Ch. 22 Musculoskeletal System Flashcards
ligaments in infants/children are stronger than
more prone to _ than _ until _
bone
fracture, sprains in long bones and joints. Adolescence
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 _
20
epiphysis as well as decrease in strength and flexibility.
Injury
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.
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.
fasciculation is
muscle twitching (after injury to muscles motor neuron.)
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
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
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
deviation of fingers to ulnar, swan neck and boutonniere deformaties usually indicate:
Rheumatoid arthritis
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
subcutaneous nodules near elbow on ulnar side is associated with
gout tophi or rheumatoid nodule
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
Gibbus is associated with
Lordosis seen in
kyphosis in
collapsed vertebra from osteoporosis . A sharp angular deformity of spine
obesity and pregnant
aging adults
genu valgum=
genu varum=
genu recurvatum=
knock knees
bowlegs
hyperextension (weakness of quads).
gouty arthritis should be suspected if inflamed
persistent thickened achilles tendon may indicate
metotarsophalangeal joint of great toe
tendonitis
Heat, redness, swelling, tenderness, are signs of an inflamed joint and possibly caused by
RA, gout, septic joint, fracture or tendonitis
pes planus=
pes cavus=
flat foot
high instep
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
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.
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
