MOBILITY - ABNORMALITY Flashcards
Observe posture
is erect and comfortable for age
Poor posture - slumped shoulders
Lordosis -inward curve
scoliosis - sideways curve
kyphosis - outward (hunching )
observe gait
- Base of support
- Weight-bearing stability
- Foot position
- Stride and length and cadence of stride
- Arm swing
- Posture
- Uneven weight bearing is evident.
- Client cannot stand on heels or toes.
- Toes point in or out. Client limps, shuffles, propels forward, or has wide-based gait
Nudge Test?
older or handicapped pt.
Stand behind the client and put your arms around the client while you gently nudge the sternum.
normal :Client does not fall backward.
nudge test abnormality
Falling backward easily is seen with cervical spondylosis and Parkinson disease.
spondylosis
arthritis spurred by wear and tear to the spine.
Inspect and palpate the TMJ.
client sit; put your index and middle fingers just anterior to the external ear opening. Ask the client to open the mouth as widely as possible.
Normal finding?
Snapping and clicking may be felt and heard in the normal client.
Mouth opens 1–2 in
Jaw moves laterally 1–2 cm. Jaw protrudes and retracts easily.
TMJ abnormalities
Decreased ROM, swelling, tenderness, or crepitus may be seen in arthritis
Decreased ROM, and a clicking, popping, or grating sound may be noted with TMJ dysfunction.
Test ROM TMJ
- open the mouth and move the jaw laterally against resistance.
- clenches the teeth, feel for the contraction of the temporal and masseter muscles to test cranial nerve V (trigeminal nerve).
normal findings
There is no visible bony overgrowth, swelling, or redness; joint is nontender
Test ROM TMJ abnormal
Lack of full contraction with cranial nerve V lesion.
Pain or spasms occur with myofascial pain syndrome.
myofascial pain syndrome
- muscle pain
pain and inflammation in the body’s soft tissues
inspect the sternoclavicular joint
pt. sitting in a chair. inspect - location, color, swelling masses, tenderness/ pain
Normal findings
no visible bony overgrowth, swelling, or redness; joint is nontender
sternoclavicular joint abnormalities
Swollen, red, or enlarged joint or tender, painful joint is seen with inflammation of the joint.
Observe the cervical, thoracic, and lumbar curves
from lateral and posterior view, Observe for symmetry, noting differences in height of the shoulders, iliac crests, and buttock creases.
normal findings
- Cervical and lumbar spines are concave;
- thoracic spine is convex.
- Spine is straight (when observed from behind).
cervical, thoracic, and lumbar curves
abnormalities
flattened lumbar curvature may be seen with a herniated lumbar disc or ankylosing spondylitis.
. Lateral curvature of the thoracic spine with an increase in the convexity on the curved side is seen in scoliosis
lumbar curve (lordosis) is often seen in pregnancy or obesity
Unequal heights of the hips suggest unequal leg lengths.
Palpate the spinous processes and the paravertebral muscles
both sides of the spine for tenderness or pain.
Normal findings
- Nontender spinous processes;
- well-developed,
- firm and smooth, –nontender paravertebral muscles.
- No muscle spasm.
spinous processes and the paravertebral muscles
abnormalities
Compression fractures and lumbosacral muscle strain can cause pain and tenderness of the spinal processes and paravertebral muscles.
Test ROM of the cervical spine.
asking the client to touch the chin to the chest (flexion) and to look up at the ceiling (hyperextension)
normal findings
is 45 degrees. Extension of the cervical spine is 45 degrees.
ROM of the cervical spine
abnormal
- characterized by impaired ROM and neck pain from abnormalities of the
- soft tissue (muscles, ligaments, and nerves)
- due to straining or injuring the neck.
-Causes of strains can include
- sleeping in the wrong position,
-carrying a heavy suitcase,
being in an automobile crash.
Cervical disc degenerative disease and spinal cord tumors are associated with impaired ROM and pain that radiates to the back,
Cervical disc degenerative disease
one or more of the cushioning discs in the cervical spine starts to break down due to wear and tear
cervical spinal cord compression.
shoulder, or arms. Neck pain with a loss of sensation in the legs may occur
meningitis related to neck pain
Impaired ROM and neck pain associated with fever, chills, and headache could be indicative of a serious infection
Test lateral bending.
Ask the client to touch each ear to the shoulder
normal findings
bend 40 degrees to the left side and 40 degrees to the right side.
lateral bending
abnormal
Limited ROM is seen with neck injuries, osteoarthritis, spondylosis, or with disc degeneration.
Evaluate rotation.
Ask the client to turn the head to the right and left
Normal findings
about 70 degrees of rotation is normal.
Limited ROM is seen with neck injuries, osteoarthritis, spondylosis, or with disc degeneration.
Abnormal findings are seen in ?
- Lateral bending
- Evaluate rotation
Test ROM of the lumbar spine.
Ask the client to bend forward and touch the toes.
Observe for symmetry of the shoulders, scapula, and hips.
normal findings
Flexion of 75–90 degrees, smooth movement, lumbar concavity flattens out, and the spinal processes are in alignment.
functional scoliosis vs, structural scoliosis.
abnormal of lumbar spine
Lateral curvature disappears in functional scoliosis;
-unilateral exaggerated thoracic convexity increases in structural scoliosis.
- Spinal processes are out of alignment.
describe bending type (relation to back)
- bend sideways is
- bend backward
- twist the shoulders one way then the other.
(lateral bending),
(hyperextension) ,
(rotation) .
Test for back and leg pain.
when to preform this test :
If the client has low back pain that radiates down the back
Ask the client to lie flat and raise each relaxed leg independently to the point of pain. At the point of pain, dorsiflex the client’s foot
Note the degree of elevation when pain occurs, the distribution and character of the pain, and the results from dorsiflexion of the foot.
Inspect and palpate shoulders and arms.
normal findings
Anteriorly palpate the clavicle, acromioclavicular joint, subacromial area, and the biceps.
Posteriorly palpate the glenohumeral joint, coracoid area, trapezius muscle, and the scapular area.
Shoulders are symmetrically round; no redness, swelling, or deformity or heat. Muscles are fully developed. Clavicles and scapulae are even and symmetric. The client reports no tenderness.
Inspect and palpate shoulders and arms
dislocation.
Muscle atrophy
Tenderness, swelling, and heat may be noted with shoulder strains, sprains, arthritis, bursitis, and degenerative joint disease
Flat, hollow, or less-rounded shoulders are seen with
dislocation
is seen with nerve or muscle damage or lack of use.
Muscle atrophy
Test ROM shoulders, arms, elbows
flexion, extension, adduction, abduction, and motion against resistance).
normal findings
Extent of forward flexion should be 180 degrees; hyperextension, 50 degrees; adduction, 50 degrees; and abduction 180 degrees.
ROM shoulders, arms, elbows
abnormalities
- rotator cuff tear.
- rotator cuff tendinitis
calcified tendinitis.
-inability to shurg
-Decreased muscle strength is seen with muscle or joint disease.
calcified tendinitis.
Chronic pain and severe limitation of all shoulder motions
rotator cuff tear
Painful and limited abduction accompanied by muscle weakness and atrophy
rotator cuff tendinitis.
Client has sharp catches of pain when bringing hands overhead
Inability to shrug shoulders against resistance is seen with a lesion of
cranial nerve XI (spinal accessory)
Inspect for size, shape, deformities, redness, or swelling of elbow
abnormal findings
- bursitis of the olecranon process due to trauma/arthritis
- rheumatoid arthritis or rheumatic fever
- Tenderness or pain over the epicondyles may be palpated in epicondylitis (tennis elbow) due to repetitive movements of the forearm or wrists
Decreased ROM against resistance is seen with joint or muscle disease or injury.
bursitis
occurs when bursae become inflamed.
Redness, heat, and swelling
common in e shoulder, elbow and hip
Wrist abnormalities
- rheumatoid arthritis
- Tenderness and nodules
- A nontender, round, enlarged, swollen, fluid-filled cyst (ganglion) may be noted on the wrists (
wrist fracture include pain
- tenderness, swelling, and inability to hold a grip
- pain that goes away and then returns as a deep, dull ache. -Extreme tenderness occurs when pressure is applied on the side of the hand between the two tendons leading to the thumb
Perform the squeeze test
abnormal
Extreme pain may indicate rheumatoid arthritis and psoriatic arthritis of the hand
scaphoid fracture,
rheumatoid arthritis
autoimmune disease that can cause joint pain and damage throughout your body. The joint damage that RA causes usually happens on both sides of the body.
scaphoid fracture,
break of the scaphoid bone in the wrist.
The anatomic snuffbox is generally tender and swelling may occur.
