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Health Assessment > Chapter 23: MSK > Flashcards

Chapter 23: MSK Flashcards

1
Q

Why do humans need the MSK system?

A
  • for support and to stand erect
  • for movement
  • to encase and protect the inner vital organs
  • to produce the RBCs, WBCs and platelets in the bone marrow
  • as a reservoir for storage (Ca and PO)
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2
Q

How many bones does the body consist of? What type of tissue are bones and cartilage made of?

A

206 (bones and cartilage are forms of connective tissue)

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3
Q

What is a joint?

A

a place of union of two or more bones (functional units of the MSK b/c they permit the mobility needed for ADLs

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4
Q

These joints are freely moveable b/c their bones are separated from one another and enclosed in a joint cavity

A

synovial

** cartilage is avascular and gets nourishment from synovial fluid **

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5
Q

What is a bursa?

A

an enclosed sac filled w/viscous synovial fluid (like a joint); located in areas of potential friction and helps muscles and tendons glide smoothly over bone

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6
Q

What are some facts about muscles?

A
  • they account for 40%-50% of body weight
  • contraction produces movement
  • theres 3 types (skeletal, cardiac and smooth)
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7
Q

What are some facts about skeletal muscles?

A
  • composed of bundles of muscle fibers (fasciculi)
  • skeletal muscle attached to bone by tendons (a strong fibrous cord)
  • produce the following movements:
    > flexion (bending of limb to joint)
    > extension (straightening of limb)
    > abduction (away from midline)
    > adduction (towards midline)
    > pronation (palm down)
    > supination (palm up)
    > circumduction (moving arm in circle)
    > inversion (sole of foot inward)
    > eversion (sole of foot outward)
    > rotation (moving head around central)
    > protraction
    > retraction
    > elevation (raising a body part)
    > depression (lowering a body part)
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8
Q

What is the temporomandibular joint?

A

the articulation of the mandible and temporal bone; found in the depression anterior to the tragus of the ear. TMJ permits jaw function for speaking/chewing and allows 3 motions:

  1. open and close jaw
  2. gliding action for protrusion/retraction
  3. gliding for side to side movement of the lower jaw
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9
Q

How many bones does the vertebrae have?

A

33 connecting bones

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10
Q

What are the motions of the vertebral column?

A
  • flexion (bending forward)
  • extension (bending back)
  • abduction (to either side)
  • rotation
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11
Q

What is the shoulder girdle?

A

a belt of 3 large bones (humerus, scapula and clavicle), joints and muscles

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12
Q

This is the articulation of the humerus with the glenoid fossa of the scapula

A

glenohumeral joint

** ball and socket action in arm allows for great mobility of the arm **

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13
Q

What are the 4 muscles of the rotator cuff?

A

SITS muscles:

  • supraspinatus
  • infraspinatus
  • teres minor
  • subscapularis
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14
Q

These joints permit finger flexion and extension

A

metacarpophalangeal and interphalangeal

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15
Q

What are the muscles of the knee?

A
  • articulation of 3 bones: the femur, tibia and patella
  • largest joint in the body with the largest synovial membrane (forming a sac called suprapatellar pouch)
  • the medial and lateral menisci cushion the tibia and femus
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16
Q

These ligaments give anterior and posterior stability and help control rotation

A

cruciate ligamants

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17
Q

These ligaments connect the joint at both sides, giving medial and lateral stability and preventing dislocation

A

collateral ligaments

18
Q

The aging adult:

A
  • older women have a greater amount of bone loss then men due to dec. levels of estrogen (occurs in both sexes); osteoblasts that form new bone have estrogen receptors
  • exercise should be regular and high density (weight bearing exercise and resistance is best to inc. bone density at the hip and lumbar spine)
  • long bones do NOT shorten with age
  • postural changes are evident
  • dec. height occurs with shortening of the vertebral column d/t loss of water content and thinning of the intervertebral discs and by a dec. in height of vertebrae from osteoporosis
  • progressive dec. in height is not significant until 60 (greater decrease in the 70s and 80s d/t osteoporotic collapse of the vertebrae
  • kyphosis –> backward head tilt –> slight flexion of hips and knees
  • fat dec. in the periphery and inc. in the abdomen and hips (leaving bony prominences more marked and body hollows more deeper)
  • loss in muscle mass, some muscles dec. in size some atrophy and produce weakness
19
Q

What is bone remodeling?

A

the cyclic process of bone resorption and deposition responsible for skeletal maintenance at sites that need repair or replacement

** bone resorption (loss of bone matrix) should equal bone replacement but if bone resorption occurs more rapidly, osteoporosis results **

20
Q

Culture and genetics:

A
  • higher bone mineral density = denser bone
  • lower bone mineral density = predictor of hip and vertebral fracture among postmenopausal women
  • BMD hip site measurements are higher in Afro-Caribbean, AA and south korean women –> lower r/f fracture
  • weight bearing exercise imperative during the reproductive and middle adult years to slow process of decline in BMD
21
Q

What are some abnormalities found in the joint?

A
  • pain and loss of function
  • RA involves symmetric joints
  • RA pain is worse in the AM when arising
  • OA is worse later in the day
  • movement inc. most joint pain BUT in RA, movement dec. pain
  • joint pain 10-14 days after an untreated strep throat suggests rheumatic fever
  • RA stiffness occurs in the AM and after periods of rest (assess r/f lyme disease)
  • dec. ROM may be d/t joint injury to cartilage or capsule or to muscle contracture
  • inside knee injury can strain/rupture medial ligaments; outside injury can strain or rupture lateral ligament; abrupt twisting can injure anterior cruciate ligament
  • with a knee injury, obtain an x-ray if pt cant flex knee to 90 degrees or unable to bear weight for 4 steps, if pain is felt at fibula head or patella or if the pt is > 55 (ottawa knee rules)
22
Q

What are some abnormalities found in the muscles?

A
  • myalgia is usually felt as cramping or aching (suggest intermittent claudication)
  • ## viral illness often includes myalgia
23
Q

What are some abnormalities found in the bones?

A
  • fracture causes sharp pain that inc. with movement; other bone pain feels dull and deep and is unrelated to movement
  • low back pain occurs w/degenerative discs, osteoporosis, lumbar stenosis or nonspecific
  • chronic pain can inc. anxiety
24
Q

What does a functional assessment assess for?

A

screens the safety of independent living, the need for HH and QOL
- assess any self care deficit

25
Q

What medication is first line therapy for osteoporosis?

A

bisphosphonates (for specific guidelines); hormone therapy not recommended d/t r/f

26
Q

If a person has a chronic disability what should be assessed?

A
  • self esteem disturbance
  • loss of independence
  • body image disturbance
  • role performance disturbance
  • social isolation
  • smoking inc. bone loss and results in r/f fracture in older women
27
Q

What is a fracture?

A

a break in a bone

28
Q

What is dislocation?

A

complete loss of contact b/w the two bones in a joint

29
Q

What is subluxation?

A

two bones in a joint stay in contact but their alignment is off

30
Q

What is contracture?

A

shortening of a muscle leading to limited ROM of the joint

31
Q

What is ankylosis?

A

stiffness or fixation of a joint

32
Q

How much Ca do women under 50 need daily?

A

1000mg daily

33
Q

How much Ca do women over 50 need daily?

A

1200 mg daily

34
Q

How much Ca do men under 70 need daily?

A

1000 mg daily

35
Q

How much Ca do men over 70 need daily?

A

1200 mg daily

36
Q

How much vitamin D do men and women under 50 need daily? How much vitamin D do men and women over 50 need daily?

A

400-800 IU daily; 800-1000 IU daily

** 8oz milk has 25% vit. D **

37
Q

What exercise is the best prevention for osteoporosis?

A
  • exercise 2-3 days/wk OR 30 min/day for 5 days/wk

- fast walking is the best prevention for osteoporosis

38
Q

When should women and men get a BMD scan by DEXA?

A

by age 65; by age 70

** BMD measurement by DEXA is the best predictor for future hip fracture risk **

** FRAX is a computerized fracture risk algorithm for men and women 40-90 and is most useful for people with low hip BMD **

39
Q

What types of nodules occur with OA?

A

heberden and bouchard nodules (hard and non-tender)

40
Q

What types of nodules occur with RA?

A

subcutaneous nodules (raised, firm and non-tender found in the olecranon bursa and surface of the ulna)

Health Assessment (4 decks)

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