Assessment of the Extremities - Unit 3

Question 1

What are some signs of musculoskeletal problems?

Answer 1

Pain, redness (erythema), swelling/edema, increased warmth, deformity, loss of function.

Question 2

Osteoarthritis - what is it?

Answer 2

Bone spurs, caused by age, sports, overuse, etc. Weight reduction could help!

Question 3

Rheumatoid Arthritis - what is it?

Answer 3

Muscle atrophy and it feels better to move! It is an inflamed synovial membrane.

Question 4

Osteoporosis - what is it?

Answer 4

“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!

Question 5

In what order do we assess the MSK?

Answer 5

1. Inspection.
2. Palpation.
3. Range of Motion
4. Strength.

Question 6

What are some of the things that the MSK assessment might include?

Answer 6

Special Tests, Vascular Assessment, Neuro Assessment

Question 7

Inspection - what do we do to prepare?

Answer 7

Adequate exposure is needed, visualize anatomy of the body part, start on the “normal” side.

Question 8

We look for size and shape of joints and muscles. T/F?

Answer 8

True!

Question 9

What is active range of motion?

Answer 9

When the joints are moved by the person.

Question 10

Use passive ROM if active ROM is abnormal. (What is passive?)

Answer 10

Joints moved by examiner and the painful areas are done last!

Question 11

With passive ROM, we push through, even with painful areas. T/F?

Answer 11

FALSE - we do not force/push if there is resistance or pain.

Question 12

Assessing strength - what is the strength of movement scale?

Answer 12

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.

Question 13

Vascular Assessment - what do we do?

Answer 13

Pulses, capillary refill, edema, cyanosis, and clubbing.

Question 14

Outline of Exam - Head/Neck, Upper Extremities, Lower Extremities, Spine & Gait

Answer 14

Head/Neck - TMJ, Neck.
Upper Extremities - Wrists & hands, arms & elbows, shoulders.
Lower Extremities - ankles & feet, knees, hips.
Spine
Gait

Question 15

Neurovascular Assessment - CSM - What is it?

Answer 15

Circulation, Sensation & Movement

Question 16

CSM Indication - what are they needed for?

Answer 16

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.

Question 17

Circulation - what is included in this assessment?

Answer 17

Capillary refill, temp, color, pulse, edema, symmetry for all.

Question 18

What is Raynaud’s Disease?

Answer 18

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)

Question 19

Both legs should be symmetrical without swelling. Asymmetry of calves greater than __ is abnormal.

Answer 19

1 CM.

Question 20

Unilateral swelling of legs indicated a local problem that could be ___.

Answer 20

DVT.

Question 21

What is “Homan’s Sign” ?

Answer 21

When dorsiflexing the foot, if there is intense pain….it could be a sign of DVT!!

Question 22

Sensation - compare __ and ___.

Answer 22

Soft and hard touch.

Question 23

Sensation - is there a presence of pain, burning and tingling? T/F?

Answer 23

True!

Question 24

Movement - ____ and ____ of movement, done on a scale, which is…

Answer 24

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

Question 25

What is compartment syndrome?

Answer 25

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.

Question 26

What are the 6 P’s of Peripheral Vascular Disease?

Answer 26

Pulse, Pallor, Polar (temp), Paresthesia, Paralysis, Pain

Question 27

Occlusion vs Aneurysm

Answer 27

Occlusion - blocking off.

Aneurysm - weak vessel that balloons.

Question 28

What is the goal of Ankle/Brachial Indices ?

Answer 28

Determine the effect of PVD on the systolic pressure, especially pre/post operative patients with PVD, who also have above the knee incisions.

Question 29

What is the ABI procedure?

Answer 29

It’s where the patient lays flat, we use a doppler and take systolic ankle BP and systolic brachial pulse. We then divide.

Question 30

ABI Resulting and meaning - Normal, abnormal, etc.

Answer 30

Normal is 1.

.9-.7 = mild occlusion.
.7-.5 = moderate occlusion.
.5-.3 or less = severe ischemia.

Question 31

ABI - results should be INCREASED post operatively. If not (they are lower), we should expect a __ in graft.

Answer 31

CLOT.

Question 32

What are some signs of Acute Arterial Insufficiency (Arterial Clot)?

Answer 32

No swelling, no pulse, collapsed veins, possible pain, cold, mottling/color variations.

Question 33

What are some signs of Chronic Arterial Insufficiency?

Answer 33

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.

Question 34

Acute Venous Insufficiency (DVT) - what are some signs?

Answer 34

Pulses present, some swelling, hard cord in leg, Homan’s sign, may be warm or erythematous.

Question 35

What are some signs of Chronic Venous Insufficiency?

Answer 35

Achy legs, brown pigmentation, stasis dermatitis, normal pulses, marked edema, normal temp, ulcerations at sides of ankles.

Question 36

Hyperpigmentation can also be seen in…

Answer 36

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)