Exam 4: Chapter 39 - Assessment of Musculoskeletal Function Flashcards
Functions of the Musculoskeletal System: Protection of
vital organs (the brain)
Functions of the Musculoskeletal System: Framework
to support body structures, mobility. Allows you to move
Functions of the Musculoskeletal System: Movement;
produce heat and maintain body temperature
Functions of the Musculoskeletal System: Facilitate the
return of blood to the heart. When we walk, calf muscles squeeze and promote blood return to the heart
Functions of the Musculoskeletal System: Reservoir for
immature blood cells and vitamin minerals. Those made in the blood marrow
Functions of the Musculoskeletal System: What vitamin minerals are stored?
Calcium, Phosphorus, Magnesium, Fluoride.
98% of calcium is stored inside of the bone.
What are the four shapes of bone?
Long, Short, Flat, and Irregular
What is the shaft of the bone known as?
Diaphysis
What are the ends of bones called?
Epiphyses
atonic
without tone; denervated muscle that atrophies
Atrophy
decrease in the size of a muscle
Bursa
fluid filled sac found in connective tissue, usually in the area of joints
Callus
cartilaginous/fibrous tissue at fracture site
Cancellous Bone
latticelike bone structure; trabecular bone
Cartilage
tough elastic avascular tissue at ends of bone
Clonus
rhythmic contractions of a muscle
Contracture
abnormal shortening of muscle, joint or both; fibrosis
Cortical Bone
compact bone
Crepitus
grating or crackling sound or sensation; may occur with movement of ends of a broken bone or irregular joint surface
Effusion
excess fluid in joint
Endosteum
a thin, vascular membrane covering the marrow cavity of long bone and the spaces in cancellous bone
Fascia (Epimysium)
fibrous tissue that covers, supports and seperates muscles
Fasciculation
involuntary twitch of muscle fibers
Flaccid
limp; without muscle tone
Hypertrophy
enlargement; increase in the size of a muscle
Isometric Contraction
muscle tension is increased without changing its length; there is no associated joint motion
Isotonic Contraction
muscle is shortened without a change in its tension; a joint is moved as a result
Joint
area where bone ends meet; provides for motion and flexibility
Joint Capsule
fibrous tissue that encloses bone ends and other joint surfaces
Kyphosis
increase in the convex curvature of the thoracic spine
Lamellae
mature compact bone structures that form concentric rings of bone matrix, lamellar bone
Ligament
ropelike bundles of collagen fibrils connecting bones
Lordosis
increase in concave curvature of the lumbar spine
Ossification
process in which minerals (calcium) are deposited in bone matrix
Osteoblast
bone forming cell
Osteoclast
bone resorption cell (breaks down)
Osteocyte
mature bone cell
Osteogenesis
bone formation
Osteon
microscopic functional bone unit
Osteopenic
refers to a reduction in bone mass to below normal levels
Paresthesia
abnormal sensation ( burning, tingling, numbness)
Periosteum
fibrous connective tissue covering bone
REmodeling
process that ensures bone maintenance through simultaneous bone resorption and maintenance
Resorption
removal/destruction of tissue such as bone
Scoliosis
lateral curving of the spine
Spastic
having greater than normal muscle tone
Synovium
membrane in joint that secretes lubricating fluid
Tendon
cord of fibrous tissue connecting muscle to bone
Tone (Tonus)
normal tension (resistence to stretch) in resting muscle
Trabecula
lattice like bone structure; cancellous bone
the _____ system serves as a reservoir for immature blood cells and essential minerals, including calcium, phosphorus, magnesium and flouride
musculoskeletal
How many bones in body?
206
the _____ bones are found in the upper and lower extremities
long
the _____ bones are irregularly shaped bones located in the ankle and the hand (e.g. metacarpals)
short
the _____ bones are located where extensive protection of underlying structures is needed (e.g. sternum or skull)
flat
_____ bones cannot be categorized in any other group and include bones such as the vertebrae and bones in the jaw
irregular
_____ bone exists in areas where support is needed, and _____ bone is found where hematopoiesis and bone formation occur
cortical cancellous
_____ bones are designed for weight bearing and movement and tend to be composed primarily of cortical bone
long
_____ bones are important sites for hematopoiesis and frequently protect vital organs. They are made of cancellous bone layered between compact bone
flat
_____ bones consist of cancellous bone covered by a layer of cortical bone
short
_____ bones have unique shapes related to their function; generally their structure is similar to that of flat bones
irregular
bone is composed of cells, protein matrix and mineral deposits. The cells are of 3 basic types: _____, _____ and _____
osteoblast osteoclast osteocytes
_____ function in bone formation by secreting bone matrix. The matrix consists of collagen and ground substances (glycoproteins and proteoglycans) that provide a framework in which inorganic mineral salts are deposited. These minerals are primarily composed of calcium and phosphorus
osteoblasts
_____ are mature bone cells involved in bone maintenance; they are located in lacunae
osteocytes
_____ located in shallow Howships lacunae (small pits in bones), are multinuclear cells involved in dissolving and resorbing bone
osteoclasts
covering the bone is a dense, fibrous membrane known as the _____. This membranous structure nourishes bone and fascilitates its growth. It contains nerves, blood vessels and lymphatic. It also provides for the attachment of tendons and ligaments
periosteum
ossification happens:
after birth
osteogenesis happens
before birth
Osteogenesis is
the process of bone formation. Bone is in a constant state of turnover
Regulating Factors of Bone
Stress and Weight Bearing
Vitamin D
Parathyroid Hormone and Calcitonin
Blood Supply
Regulating Factors of Bone: Why is Vitamin D important?
Important for Calcium Absorption
Regulating Factors of Bone: Parathyroid Hormone and Calcitonin important because?
ParathyroidHormone tells the bone to release calcium, while calcitonin tells the bone to hold onto Calcium
bone marrow is a vascular tissue located in the medullary cavity (shaft) of long bones and in flat bones. Red bone marrow located mainly in the _____, _____, _____ and _____ in adults is responsible for producing red blood cells, white blood cells and platelets through a process called hematopoiesis
sternum, ilium, vertebrae, ribs
in adults the long bone is filled with fatty _____ marrow
yellow
bone tissue is well _____
vascularized
_____ (bone formation) begins before birth
osteogenesis
____ is the process by which the bone matrix is formed and hard mineral crystals composed of calcium and phosphorus are bound to the collagen fibers. These mineral components give bone its characteristic strength, whereas the proteinaceous collagen gives bone its resilience
ossification
during childhood and the teenage years, new bone is added faster than old bone is removed; therefore bones become larger, heavier and denser. This continues until peak bone mass is reached, typically by age _____ years
20
remodeling maintains bone structure and function through simultaneous resorption and osteogenesis, and as a result complete skeletal turnover occurs every _____ years
10
the balance between bone _____ (removal or destruction) and _____ is influenced by the following factors: physical activity; dietary intake of certain nutrients, especially calcium and several hormones including calcitriol ( activated vitamin D), parathyroid hormone, calcitonin, thyroid hormone, cortisol, growth hormone and the sex hormones estrogen and testosterone
resorption
formation
physical activity, particularly weight bearing activity, acts to stimulate bone formation and remodeling. Bones subjected to continued weight bearing tend to be thick and strong. Conversely people who are unable to engage in regular weight bearing activities such as those with some physical disabilities or prolonged bed rest have increased bone resorption from calcium loss, and their bones become _____ (reduced in terms of mass) and weak. These weakened bones may fracture easily.
osteopenic
weight bearing activity or exercise should not be confused with weight resistent exercise. Weight bearing activity, which supports bone maintenance, is any activity done while a person is on their feet that works a persons bones and muscles against _____ (eg walking tennis) Weight resistence exercise on the other hand uses weights or resistence to strengthen muscles
gravity
Good dietary habits are integral to bone health. Daily intake of approximately _____ to _____ mg of calcium is essential to maintaining adult bone mass
1000 to 1200
Good sources of _____ include low fat milk, yogurt and cheese. Foods with added calcium such as orange juice, cereals and bread are also beneficial
calcium
Vitamin D also plays a major role in calcium absorption and bone health. Young adults need a daily vitamin D intake of _____ IU, whereas adults 50 years and older require a daily intake of _____ to _____ IU to ensure good bone health
600
800
1000
Dietary sources of vitamin ____ include fortified milk and cereals, egg yolks, saltwater fish and liver
D
_____ functions to increase the amount of calcium in the blood by promoting absorption of calcium from the gastrointestinal tract. It also fascilitates mineralization of osteoid tissue
calcitriol
a deficiency of vitamin _____ results in bone mineralization deficit, deformity and fracture
D
_____ and _____ are the major hormonal regulators of calcium homeostasis
PTH
Calcitonin
_____ regulates the concentration of calcium in the blood, in part by promoting movement of calcium from the bone. In response to low calcium levels in the blood increased levels of _____ prompt the mobilization of calcium, the demineralization of bone and the formation of bone cysts
PTH
_____ secreted by the _____ gland in response to elevated blood calcium levels, inhibits bone resorption and increases the deposit of calcium in bone
Calcitonin
Thyroid
Both thyroid hormone and cortisol have multiple systemic effects with specific effects on bones. Excessive _____ hormone production in adults (eg Graves disease) can result in increased bone resorption and decreased bone formation. Increased levels of _____ have these same effects
Thyroid
Cortisol
Patients recieving long term synthetic cortisol and corticosteroids (eg prednisone) are at increased risk for steroid induced _____ and fractures
osteopenia
The sex hormones testosterone and estrogen have important effects on bone remodeling. _____ stimulates osteoblasts and inhibits osteoclasts, therefor bone formation is enhanced and resorption is inhibited. _____ has both direct and indirect effects on bone growth and formation. It directly causes skeletal growth in adolescence and has continued effects on skeletal muscle growth throughout the lifespan
Estrogen
Testosterone
testosterone converts to estrogen in _____ tissue providing an additional source of bone preserving estrogen for aging men
adipose
Blood supply to the bone also effects bone formation. With diminished blood supply or hyperemia (congestion), osteogenesis and bone density _____. Bone necrosis occurs when the bone is deprived of blood
decrease
Most fractures heal through a combination of intramembranous and endochondral ossification processes. When a bone is fractured, the bone begins a healing process to reestablish continuity and strength. The bone fragments are not patched together with scar tissue; instead the bone _____ itself
regenerates
4 stages of repair of a simple fracture
·stage 1: hematoma formation
·stage 2: fibrocartilaginous callus formation
·stage 3: bony callus formation
·stage 4: remodeling
Stage 1: hematoma formation
occurs during the first 1 to 2 days of the fracture. Bleeding into the injured tissue and local vasoconstriction occur, and a hematoma forms at the site of the fracture. Cytokines are released, initiating the fracture healing processes by causing replicating cells known as fibroblasts to proliferate, which in turn causes angiogenesis to occur ( the growth of new blood vessels) Granulation tissue begins to form within the clot and becomes dense. At the same time degranulated platelets and inflammatory cells release growth factor, which stimulates the generation of osteoclasts and osteoblasts
Stage 2 Fibrocatilaginous Callus Formaiton:
occurs with the formation of granulation tissue. Fibroblasts and osteoblasts migrate into the fractured site and begin the reconstruction of bone. The fibroblasts produce a fibrocartilaginous soft callus bridge that connects the bone fragments. Although tissue repair may reach maximum girth by the end of the second or third week, it is still not strong enough for weight bearing
Stage 3: Bony Callus Formation
usually begins during the third or fourth week of fracture healing and continues until a firm bony union is formed. During this stage, mature bone gradually replaces the fibrocartilaginous callus and the excess callus is gradually reabsorbed by the osteoclasts. During this stage the fracture site feels immovable and appears aligned on x-ray. At this time it is usually safe to remove a cast if one is present
Stage 4: Remodeling
occurs as necrotic bone is removed by the osteoclasts. Compact bone replaces spongy bone around the periphery of the fracture. Although the final structure of the remodeled bone resembles the original unbroken bone, a thickened area on the surface of the bone may remain after healing. Remodeling may take months to years, depending on the extent of bone modification needed, the function of the bone, and the functional stresses on the bone
Serial xrays are used to monitor the progress of bone healing. The type of bone fractured, the adequacy of blood supply, the condition of the fracture fragments, the immobility of the fracture site and the age and general health of the person influence the rate of fracture _____. Adequate immobilization is essential until there is x-ray evidence of bone formation with ossification.
healing
when fractures are treated with internal or external fixation techniques, the bony fragments can be placed in direct contact. _____ bone healing occurs through cortical bone (Haversian) remodeling. Little or no cartilaginous callus develops. _____ bone develops from the endosteum. There is an intensive regeneration of new osteons, which develop in the fracture line by a process similar to normal bone maintenance. Fracture strength is obtained when the new osteons have become established
primary
immature
there are three basic kinds of joints: _____, _____ and _____
Synarthrosis
Amphiarthrosis
Diarthrosis
Synarthrosis Joints
also referred to as fibrous joints, are immovable because of fibrous tissue banding (eg the skull sutures)
Amphiarthrosis Joints
also referred to as cartilaginous joints allow limited motion (eg the vertebral joints and the symphysis pubis)
Diarthrosis Joints
also referred to as synovial joints are freely movable joints
types of diarthrosis/synovial joints
·ball and socket ·hinge ·saddle ·pivot ·gliding
_____ _____ _____ joints: permit full freedom of movement (hip and shoulder)
ball and socket
_____ joints: permit bending in only one direction, either flexion or extention (elbow and knee)
hinge
_____ joints: allow movement in two planes at right angles to eachother. The joint at the base of the thumb is a saddle biaxial joint
saddle
_____ joints: allow one bone to move around a central axis without displacement. An example of a pivot joint is the articulation between the radius and the ulna. They permit rotation for such activities as turning a door knob
pivot
_____ joints: allow for limited movement in all directions and are represented by the joints of the carpal bones in the wrist
gliding
gliding joints examples
wrist and ankle
pivot joint example
neck radius and ulna
ball and socket joint examples
shoulder and hip
hinge joint examples
elbow, knee, fibers, toes
saddle joint examples
carpometacarpal joint of the thumb
_____ (ropelike bundles of collagen fibrils) bind the articulating bones together
ligaments
_____ are cords of fibrous tissue that connect muscle to bone
tendons
_____ can be found in the joints of the elbow, shoulder, hip and knee. They may become inflamed, causing discomfort, swelling and limited movement in that area
bursae
muscles are attached by _____ to bones, connective tissue, other muscle, soft tissue or skin
tendons
_____ (striated) muscles are involved in body movement, posture, and heat production functions. Muscles contract to bring the two points of attachment closer together, resulting in movement
skeletal
What is fascia?
the muscles of the body are composed of parallel groups of muscle cells encased in this fibrous tissue
The more fasciculi contained in a muscle,….
the more precise the movements
actin and myosin do not interact in the absence of _____
calcium
in _____ _____ the length of the muscles remains constant but the force generated by the muscles is increased; an example of this is pushing against an immovable wall
isometric contraction
_____ _____ is characterized by the shortening of the muscle without an increase in tension within the muscle; an example of this is flexing the forearm
isotonic contraction
in normal activites, many muscle movements are a combination of isometric and isotonic contraction. For example during walking _____ contraction results in shortening of the leg and _____ contraction causes the stiff leg to push against the floor
isotonic
isometric
during periods of strenous activity, when sufficient oxygen may not be available, glucose is metabolized primarily to _____ _____, an inefficient process compared to that of oxidative pathways
lactic acid
muscle fatigue is thought to be caused by depletion of _____ and accumulation of lactic acid. As a result, the cycle of muscle contraction and relaxation cannot continue
glycogen
muscle _____ is produced by the maintenance of some of the muscle fibers in a contracted state
tone
a muscle that is limp and without tone is described as _____
flaccid
What is a sacrcomere?
The contrctile unit of skeletal muscle that contains actin and myosin
Anaerobic pathways use
glucose metabolized from stored glycogen providing energy for more strenous muscle activity
Where is glucose stored?
the liver
a muscle with greater than normal tone is described as _____
spastic
typically upper motor neuron lesions produce _____ tone, whereas lower motor neuron lesions produce decreased tone. For example in conditions characterized by upper motor neuron destruction (cerebral palsy) muscle becomes hypertonic and reflexes become hyperactive. In contrast conditions characterized by lower motor neuron destruction (muscular dystrophy) denervated muscle becomes _____ (soft and flabby) and atrophies
increased
atonic
the _____ mover is the muscle that causes a particular motion
prime
the muscles assisting the prime mover are known as _____
synergists
the muscles causing movement opposite of that of the prime mover are known as _____. An antagonist must relax to allow the prime mover to contract producing motion.
antagonists
a person with muscle paralysis (a loss of movement possibly from nerve damage) may be able to retrain functioning muscles within the synergistic group to produce the needed movement. Muscles of the synergistic group then become the _____ movers
prime
when a muscle repeatedly develops maximum or close to maximum tension over a long time, as in regular exercise with weights, the cross sectional area of the muscle increases. This enlargement known as _____, results from the increase in size of individual muscle fibers without an increase in their number. Hypertrophy persists only if the exercise is continued
hypertrophy
age and disuse cause loss of muscular function as fibrotic tissue replaces the contractile muscle tissue. The decrease in the size of a muscle is called _____
atrophy
when immobility is the result of a treatment modality (casting, traction, bed rest) the patient can decrease the effects of immobility by _____ exercise of the muscles of the immobilized part
isometric
quadriceps contraction exercises (tightening the muscles of the thigh) and gluteal setting exercises (tightening the muscles of the buttocks) help maintain the larger muscle groups that are important in _____
ambulation
_____ pain is typically described as a dull deep ache that is boring. This pain is not usually related to movement and may interfere with sleep
bone
_____ pain is described as soreness or aching and is referred to as muscle cramps
muscular
_____ pain is sharp and piercing and is relieved by immobilization. Sharp pain may also result from bone infection with muscle spasm or pressure on a sensory nerve
fracture
_____ pain is felt around or in the joint and typically worsens with movement
joint
the patient may describe _____ which are sensations of burning, tingling, or numbness. These sensations may be caused by pressure on nerves or by circulatory impairement
paresthesias
_____ can occur at any age and may be caused by degenerative diseases of the spine. (arthritis or disk degeneration) fractures related to osteoporosis, and injury or trauma. It may also be seen in patients with other neuromuscular disease
kyphosis
_____ can effect persons of any age. Common causes include tight lower back muscles, excessive visceral fat, and pregnancy as the woman adjusts her posture in response to changes in her center of gravity
Lordosis
_____ may be congenital, idiopathic, or the result of damage to the paraspinal muscles (muscular dystrophy)
scoliosis
_____ is evidenced by an abnormal lateral curve in the spine; shoulders that are not level; an asymetric waist line; and a prominant scapula which is accentuated by bending forward
scoliosis
a variety of neurologic conditions are associated with abnormal _____ such as a spastic hemiparesis gait (stroke), steppage gait (lower motor neuron disease) and shuffling gait (parkinsons disease)
gait
the most common site for joint effusion is the _____. If large amounts of fluid are present in the joint spaces beneath the patella it may be identified for assessing for the ballon sign and for the belottement of the knee. If inflammation or fluid is suspected in a joint consultation with a specialist (orthopedic surgeon or rheumatoidologist) is indicated
knee
rheumatoid arthritis, gout and osteoarthritis may produce characteristic nodules. The subcutaneous nodules of _____ arthritis are soft and occur within and along tendons that provide extensor function to the joints. The nodules of _____ are hard and lie within and immediately adjacent to the joint capsule itself . They may rupture exuding white uric acid crystals onto the skin surface. _____ nodules are hard and painless and represent bony overgrowth that has resulted from the destruction of the cartilaginous surface of bone within the joint capsule. They are frequently seen in older adults.
Rheumatoid
Gout
Osteoarthritic
the nurse may elicit muscle _____ (rhythmic contractions of a muscle) in the ankle or wrist by sudden forceful sustained dorsiflexion of the foot or extentionof the wrist
clonus
palpation of the skin may reveal whether any areas are _____ suggesting increased perfusion or inflammation, or _____ suggesting decreased perfusion and whether edema is present
Warmer
Cooler
a neurovascular problem that is caused by pressure within a muscle compartment that increases to such an extent that microcirculation diminishes leading to nerve and muscle anoxia and necrosis. Function can be permanently lost if the anoxic situation continues for longer than 6 hours
Compartment Syndrome
bone _____ determine bone density, texture, erosion, and change in bone relationships. xray study of the cortex of the bone reveals any widening, narrowing or signs of irregularity. Joint xrays reveal fluid , irregularity, spur formation, narrowing and changes in the joint structure. Serial xrays may be indicated to determine the status of the healing process
Xrays
What are the five P’s?
Pain Pulse Pallor Paresthesia Paralysis Temperature
diagnostic test that may be used to visualize and assess tumors, injury to the soft tissue, ligaments or tendons; and severe trauma to the chest, abdomen, pelvis, head or spinal cord. It is also used to identify the location and extent of fractures in areas that are difficult to evaluate (acetabulum) and not visible on xray
CT
_____ can be used to visualize and assess torn muscles, ligaments, and cartilage; herniated discs and a variety of hip or pelvic conditions
MRI
_____ is used to identify the cause of any unexplained joint pain and progression of joint disease. A radiopaque contrast agent or air is injected into the joint cavity to visualize the joint structures, such as the ligaments, cartilage, tendons and joint capsule. The joint is put throigh its range of motion to distribute the contrast agent while a series of xrays are obtained. If a tear is present the contrast agent leaks out of the joint and is evident on the x-ray image
arthrography
Bone Densitometry can be performed through the use of
Xray or Ultrasound
Point of Bone Densitometry?
Predicts fracture risk through accurate monitoring of bone density changes in patients with osteoporosis who are undergoing treatment
During an MRI, A patient may hear a
knocking sound
A patient having an arthropgram may feel
soem discomfort or tingling during the procedure
A _____ _____ is performed to detect metastatic and primary bone tumors, osteomyelitis, some fractures and aseptic necrosis, and to monitor tje progression of degenerative bone diseases. A bone scan may accurately identify bone disease before it can be detected on xray; as such it may diagnose a stress fracture in a patient who continues to experience pain after x-ray findings are negative
bone scan
aseptic _____ (joint aspiration) is carried out to obtain synovial fluid for purposes of examination or to relieve pain due to effusion. Examination of synovial fluid is helpful in the diagnosis of septic arthritis and other inflammatory arthropathies and reveals the presence of hemarthrosis (bleeding into the joint cavity) which suggests trauma or a bleeding disorder. Normally synovial fluid is clear, pale yellow, straw colored or scanty in volume.
arthrocentesis
after arthrocentesis ice may be prescribed for _____ to _____ to deminish edema formation and pain
24-48 hours
EMG provides information about
the electrical potential of the msucles and the nerves leading to them. Performed to evaluate muscle weakness, pain, and disability
serum _____ levels are altered in patients with osteomalacia, parathyroid dysfunction, pagets disease, metastatic bone tumors or prolonged immobilization. Serum phosphate levels are inversely related to calcium levels and are diminished in osteomalacia associated with malabsorption syndrome
calcium
_____ phosphatase is elevated in pagets disease and metastatic cancer
acid
_____ phosphatase is elevated during early fracture healing and in diseases with increased osteoblastic activity (metastatic bone tumors)
alkaline
serum enzyme levels of creatin kinase and aspartate aminotransferase become _____ with muscle damage
elevated
serum _____ indicates the rate of bone turnover
osteocalcin
urine calcium levels _____ with bone destruction (parathyroid dysfunction, metastatic bone tumors, multiple myeloma)
increase
Serum phosphorus levels are related to Calcium how?
Inversely related, and are diminished in osteomalacia associated with malabsorption syndrome
