Ch 61 Asses Muscuskeletal Flashcards
bone, cartilage, ligaments, tendons, fascia, and bursae.
musculoskeletal system is composed of voluntary muscle and 6 types of connective tissue:
is to protect body organs, provide support and stability for the body, store minerals, and allow coordinated movement.
purpose of the musculoskeletal system
support, protection of internal organs, voluntary movement, blood cell production, and mineral storage. Bones provide the supporting framework that keeps the body from collapsing
main functions of bone are
to bones by tendons.
Muscles are connected
Movement occurs because of muscle contractions applied to these levers.
Bones act as a lever for muscles.
to joints.
Ligaments provide stability
for making red and white blood cells
Bone marrow contains hematopoietic tissue responsible
calcium and phosphorus.
Bones serve as a storage site for inorganic minerals, including
Bones contain (organic material & inorganic mat)
It contains both organic material (collagen) and inorganic material (calcium, phosphate).
cortical (compact and dense) or cancellous (spongy).
Bone is classified according to structure as
, cylindrical structural units called osteons (Haversian systems) fit closely together to create a dense bone structure
In cortical bone (classification of bone)
Surrounding each osteon are concentric rings known as lamellae, which indicate mature bone. Smaller canals (canaliculi) extend from the Haversian canals to the lacunae, where mature bone cells are embedded.
lamellae
L red or yellow marrow. Blood reaches the bone cells by passing through spaces in the marrow.
Cancellous bone is filled with
osteoblasts, osteocytes, and osteoclasts.
types of bone cells are
organic bone matrix (collagen) and are the basic bone-forming cells.
Osteoblasts synthesize
are mature bone cells.
Osteocytes
take part in bone remodeling by helping in the breakdown of bone tissue.
Osteoclasts
is the removal of old bone by osteoclasts (resorption) and the deposit of new bone by osteoblasts (ossification).
Bone remodeling
the epiphysis, diaphysis, and metaphysis
Each long bone consists of
, the widened area at each end of a long bone, is made mostly of cancellous bone.
epiphysis
primary location of muscle attachment. Articular cartilage covers the ends of the epiphysis. It provides a smooth, low-friction surface for joint movement.
Epiphysis. Function
is the main shaft of the long bone. It provides structural support and is composed of cortical bone. The tubular structure of the diaphysis allows it to withstand bending and twisting forces more easily.
diaphysis
is the flared area between the epiphysis and diaphysis. Like the epiphysis, it is composed of cancellous bone.
metaphysis
is the cartilaginous area between the epiphysis and metaphysis. In skeletally immature children who still have open growth plates, the epiphyseal plate actively makes chondrocytes that become mature bone. Division of the chondrocytes causes longitudinal bone growth in children.
epiphyseal plate (physis or growth plate)
in the center of the diaphysis contains either red or yellow bone marrow.
medullary (marrow) cavity
the pelvis, skull, sternum, cranium, ribs, vertebrae, and scapulae, and cancellous (“spongy”) bone at the epiphyseal ends of long bones, such as the femur and humerus.
In adults, red marrow is found mainly in the flat bones, such as
yellow bone marrow (mainly adipose tissue).
the adult, the medullary cavity of long bones contains
to shape as long, short, flat, or irregular.
Bone classified according
have a central shaft (diaphysis) and 2 widened ends (epiphyses)
-Examples include the femur, humerus, and tibia.
Examples Long bones
cancellous bone covered by a thin layer of compact bone. Examples include the carpals in the hand and tarsals in the foot.
Short bones are composed of
separated by a layer of cancellous bone. Examples include the ribs, skull, scapula, and sternum. The spaces in the cancellous bone contain bone marrow
Flat bones have 2 layers of compact bone
shapes and sizes. Examples include the sacrum, mandible, and ear ossicles
Irregular bones appear in a variety of
is a place where the ends of 2 bones are close and move in relation to each other.
A joint (articulation)
the degree of movement that they allow
Joints are classified by
freely movable diarthrodial (synovial) type.
most common joint is the
, which secretes thick synovial fluid. This fluid lubricates the joint, reduces friction, and allows opposing surfaces to slide smoothly over each other.
capsule is lined by a synovial membrane
articular (hyaline) cartilage.
end of each bone is covered with
hyaline, elastic, and fibrous.
3 types of cartilage are
is the most common.
- It has a moderate amount of collagen fibers. It is found in the trachea, bronchi, nose, epiphyseal plate, and articular surfaces of bones.
Hyaline cartilage
, which has both collagen and elastic fibers, is more flexible than hyaline cartilage. It is found in the ear, epiglottis, and larynx.
Elastic cartilage
collagen fibers. It is a tough tissue that often functions as a shock absorber.
Fibrous cartilage (fibrocartilage) consists mostly of
is found between the vertebral discs. It also forms a protective cushion between the bones of the pelvic girdle, knee, and shoulder
Fibrous cartilage
as a support for soft tissue and provides the articular surface for joint movement. It protects underlying tissues. Because articular cartilage is avascular, it must receive nourishment by the diffusion of material from the synovial fluid.
Cartilage in synovial joints serves
cardiac (striated, involuntary), smooth (nonstriated, involuntary), and skeletal (striated, voluntary) muscle.
3 types of muscle tissue are
is found only in the heart. Its spontaneous contractions pump blood through the circulatory system.
Cardiac muscle
is found in the walls of hollow structures, such as airways, arteries, gastrointestinal (GI) tract, urinary bladder, and uterus.
Smooth muscle
is controlled by neuronal and hormonal influences.
Smooth muscle contraction
neuronal stimulation for contraction, accounts for about half of a human’s body weight.
Skeletal muscle, which requires
a continuous layer of deep fascia.
skeletal muscle is enclosed by the epimysium,
helps muscles slide over nearby structures.
epimysium
Connective tissue surrounding and extending into the muscle can be subdivided into fiber bundles (fasciculi).
subdivided into fiber bundles (fasciculi).
muscle cell or muscle fiber
structural unit of skeletal muscle is the
are long, multinucleated cylinders that contain many mitochondria to support their high metabolic activity.
Skeletal muscle fibers
myofibrils, which in turn are made up of protein contractile filaments
Muscle fibers are composed of
is the contractile unit of the myofibrils.
sarcomere
of myosin (thick) filaments and actin (thin) filaments. The arrangement of the thin and thick filaments causes the characteristic banding of muscle seen under a microscope.
Each sarcomere consists
as thick and thin filaments slide past each other, causing the sarcomeres to shorten.
Muscle contraction occurs
posture maintenance, body movement, and facial expressions
Skeletal muscle contractions allow
increase the tension within a muscle but do not produce movement.
Isometric contractions
shorten a muscle to produce movement.
Isotonic contractions function
of tension generation (isometric) and shortening (isotonic).
Most contractions are a combination
with the absence of contractions that results from immobility or decreased neuronal stimulation
Muscular atrophy (decrease in size) occurs
- Slow-twitch muscle fibers
- Fast-twitch muscle fibers
Skeletal muscle fibers are divided into 2 groups based on the type of activity they show
prolonged muscle activity, such as marathon running. Because they also support the body against gravity, they help in posture maintenance.
Slow-twitch muscle fibers support
for rapid muscle contraction needed for activities, such as blinking the eye, jumping, or sprinting. Fast-twitch fibers tend to tire more quickly than slow-twitch fibers.
Fast-twitch muscle fibers are used
nerve fiber and the skeletal muscle fibers it stimulates are called a
motor endplate
junction between the axon of the nerve cell and the adjacent muscle cell is called the
myoneural or neuromuscular junction
contraction in the myofibrils. When calcium is low, tetany (involuntary contractions of skeletal muscle) can occur.
presence of calcium triggers the
direct energy source for muscle fiber contractions is
adenosine triphosphate (ATP).
a rapid source for the resynthesis of ATP, but it is, in turn, converted to creatine
Phosphocreatine provides
attach muscles to bones as an extension of the muscle sheath that adheres to the periosteum.
Tendons
connect bones to bones (e.g., tibia to femur at knee joint).
-have a higher elastic content than tendons
Ligaments
blood supply
Ligaments and tendons have a relatively poor
layers of connective tissue with intermeshed fibers that can withstand limited stretching.
Fascia refers to
lies right under the skin.
Superficial fascia
is a dense, fibrous tissue that surrounds muscle bundles, nerves, and blood vessels. It also encloses individual muscles, allowing them to act independently and to glide over each other during contraction
Deep fascia
are small sacs of connective tissue lined with synovial membrane and containing viscous synovial fluid
Bursae
found at bony prominences or joints to relieve pressure and decrease friction between moving parts
Bursae function
(1) patella and skin (prepatellar bursae), (2) olecranon process of the elbow and skin (olecranon bursae), (3) head of the humerus and acromion process of the scapula (subacromial bursae), and (4) greater trochanter of the proximal femur and skin (trochanteric bursae).
For example, bursae are found between the
is an inflammation of a bursa sac. The inflammation may be acute or chronic.
Bursitis
Increased bone resorption and decreased bone formation cause a loss of bone density. This
contributes to the development of osteopenia and osteoporosis
bone remodeling process changes in the aging adult
-Muscle mass and strength decrease. Almost 30% of muscle mass is lost by age 70.
-loss of motor neurons can cause problems with skeletal muscle movement.
geriatric changes with muscles
(awareness of self in relation to the environment) may be altered
Proprioception
is more likely to affect joints in the aging adult
-destruction of cartilage
Osteoarthritis
Metabolic bone diseases involve the deterioration of bone tissue
osteoporosis
Loss of height and deformity, such as
dowager’s hump (kyphosis),
less new bone made as quickly as it reabsorbs old bone
osteopenia
pain, weakness, deformity, limitation of movement, stiffness, and joint crepitation (crackling sound)
most common manifestations of musculoskeletal impairment include
infections can enter the bones, resulting in
osteomyelitis or joint destruction.
antiseizure drugs (osteomalacia), phenothiazines (gait changes), corticosteroids (avascular necrosis, decreased bone and muscle mass), and potassium-depleting diuretics (muscle cramps and weakness)
postmenopausal women about the use of hormone therapy.
Drugs with SE effect muscular problems
softening of bone bc defivint vit D
osteomalacia
ankylosing spondylitis, rheumatoid arthritis, and SLE.
autoimmune disease involving human leukocyte antigens (HLAs).
human leukocyte antigens (HLAs).
Many autoimmune diseases of the musculoskeletal system have a genetic basis involving
influencing bone mineral density, and bone size, quality, and turnover.
Genetic factors contribute to osteoporosis by
Osteoarthritis, Gout, and Scoliosis
genetic predisposition
X-linked recessive disorders.
most common types of muscular dystrophy are
to the development of osteoporosis.
Episodes of premenopausal amenorrhea can contribute
inspection, palpation, neurovascular assessment, and range of motion, strength, and reflex testing
physical examination of musculoskeletal
butterfly rash over the cheeks and nose is
characteristic of SLE.
Examine the neck, shoulders, elbows, wrists, hands, back, hips, knees, ankles, and feet. Warm your hands to prevent muscle spasm, which can interfere with identifying essential landmarks or soft tissue structures.
palpation of musculoskeletal
is the full movement potential of a joint
ROM (motion)
to accurately assess ROM. It measures the angle of the joint
goniometer
is a lateral S-shaped curvature of the thoracic and lumbar spine.
Scoliosis
Unequal shoulder and scapula height is usually noted when the patient is observed from the back
Scoliosis description
Ask the patient to place the hands together above the head as if diving into a swimming pool and slowly bend forward at the waist, allowing assessment of thoracic rib prominence or paravertebral muscle prominence in the lumbar spine.
how to assess for Scoliosis
lung and heart function.
Advanced scoliosis can impair
is done on the supine patient with sciatica or leg pain.
straight-leg-raising test
Passively raise the patient’s leg 60 degrees or less. The test is positive if the patient reports pain along the distribution of the sciatic nerve. A positive test shows nerve root irritation from intervertebral disc prolapse and herniation, especially at level L4-5 or L5-S1.
straight-leg-raising test (process)
Pain in ankle and posterior calf, initially when running or walking. Can progress to pain at rest.
Achilles tendonitis
Stiffness and fixation of a joint.
Ankylosis (progessess= rheumatoid arthirtis)
Shortened stride(step) with minimal weight bearing on the affected side, resulting in a limp.
Antalgic gait
Staggering, uncoordinated gait often with sway.
Ataxic gait
↓ Size and strength of muscle leading to ↓ function and tone.
Atrophy
Finger abnormality, flexion of proximal interphalangeal (PIP) joint and hyperextension of the distal interphalangeal (DIP) joint of the fingers
Boutonnière deformity
Resistance of movement of muscle or joint due to fibrosis of supporting soft tissues.
Contracture
Frequent, audible crackling sound with palpable grating that accompanies movement.
Crepitation(crepitus)
While walking, neck, trunk, and knees flex and the body is rigid. Delayed start with short, quick, shuffling steps. Speed may ↑ as if patient is unable to stop (festination)
-ex: parkinsons disease
Festinating gait
x-ray is the most common diagnostic study used to assess musculoskeletal problems and to monitor treatment effectiveness
x-ray is the most common diagnostic for musculoskeletal
bone deformity, joint congruity, bone density, and calcification in soft tissue.
Dense areas show as white on the standard x-ray. X-rays provide information about
help evaluate genetic, developmental, infectious, inflammatory, malignant, metabolic, and degenerative disorders.
x-ray help evaluate
for volume, color, clarity, viscosity, and mucin clot formation.
Aspirated synovial fluid is assessed
transparent and colorless or straw colored.
-It should be scant in amount and of low viscosity.
Normal synovial fluid is
purulent and thick or gray and thin.
Fluid from an infected joint may be
the fluid may be whitish yellow.
in gout,
if there is hemarthrosis (bleeding into joint) due to injury or a bleeding disorder.
Blood may be aspirated
the character of the protein portion of the synovial fluid
mucin clot test indicates
Normally a white, ropelike mucin clot is formed. In the presence of inflammation, the clot fragments easily.
-fluid is examined grossly for floating fat globules, which indicate bone injury
mucin clot description
protein content is increased, and glucose is considerably decreased.
septic arthritis
a diagnosis of gout
Presence of uric acid crystals suggests
