Chapter 52: Assessment of th Musculoskeletal system

Question 1

Hormones involved in bones

Answer 1

Bones account for 99% of calcium and 90% of phosphorus.

Calcitonin, produced by thyroid, decreases serum calcium by inhibiting bone resorption and increasing renal excretion.

Vitamin D promotes the absorption of calcium and phosphorus from the small intestine. A decrease can result in osteomalacia.

Parathyroid hormone stimulates the bone to release calcium into the blood.

Growth hormone secreted by the anterior lobe of the pituitary is responsible for increasing bone length and determining the amount of matrix form before puberty. Increase can result in gigantism and a decrease in dwarfism. An increase in adulthood causes acromegaly.

Adrenal glucocorticoids regulate protein metabolism and helping with that matrix of the bone. They aid in regulating intestinal calcium and phosphorus absorption.

Estrogens stimulate osteoblastic/bone building activity and inhibit parathyroid hormone. Decreases in menopause increased the risk of osteoporosis. Androgens and testosterone promote anabolism/bone building and increase bone mass.

Thyroxine is secreted by the thyroid gland and is to increase the rate of protein synthesis synthesis in all types of tissues including bone.

Question 2

Synovial joint

Answer 2

Type eventually lined with synovium, remembering that secrete synovial fluid for lubrication and shock absorption

Question 3

Tendon

Answer 3

Tough fibrous tissue that attaches muscle to bones

Question 4

Ligament

Answer 4

attach bones to other bones at joints and serve to support joints

Question 5

Musculoskeletal changes with aging

Answer 5

Osteopenia is decreased bone density. We need to prevent falls, reinforce exercise and weight-bearing exercise. The bones are more likely to fracture and exercise slows bone loss.

There is an increase in bony prominence due to less soft tissue and skin breakdown. Prevent pressure on boney prominences

Kyphotic posture: wide gait, shift in center of gravity. Teach proper body mechanics and instruct the patient to sit in supportive chairs with arms. Correct posture problems to prevent further deformity. There should be support for bony structures.

Cartilage degeneration: Moist heat increases blood flow to area.

Decreased ROM: The ability to perform ADLs and mobility. They may need assistance

Muscle atrophy, decreased strength: Teach isometric exercises to increase muscle strength

Slowed movement: do not rush.

Question 6

Myopathy

Answer 6

A problem in muscle tissue and is usually a proximal weakness

Question 7

Neuropathy

Answer 7

A problem in nerve tissue and is usually a distal weakness

Question 8

Antalgic gait

Answer 8

Abnormality in the stance phase of gait. When one leg is painful the person shortens the stance phase on the affected side.

Question 9

Lurch

Answer 9

An abnormality in the swing phase of gait. Occurs when the muscles in the butt or legs are too weak to allow the person to change weight from 1 foot to the other

Question 10

genu valgum

Answer 10

a deformity in which the knees are abnormally close together and the space between the ankles is increased. Knock-kneed

Question 11

Genu Varum

Answer 11

A deformity in which the knees are abnormally separated and the lower extremities are bowed inward. Bowleg

Question 12

Neurovascular assessment

Answer 12

Assessment of the neuromuscular system that includes inspection of skin color, temperature, capillary refill distant to injury, surgical procedure, or cast. Palpation of pulses in the extremities below the level of injury and assessment of sensation, movement, and pain in the injured part

Question 13

Lovetts scale for grading muscle strength

Answer 13

5: normal ROM with full resistance
4: Good
3: fair, ROM against gravity
2: Poor
1: trace
0: no evidence of muscle contractility

Question 14

ALP alkaline phosphatase

Answer 14

30-120 units/L (slightly higher with age)
Increase indicates metastatic cancers of the bone, Paget’s disease, or osteomalacia
It increases with bone or liver damage

Question 15

Serum CK creatine kinase

Answer 15

Men 55-170
Women 30-135
Elevations include muscle trauma, progressive muscular dystrophy, effects of electromyography.

They begin to rise 2 to 4 hours after muscle injury.

Question 16

AST aspartate aminotransferase

Answer 16

0-35units/L increased in elderly

Elevations indicate skeletal muscle trauma and progressive muscular dystrophy

Question 17

Serum calcium

Answer 17

9-10.5 mg/dL decreased with age

Hypercalcemia is seen with metastatic cancers of the bone, Pagets disease, bone fractures in the healing stage.

Hypocalcemia is seen osteoporosis and osteomalacia

Question 18

Serum phosphorus

Answer 18

3.0-4.5 mg-dL decreased with age

Hyperphosphatemia is seen with bone fractures in the healing stage, bone tumors, acromegaly.

Hypophosphatemia is seen with osteomalacia

Question 19

tomography

Answer 19

An imaging technique that produces planes or slices for focus and blurs the images of other structures. Different from standard x-rays which superimpose one structure on another

Question 20

xeroradiography

Answer 20

X-ray technique in which images are produced electrically rather than chemically, permitting lower exposure time and radiation energy than those of ordinary x-rays. Images exhibit edge contrast which is useful for identifying minute calcifications in the breast.

they do not determine tissue densities

Question 21

myelography

Answer 21

Radiography of the spine after injection with contrast into the subarachnoid space of the spine. Used to visualize the vertebral column, intervertebral discs, spinal nerves, and blood vessels. CT and MRI have replaced for the most part. care is similar to lumbar puncture, keep head elevated to 30-50 degrees to prevent contrast from brain.

Question 22

Arthrogram

Answer 22

X-ray of a joint after contrast medium of air or solution has been injected to enhance its visualization

Question 23

CT computed tomography

Answer 23

Cross-sectional slices are taken and can build three-dimensional pictures. The contrast medium may be used. Ask patient about iodine-based allergies

Question 24

Bone scan

Answer 24

The nuclear scan in which radioactive material is injected for visualization of the entire skeleton. Used to detect tumors, arthritis, osteomyelitis, osteoporosis, vertebral compression fractures, or unexplained bone pain. Very helpful for hairline fractures and metastatic the bone disease

gallium: Migrates to the brain, liver, a breast tissue. More specific and sensitive in detecting bone problems. Give 4-6 hours before scan. Must lie still for 30-60 minutes. Push fluids to help with excretion. Not harmful or radioactive.

Thallium: Evaluates the extent of disease in patients with osteosarcoma

Question 25

MRI

Answer 25

Not safe with pacemakers, stent, and surgical clips. must ask the patient if pregnant, have ferromagnetics fragments or implants, an aneurysm clip, Electronic implants, they lie still for 45 to 60 minutes, they need life-support equipment available, they communicate clearly, tattoo more than 20 years ago, claustrophobic?

Question 26

Ultrasonography

Answer 26

Used to see soft tissue disorders such as masses and fluid accumulation, traumatic joint injuries, osteomyelitis, surgical hardware placement.

Question 27

EMG Electromyography

Answer 27

Evaluate diffuse or local muscle weakness. Usually along with nerve conduction studies. It is contra indicated for patients undergoing anticoagulant therapy. Inform the patient it may cause discomfort. Mild sedation could be prescribed. Inspect needle sites for hematoma. Ice can prevent it. Some physicians require you to discontinue your muscle relaxants several days before the test.

Question 28

Arthroscopy

Answer 28

Knee must be able to flex 40° and must not have infection. Follow-up care is to evaluate the neurovascular status of the affected limb every hour. monitor distal pulses, warm, color, capillary refill, pain, movement, and sensation. Encourage patient to perform exercises taught before the procedure. Use ice for 24 hours, elevate 12 to 24 hours. Complications include swelling, increased joint pain, thrombophlebitis, infection.