover of knee and central to joint stability during weight bearing)
    -
30
Q

Knee

A
  • Palpate knee in supine position by starting high anterior thigh above patella.
  • Muscles should feel solid, joint should feel smooth with no warmth, tenderness, thickening, nodularity
    ABNORMALITIES
  • Limited ROM, Pain, Contracture
  • Sudden locking (inability to extend knee fully) or buckling (giving away - ligament injury)
31
Q

Knee Bulge Test/Ballottement Test

A

Checks Fluid around Patella
- Bulge Sign confirms small amounts of fluid
Tap lateral side of patella positive sign would be fluid wave moving across patella
- Ballottement Test confirms larger amounts of fluid
While hold quadricep with one hand, use other hand to push upward on the patella
- If large amounts of fluid is present patella will float towards the femoral condyles.

32
Q

McMurray Test

A

Test with reports of trauma
- Have patient flex knee
- Externally rotate hip while pushing inward on the knee
(clicking indicates torn meniscus)

33
Q

Ankle/Foot Test

A
  • Assess while both sitting and standing/walking
    Compare both feet assessing for contour of joints
  • Foot should align with long axis of lower leg
  • Weight bearing should fall on middle of foot
  • Most feet have longitudinal arch, but can vary from flat feet to high instep
  • Toes should point straight and forward and lie flat
    (Note calluses or bursal reaction)
34
Q

Ankle/Foot

A
  • Palpate the joints between the thumb and plantar surface
  • TEST ROM
    Dorsiflexion, plantar flexion, eversion, and inversion
35
Q

Full Spine

A

Inspect spine while patient is standing
- Assess straightness with vertical line from head through the spinous process to the gluteal cleft
(equal horizon positions of shoulder, scapulae, iliac crest, gluteal folds)
- Knees and feet should align with trunk and pointing forward

36
Q

Full Spine

A

Assess abnormal curvature (kyphosis, lordosis, scoliosis)

  • Check ROM of spine by asking patient to touch toes
  • Look for flexion 75-90 degrees and smoothness/symmetry of movement
37
Q

Assessing Infants

A
  • Congenital Dislocation
    Ortolani’s maneuver test - every visit until infant is 1 years old
    Allis test - check for hip dislocation
  • Inspect hands, noting shape, number, position, of fingers and palmar creases
    Note for single transverse palmar crease (simian crease)
  • Palpate length of clavicles, most frequently fractured at birth
38
Q

Preschool/School Aged

A
  • Assess gait
    Bowlegged Stance (genuvarum) - Normal for 1 year after child begins walking
    Knock-Knee (genuvalgum) - occurs between 2 and 3 and a half years old. (No treatment)
39
Q

Inflammatory Disease

A 
Rheumatoid Arthritis (RA) - Chronic, systemic inflammatory disease of joints and surrounding connective tissue 
- Causes fusiform (spine shaped swelling)
Ankylosing Spondylitis - Chronic progressive inflammation of the spine and larger joints
40
Q

Degenerative Diseases

A

Osteoarthritis - Noninflammatory, localized deterioration of articular cartilages and subchondral bone and formation of new bone.
Osteoporosis - Decrease in skeletal bone mass

41
Q

Wrist and Hand Disease

A

Ulnar Deviation - fingers listing to the ulnar side of hand
Ankylosis - Extreme wrist flexion
Dupuytren’s Contracture - Chronic hyperplasia of palmar fascia which causes flexion contractures of the digits. (Band extends from midpalm)
Swan Neck Deformity - Flexion contracture resembles curve neck of swan
Polydactyty - Extra Digits

42
Q

Shoulder/Elbow

A

Joint effusion - Condition causing swelling and excess fluid in capsule
Frozen Shoulder - Formation of fibrous tissue in capsule that causes stiffness, progressive limited ROM, and pain
Subcutaneous Nodules - Painless nodules due to RA

Health Assesment (14 decks)

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