Assessment of the Extremities - Unit 3 Flashcards
What are some signs of musculoskeletal problems?
Pain, redness (erythema), swelling/edema, increased warmth, deformity, loss of function.
Osteoarthritis - what is it?
Bone spurs, caused by age, sports, overuse, etc. Weight reduction could help!
Rheumatoid Arthritis - what is it?
Muscle atrophy and it feels better to move! It is an inflamed synovial membrane.
Osteoporosis - what is it?
“Swiss cheese” bone - loss of bone. Long term use of oral steroids can cause this!
Vertibroplasty can help - they inject this cement like substance in the area and it helps!
In what order do we assess the MSK?
- Inspection.
- Palpation.
- Range of Motion
- Strength.
What are some of the things that the MSK assessment might include?
Special Tests, Vascular Assessment, Neuro Assessment
Inspection - what do we do to prepare?
Adequate exposure is needed, visualize anatomy of the body part, start on the “normal” side.
We look for size and shape of joints and muscles. T/F?
True!
What is active range of motion?
When the joints are moved by the person.
Use passive ROM if active ROM is abnormal. (What is passive?)
Joints moved by examiner and the painful areas are done last!
With passive ROM, we push through, even with painful areas. T/F?
FALSE - we do not force/push if there is resistance or pain.
Assessing strength - what is the strength of movement scale?
0 - No muscular movement.
1 - Muscle tensing only.
2 - Moves but cannot lift.
3 - Lifts against gravity but not against resistance.
4 - Weak against resistance, good to full ROM.
5 - Normal strength, full ROM.
Vascular Assessment - what do we do?
Pulses, capillary refill, edema, cyanosis, and clubbing.
Outline of Exam - Head/Neck, Upper Extremities, Lower Extremities, Spine & Gait
Head/Neck - TMJ, Neck.
Upper Extremities - Wrists & hands, arms & elbows, shoulders.
Lower Extremities - ankles & feet, knees, hips.
Spine
Gait
Neurovascular Assessment - CSM - What is it?
Circulation, Sensation & Movement
CSM Indication - what are they needed for?
Needed for baseline data, surgery on extremities, spine, brain, Injury to extremities, brain or spinal cord injury, following certain diagnostic procedures, patient is restrained with arm/and or leg restraints.
Circulation - what is included in this assessment?
Capillary refill, temp, color, pulse, edema, symmetry for all.
What is Raynaud’s Disease?
intermittent attacks of aschemia of the extremities of the body, especially nose, fingers, ears and toes, caused by exposure to cold or by emotions.
Skin can go from White/Blue (cyanotic) to Red (where blood returns with throbbing)
Both legs should be symmetrical without swelling. Asymmetry of calves greater than __ is abnormal.
1 CM.
Unilateral swelling of legs indicated a local problem that could be ___.
DVT.
What is “Homan’s Sign” ?
When dorsiflexing the foot, if there is intense pain….it could be a sign of DVT!!
Sensation - compare __ and ___.
Soft and hard touch.
Sensation - is there a presence of pain, burning and tingling? T/F?
True!
Movement - ____ and ____ of movement, done on a scale, which is…
Degree & Strength. 0 - No Muscular Movement 1 - Muscle tensing only 2 - Moves but cannot lift. 3 - Lifts against gravity but not against resistance. 4 - Weak against resistance 5 - Normal strength, full ROM
What is compartment syndrome?
Comes from compression of arteries. Comes from fractures, crush injuries or peripheral vascular surgeries. Swelling compresses nerves and blood vessels and includes decreased venous flow and tissues perfusion.
What are the 6 P’s of Peripheral Vascular Disease?
Pulse, Pallor, Polar (temp), Paresthesia, Paralysis, Pain
Occlusion vs Aneurysm
Occlusion - blocking off.
Aneurysm - weak vessel that balloons.
What is the goal of Ankle/Brachial Indices ?
Determine the effect of PVD on the systolic pressure, especially pre/post operative patients with PVD, who also have above the knee incisions.
What is the ABI procedure?
It’s where the patient lays flat, we use a doppler and take systolic ankle BP and systolic brachial pulse. We then divide.
ABI Resulting and meaning - Normal, abnormal, etc.
Normal is 1.
.9-.7 = mild occlusion.
.7-.5 = moderate occlusion.
.5-.3 or less = severe ischemia.
ABI - results should be INCREASED post operatively. If not (they are lower), we should expect a __ in graft.
CLOT.
What are some signs of Acute Arterial Insufficiency (Arterial Clot)?
No swelling, no pulse, collapsed veins, possible pain, cold, mottling/color variations.
What are some signs of Chronic Arterial Insufficiency?
Claudication (pain caused by lack of blood flow), decreased or absent pulses, cold, shiny skin, absence of hair, nails thickened and ridged, pallor/dusky red (rubor), gangrene or ulcerations on toes or points of trauma, edema mild or absent.
Acute Venous Insufficiency (DVT) - what are some signs?
Pulses present, some swelling, hard cord in leg, Homan’s sign, may be warm or erythematous.
What are some signs of Chronic Venous Insufficiency?
Achy legs, brown pigmentation, stasis dermatitis, normal pulses, marked edema, normal temp, ulcerations at sides of ankles.
Hyperpigmentation can also be seen in…
Addison’s disease (adrenal glands don’t produce enough), Thyrotoxicosis (super high thyroid levels), Chronic renal failure, pregnancy, biliary cirrhosis (swelling of the liver ducts)
