Ch. 22 Musculoskeletal System Flashcards by Maria Pseftelis

ligaments in infants/children are stronger than

more prone to _ than _ until _

bone

fracture, sprains in long bones and joints. Adolescence

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In Adolescence bone growth is completed at what age

Rapid growth in Tanner stage 3 results in decreased strength in the

More at risk for _

epiphysis as well as decrease in strength and flexibility.

Injury

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pregnant women have increased hormone levels which contribute to elasticity of ligaments and softening of the cartilage in pelvis at _ to _ weeks

Increased mobility occurs in

muscles of ligaments and muscles of lower spine can become stressed and cause

12 to 20

symphysis pubis

lower back pain from lordosis.

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elderly experience more bone resorption which causes especially in menopausal women from decrease in _

_lose up to _% of bone

_ and _ _ _ more vulnerable to fractures

_ around joints deteriorates

_ become less elastic

bone loss, estrogen

women, 30

Vertebrae, weight bearing long bones

cartilage

tendons (slower speed and reaction time , decrease in strength endurance.

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fasciculation is

muscle twitching (after injury to muscles motor neuron.)

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Crepitus is when

Muscle tone should be

Synovial thickening can be felt if

grating sound sensation occurs from bone on bone rub together or with tendosynovitis.

firm (not doughy or hard)

inflammation

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During passive ROM muscle should have _ tension

Passive often exceeds active by _ degrees

If an increase or limitation in ROM a _ should be used to measure angle

slight

5 ( discrepancies between the two may indicate true muscle weakness or joint disorder.)

goniometer

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muscle strength is graded from _ to _

0 to 5
0= no evidence of movement
1= trace
2= Full ROM but not against gravity
3= Full ROM against gravity but not against resistance
4= Full ROM against gravity some resistance but weak
5= Full ROM against gravity and resistance

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deviation of fingers to ulnar, swan neck and boutonniere deformaties usually indicate:

Rheumatoid arthritis

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distal interphalangeal joints with bony overgrowths like hard nodules 2-3 mm in diameter are associated with

osteoarthritis (also called Heberden nodes). if proximan called Bouchard nodes

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subcutaneous nodules near elbow on ulnar side is associated with

gout tophi or rheumatoid nodule

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olecranon bursa is _ _ sac that acts as a cushion between skin and _ _

_ _ results in swelling and tenderness of the bursa

_ or _ when a boggy soft or fluctuant swelling point tenderness at lateral epicondyle or along grooves of olecranon process and epicondyles… increased pain with pronation and supination

fluid filled, olecranon process.

olecranon bursitis

epicondylitis and tendonitis

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Gibbus is associated with

Lordosis seen in

kyphosis in

collapsed vertebra from osteoporosis . A sharp angular deformity of spine

obesity and pregnant

aging adults

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genu valgum=
genu varum=
genu recurvatum=

knock knees
bowlegs
hyperextension (weakness of quads).

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gouty arthritis should be suspected if inflamed

persistent thickened achilles tendon may indicate

metotarsophalangeal joint of great toe

tendonitis

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Heat, redness, swelling, tenderness, are signs of an inflamed joint and possibly caused by

RA, gout, septic joint, fracture or tendonitis

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pes planus=

pes cavus=

flat foot

high instep

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carpal tunnel syndrome assessed by following tests:

4 tests for median nerve integrity

thumb abduction test… if weakness to resistance carpal

Phalen test wrists in palmar flexed position with dorsal surfaces (1 min) if numb paresthesia = carpal

Tinel sign striking wrist with index finger or middle finger (tingling sensation=positive).

4th is kats hand diagram

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Shoulder tests are (2)

Neer test, Hawkins Kennedy test

Neer test forward flex patients arm up to 150 while depressing scapula… if pain rotator cuff inflammation or a tear.
Hawkins Kennedy test- performed by abducting shoulder to 90 degrees flexing elbow to 90 then internally rotating arm to limit. If pain rotator cuff inflammation or tear.

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Straight leg raising test if pain means

disk herniation

femoral stretch is done in _ positition to detect

prone, inflammation of the nerve root (if pain present). (L1, L2, 3, 4)

thomas test is used to detect flexion _ of hip

this can be masked by excessive _ _

contractures (if leg is lifted off table positive)

lumbar lordosis

Trendelenburg test is a maneuver to detect weak

hip abductor muscles

done by asking them to stand on one foot observe from behind note any asymmetry or change in level of iliac crest.

** when the iliac crest drops on side of lifted foot that means the weight bearing foots abductor muscles are weak,

Ballotement is used to determine _ in the knee

Bulge sign is also another test to detect

effusion from excess fluid. If positive patella will float out as if fluid wave were pushing it.

effusion in the knee. (observe for a buldge of returning fluid to the hollow area medial to patella.)

Mcmurray test is used to detect a torn to assess medial meniscus turn heel for lateral meniscus turn heel

lateral meniscus or medial. ( a palpable audible click or pain, or limited extension of the knee is a positive sign of a torn meniscus.) outward (valgus stress) inward. (varus stress)

Ottawa Knee rules for a radiograph of the knee include:

age older than 55 tenderness at head of fibula isolated tenderness of patella inability to flex knee to 90 degrees.

circumference and length in extremities should not differ more than

1 cm

Mass on infants spine is most likely Polydactyly in baby is syndactyly is when

meningocele, or myelomeningocele more than 5 fingers two or more digits are fused together

One of the most easily missed findings in newborn is a

fractured clavicle. Lump on clavicle will be present from healing,

Barlow Ortolani maneuver is used to detect

hip dislocation or subluxation (perform each time infant is assessed in first year of life). ** limitation in abduction and asymmetric gluteal folds sign of hip dislocation. ** a positive sign is when clunk or sensation is felt as the femoral head exits the acetabulum posteriorly.

Allis sign is when the babys _ are assessed by laying the feet _ at 90 degrees while supine Positive sign if

knee, flat one knee appears lower than the other

young children will have a

lumbar curvature of spine and protuberant abdomen

tibial torsion is when

the shin bone twists inward from fetal positioning should resolve with weight bearing.

Genu Valgum (knock-knee) bowleg is a _ finding in toddlers until 18 months of age gower sign is when child uses

normal hands on legs to stand up which means proximal muscle weakness.

Adolescents may have slight Pregnant patients may feel pain in _ _ In pregnant women fluid retention can cause _ _

Kyphosis and rounded shoulders with an interscapular space of 5-6 inches. pubic symphysis carpel tunnel

Changes in elderly seen are:

increased dorsal kyphosis flexion of hips and knees head tilt backward to compensate for thoracic curvature. feet more widely spaced atrophy in muscle from disuse, arthritis,

Gout is a form of_ resulting from chronic elevation of serum _ _ typically affects men older than 40 years and women of postmenopausal age

arthritis , uric acid

Rheumatoid Arthritis cause joint pain stiffness is worse when?

a chronic systemic inflammatory disorder of synovial tissue surrounding joints (gradual typically weeks to months) sometimes sudden 24-48 hours unknown mornings or inactivity (pain at rest) morning stiffness can last several hours Fatigue (common 4-5 hours after rising) , myalgias, weight loss, and low grade fever are common. depression common too. crepitus medium to fine

Osteoarthritis

insidious over many years. Pain occurs on motion with prolonged activity and relieved by rest. fatigue is uncommon and depression crepitus coarse to medium on motion weakness is usually localized and not severe.

rotator cuff tear usually due to degeneration of muscle and tendon from repeated overhead lifting and compression under the acromion. Acute if inability to maintain a

fall on an outstretched arm lateral raised arm against resistance and grating sound on movement, crepitus, and weakness in external shoulder

club foot is also called caused by:

Talipes Equinovarus genetics or external factors in final trimester such as intrauterine compression

Radial head subluxation (Nursemaid's Elbow). caused by common in children pain in

dislocation injury jerking arm upward while elbow is extended pulls apart elbow joint and tears the margin of the annular ligament around radial head into the joint. 1-4 years old elbow and wrist and refuses to move arm...holds slightly flexed and pronated (supination motion is resisted).

osteoporosis is largely seen in glucocorticoid excess and hypogonadism are also risk factors. most common fracture sites are In vertebrae causes

women ratio 4:1 to men hips, wrists, vertebrae. (Loss of height or an acute painful fracture can occur.) kyphosis or scoliosis

Drawer test is used to identify instability of movement of knee anterior or posterior greater than _mm is unexpected

anterior and posterior cruiciate ligaments have patient lie supine foot flat and sit on it ... thumbs on ridge of anterior tibia just distal to tibial tuberosity draw forward and backward 5

Lachman test to evaluate

anterior cruciate ligament integrity.

excessive bone resorption and bone formation can be caused by

Paget disease

chronic inflammatory disease involving the spine and sacroiliac joints

Ankylosing spondylitis

Tinel sign can be tested by tapping on _ _ and this assesses for _ _

medial nerve, carpal tunnel