LECTURE 4: Musculoskeletal & Mobility Assessment 🐭🦴💪 Flashcards
focused assessment of a problem - subjective data
- demographic data
- past medical history
- family history
- nutrition and medications
- psychosocial history
- occupation, lifestyle, and behaviours
- functional assessment
special circumstances - pathological fracture
- cancer caused fracture
special circumstances - pregnancy
- increased levels of circulating hormones may increase mobility of joints (relaxin)
- changes in maternal posture (lordosis)
- compensate for enlarging fetus, centre of gravity shifts
- strain on lower back muscles and pain in late pregnancy
- sciatic nerve pain from pressure
- anterior flexion of neck, slumping of shoulders to compensate
special circumstances - scoliosis + tests
patient standing erect:
- shoulders, scapula & iliac crests should be symmetrical
- spinal processes should be in a straight line
patient bending forward:
- is the scapula symmetrical, shouldn’t be a rib hump
- spinal processes should be in a straight line
limb measurement:
- leg length
- arm length
special circumstances - polio
- it’s a virus that attacks growing bones
- more common in boys
- we now have vaccines
- impacts growth on particular side
special circumstances - basilar skull fracture
Battle’s sign
- bruising from bleeding shows behind ears
Raccoon eyes
- bleeding into orbital cavities, bruising of eyes
lifespan considerations
- newborns, infants, and children
- older adults
- cultural considerations
lifespan considerations: infants and children
legs
- bowlegged until 18 months
- transition to knock-knee (genu valgus)
- legs usually straighten by 6-7 years
- growth plates, long bones at risk for infection
- teens, SCFE (slipped capital femoral epiphysis)
- femur slips out of alignment
- head of femur can deteriorate
fontanels
- anterior closed by 9-12 months
- posterior closed by 2 months
back
- C-shape curve in infancy
- spinal curvature with growth and weight-bearing
- check for scoliosis (especially 10-16)
lifespan considerations: older adults
- best treatment is to prevent falls
inspection (objective data) - posture: static and dynamic
- gait (walking pattern): locomotion/movement, observe the way she walks
- balance: cerebellum, neuro component
- coordination: organization of movement, near component
inspection - objective data
joint, muscles, and extremities
- size of joint/muscle/bone
- symmetry
- contour
- colour
- edema/deformity
- facial expression with use
- curvature of spine
palpation - objective
joints, muscles, and extremities
- muscle tone
- temperature variation
- tremor
- edema
- crepitus
- bony articulations (bone on bone rubbing)
- tenderness
physical assessment - objective
range of motion (rom):
- do not move to point of pain
- move all joints
active vs. passive:
- active = they do it themselves
- passive = nurse does it for them
- prevention of joint stiffness, muscle shortening, contractures
Assessing muscle strength
- usually integrated with exam of associated joint for ROM
- compare bilaterally
full muscle strength requires complete active ROM - grade strength scale 1-5
Rating scale for muscle strength
5/5: complete ROM against gravity and full resistance
4/5: complete ROM against gravity and moderate resistance
3/5: complete ROM against gravity
2/5: complete ROM with the joint supported, cannot perform ROM against gravity
1/5: muscle contraction detectable, but no movement at joint
0/5: no visible muscle contraction
terms of muscle tone: atony, hypotonic, spasticity, spasm, fasciculation, tremors
atony: lack of residual tension
hypotonic: diminished tone of skeletal muscles
spasticity: hypertonic, so if muscles are stiff and movements are awkward
spasm: sudden violent involuntary contraction of a muscle
fasciculation: involuntary twitching of muscle fibres
tremors: involuntary contraction of muscles
