CH 23 musculoskeletal sys Jarvis Flashcards
are specialized forms of connective tissue
Bone and cartilage
musculoskeletal system consists of the body’s
bones, joints, and muscles
Humans need this system musculoskeletal for?
(1) for support to stand erect, and (2) for movement. The musculoskeletal system also functions (3) to encase and protect the inner vital organs (e.g., brain, spinal cord, heart); (4) to produce the red blood cells, white blood cells, and platelets in the bone marrow (hematopoiesis); and (5) as a reservoir for storage of essential minerals such as calcium and phosphorus in the bones.
skeleton is the
-206 bones
bony framework of the body
joint (or articulation) is the place of union of
two or more bones
are the functional units of the musculoskeletal system because they permit the mobility needed for activities of daily living (ADLs).
Joints
fibrous joints the bones are united by
interjacent fibrous tissue or cartilage and are immovable (e.g., the sutures in the skull)
are separated by fibrocartilaginous discs and are only slightly movable (e.g., the vertebrae)
Cartilaginous joints
are freely movable because their bones are separated from one another and enclosed in a joint cavity
Synovial joints
is avascular; it receives nourishment from synovial fluid that circulates during joint movement.
-cushions the bones and gives a smooth surface to facilitate movement.
Cartilage
is an enclosed sac filled with viscous synovial fluid, much like a joint
bursa
located in areas of potential friction (e.g., subacromial bursa of the shoulder, prepatellar bursa of the knee) and help muscles and tendons glide smoothly over bone.
bursa location
Muscles are of three types:
skeletal, smooth, and cardiac.
skeletal, or voluntary, muscles—
those under conscious control.
Each skeletal muscle is composed of bundles of muscle
fibers or fasciculi
—a strong fibrous cord
-skeletal muscle attached to bone
tendon
joint located just above the ring on the finger is the
metacarpophalangeal joint
is located distal to the metacarpophalangeal joint
interphalangeal joint
is the articulation of the mandible and the temporal bone
- permits jaw function for speaking and chewing
temporomandibular joint (TMJ)
temporomandibular joint (TMJ) allows three motions:
(1) hinge action to open and close the jaws;
(2) gliding action for protrusion and retraction;
(3) gliding for side-to-side movement of the lower jaw.
are 33 connecting bones stacked in a vertical column
vertebrae
spinous processes of C7 and T1 are prominent at the =
base of the neck
inferior angle of the scapula normally is at the level of the interspace between
interspace between T7 and T8.
imaginary line connecting the highest point on each iliac crest crosses
L4.
two symmetric dimples that overlie the posterior superior iliac spines crosses the
sacrum.
cervical and lumbar curves are
concave (inward or anterior)
thoracic and sacrococcygeal curves are
convex
are elastic fibrocartilaginous plates that constitute one-fourth of the length of the column
intervertebral discs
intervertebral foramen
exit of spinal nerves
motions of the vertebral column are
flexion (bending forward), extension (bending back), abduction (to either side), and rotation
shoulder girdle is a belt of three large bones
(humerus, scapula and clavicle)
is the articulation of the humerus with the glenoid fossa of the scapula
glenohumeral joint
Rotator cuff
ball-and -socket enclosed by four muscles are the SITS muscles (supraspinatus, infraspinatus, teres minor, and subscapularis). These form a cover around the head of the humerus. They rotate the arm laterally and stabilize the head of the humer
helps during abduction of the arm so that the greater tubercle of the humerus moves easily under the acromion process of the scapula.
subacromial bursa
is the articulation of the distal radius (on the thumb side) and a row of 8 carpal bones
wrist, or radiocarpal joint
permits movement in two planes at right angles: flexion and extension, and side-to-side deviation.
condyloid action
is the articulation between the two parallel rows of carpal bones
midcarpal joint
metacarpophalangeal (MCP) and the interphalangeal joints (DIP and PIP) .
permit finger flexion and extension
elbow joint contains the three bony articulations of the
humerus, radius, and ulna of the forearm
elbow muscles are the biceps and brachioradialis for.
flexion
elbow muscles triceps and brachialis for
extension
Palpable landmarks of elbow are the
medial and lateral epicondyles of the humerus and the large olecranon process of the ulna between them
sensitive ulnar nerve runs between the
olecranon process and the medial epicondyle
(largest joint in body) knee joint is the articulation of three bones—
the femur, the tibia, and the patella (kneecap)—in one common articular cavity
no overlying fat or muscle; only the ligaments hold the tibia and femur in place, making the knee vulnerable to injury.
knee joint (hinge joint)
wedge-shaped cartilages, called the medial and lateral menisci do what?
cushion the tibia and femur
forms a sac at the superior border of the patella, called the suprapatellar pouch (or bursa), which extends up as much as 6 cm behind the quadriceps muscle
knee’s synovial membrane is the largest in the body
knee joint is stabilized by two sets of ligaments
- cruciate ligaments
2. collateral ligaments
, lies between the patella and the skin
prepatellar bursa
is a small, triangular fat pad below the patella behind the patellar ligament
infrapatellar fat pad
ankle, or tibiotalar joint, (hinge joint) is the
articulation of the tibia, fibula, and talus
calcaneus (heel) is
under the talus and points posteriorly.
permits inversion and eversion of the foot.
subtalar joint
anterior tibialis and toe extensors for
dorsiflexion. (leg flex back)
gastrocnemius and toe flexors for
plantar flexion (leg flex forward)
Lengthening occurs at the
epiphyses, or growth plates
is extreme flexion of the wrist, as observed with severe rheumatoid arthritis
ankylosis
compensates for the enlarging fetus, which would shift the center of balance forward. This shift in balance, in turn, creates a strain on the low back muscles
Lordosis (pregnancy)
is an enhanced thoracic curvature of the spine.
kyphosis
is lateral curvature of portions of the spine
Scoliosis
muscles vary in size and strength bc
genetic programming, nutrition, and exercise
(pregnancy) Increased levels of circulating hormones (estrogen, relaxin from the corpus luteum, and corticosteroids) cause
increased mobility in the joints
Increased mobility in the sacroiliac, sacrococcygeal, and symphysis pubis joints in the pelvis contributes to the noticeable changes in
maternal posture
upper-back changes may put pressure on the ulnar and median nerves during the third trimester. Nerve pressure creates aching, numbness, and weakness in the upper extremities in some women.
lordosis affect (pregnant)
, which is the cyclic process of bone resorption and deposition responsible for skeletal maintenance at sites that need repair or replacement.
bone remodeling occurs
bone resorption
(loss of bone matrix)
Peak bone mass or bone mineral density (BMD) is reached in the
early to late 20s
bone resorption net effect is a gradual loss of
bone density or osteoporosis
is a disease involving the loss of mineralized bone mass and leading to porous bone and thus the risk of fractures.
Osteoporosis
a slight flexion of hips and knees.
- increase in the thoracic curve
- backward head tilt to compensate
kyphosis (acing adult)
higher BMD (bone mass density) value means a
denser bone
low BMD (bone mass density) value is a
strong and consistent predictor of hip and vertebral fracture among postmenopausal women
are the most common musculoskeletal concerns
Joint pain and loss of function
Rheumatoid arthritis (RA) involves
symmetric joints
pain is worse in the morning when arising
-pain decreases with movement
-stiffness occurs in the morning and after rest periods.
osteoarthritis pain is worse
later in the day
tendinitis is worse in the
morning, improves during the day
causes sharp pain that increases with movement
fracture
Joint pain 10 to 14 days after an untreated strep throat suggests
rheumatic fever
Decreased ROM may be caused by
joint injury to cartilage or capsule or to muscle contracture.
Inside knee injury can
strain or rupture medial ligament
outside injury can strain or rupture
lateral ligament
abrupt twisting in knee can injure
anterior cruciate ligament
Pop may mean
tear in ligament or fracture
(muscles) Myalgia is usually felt as
cramping or aching.
(muscle) intermittent claudication (caused by obstruction of arteries, induced by exercise)
pain in calf when walking and go away with rest
Are your muscle aches associated with fever, chills, the “flu”?
Viral illness often includes myalgia.
weakness in muscles indicate?
Weakness may involve musculoskeletal or neurologic systems
muscles look smaller?
atrophy
bone pain other than fracture usually feels “dull” and “deep” and is
unrelated to movement.
Low back pain occurs with
degenerative discs, osteoporosis, lumbar stenosis, or is nonspecific.
Bisphosphonates are first-line therapy for
osteoporosis
Period of anoxia may result in
hypotonia of muscles.
Traumatic delivery increases risk for
fractures, (e.g., humerus, clavicle
Ortolani sign for infants
examiner abducts the hip while applying anterior force on femur to reduce hip joint.
Swelling may be excess
joint fluid (effusion), thickening of the synovial lining, inflammation of surrounding soft tissue (bursae, tendons), or bony enlargement.
(complete loss of contact between the two bones in a joint)
dislocation
(two bones in a joint stay in contact, but their alignment is off)
subluxation
(shortening of a muscle leading to limited ROM of joint)
contracture
(stiffness or fixation of a joint).
ankylosis
Warmth and tenderness in joint signal
inflammation.
Articular disease (inside the joint capsule [e.g., arthritis]) produces
swelling and tenderness around the whole joint, and it limits all planes of ROM in both active and passive motion.
Extra-articular disease (injury to a specific tendon, ligament, nerve) produces
swelling and tenderness to that one spot in the joint and affects only certain planes of ROM, especially during active (voluntary) motion.
is an audible and palpable crunching or grating that accompanies movement. It occurs when the articular surfaces in the joints are roughened, as with RA
Crepitation
Muscle status and joint status are
interdependent and should be interpreted together
Malocclusion of teeth also causes
palpable crepitus or audible click.
TMJ inflammation and arthritis cause
Decreased ROM occurs
TMJ
Lateral motion may be lost earlier and more significantly than vertical motion.
(cervical spine inspection) Touch chin to chest.
-also tests the integrity of cranial nerve XI (spinal).
Flexion of 45 degrees
(cervical spine inspection) Lift the chin toward the ceiling
-also tests the integrity of cranial nerve XI (spinal)..
Hyperextension of 55 degrees
(cervical spine inspection) Touch each ear toward the corresponding shoulder. Do not lift the shoulder.
-also tests the integrity of cranial nerve XI (spinal).
Lateral bending of 40 degrees
(cervical spine inspection) Turn the chin toward each shoulder
-also tests the integrity of cranial nerve XI (spinal).
Rotation of 70 degrees
is localized under deltoid muscle and may be accentuated when the person tries to abduct the arm.
Swelling of subacromial bursa
Expected postural changes in pregnancy include
progressive lordosis and, toward the third trimester, anterior cervical flexion, kyphosis, and slumped shoulders
-pregnancy is at term, the protuberant abdomen and relaxed mobility in the joints create the characteristic “waddling” gait
Phalen test, the nurse should ask the person to hold both hands back to back while flexing the wrists 90 degrees. Acute flexion of the wrist for 60 seconds produces no symptoms in the normal hand. The Phalen test reproduces
numbness and burning in a person with carpal tunnel syndrome.
Limited abduction of the hip while supine is the most common
motion dysfunction found in hip disease
Lateral tilting and sciatic pain with straight leg raising are findings that occur with a
herniated nucleus pulposus.
Allis test also tests for hip dislocation but is performed by
comparing leg lengths.
For a fractured clavicle, the nurse should observe for limited arm range of motion and unilateral response to the
Moro reflex
forward bend test//Screen for scoliosis
Seat yourself behind the standing child and ask him or her to stand with the feet shoulder-width apart and bend forward slowly to touch the toes. Expect a straight vertical spine while standing and also while bending forward. Posterior ribs should be symmetric, with equal elevation of shoulders, scapulae, and iliac crests.
nability to supinate the hand while the arm is flexed, together with pain in the elbow, indicates
subluxation of the head of the radius.
Heberden and Bouchard nodules are hard and nontender and occur with
osteoarthritis
carpal tunnel syndrome percussion of the median nerve produces burning and tingling along its distribution, which is a
positive Tinel sign.
If you hear or feel a “click,” McMurray test is positive for a
torn meniscus
Straight Leg Raising or Lasègue Test
maneuvers reproduce back and leg pain and help confirm the presence of sciatica and a herniated nucleus pulposus. Straight leg raising while keeping the knee extended normally produces no pain. Raise the affected leg just short of the point where it produces pain. Then dorsiflex the foot
acute gout consist of
redness, swelling, heat, and extreme pain like a continuous throbbing.
is a metabolic disorder of disturbed purine metabolism, associated with elevated serum uric acid
Gout
occurs with trauma involving abduction, extension, and external rotation (e.g., falling on an outstretched arm or diving into a pool)
dislocated shoulder
Knock-knees” (genu valgum) are present when there is more than 2.5 cm between the
-occurs normally between 2 and image years
medial malleoli when the knees are together
remember the two conditions, link the r’s and g’s: genu varum—knees apart; genu valgum—knees together.)
Knock-knees” (genu valgum)
are raised, firm, and nontender and occur with rheumatoid arthritis in the olecranon bursa and along the extensor surface of the ulna
Subcutaneous nodules
Fingers drift to the ulnar side because of stretching of the articular capsule and muscle imbalance caused by
chronic rheumatoid arthritis
Dupuytren contractures of the digits occur because of
chronic hyperplasia of the palmar fascia
Changes in the fingers caused by chronic rheumatoid arthritis include
swan-neck and boutonniere deformities.
is flexible and apparent with standing but disappears with forward bending
Functional scoliosis
is fixed; the curvature shows both when standing and when bending forward
Structural scoliosis
is a painful swelling of the tibial tubercle just below the knee and most likely due to repeated stress on the patellar tendon. It is usually self-limited, occurring during rapid growth and most often in boys. The symptoms resolve with rest
Osgood-Schlatter disease
Ballottement (test) of the patella is reliable when
large amounts of fluid are present
Tinel sign and the Phalen test are used to check for
carpal tunnel syndrome
McMurray test is used to test the
knee for a torn meniscus.
are collections of monosodium urate crystals resulting from chronic gout in and around the joint that cause extreme swelling and joint deformity. They appear as hard, painless nodules (tophi) over the metatarsophalangeal joint of the first toe and they sometimes burst with a chalky discharge
Tophi
, asymmetric joint involvement commonly affects hands, knees, hips, and lumbar and cervical segments of the spine. Affected joints have stiffness, swelling with hard bony protuberances, pain with motion, and limitation of motion
osteoarthritis
