Module 10 - MSK Assessment Flashcards
Structure of MSK System
- Bones
- Joints
- Cartilage
- Ligaments
- Bursa
- Muscles (Skeletal, Smooth, Cardiac)
Function of MSK
- Supports the body
- Calcium storage
- Movement
- RBC production
- Protection of the organs
Primary Muscles terminology
- Fasciculi - bundles of fibers
- Tendons - attached to bone
Movement terminology for muscles
- Flexion
- Extension
- Abduction
- Adduction
- Pronation
- Supination
- Circumduction
- Eversion
- Rotation
- Protraction
- Retraction
- Elevation
- Depression
Spinal structures - Terminology
- Vertebrae
- Spinal process (C7 - L4)
- Invertebrate discs
Shoulder structure - Terminology
- Glenohumeral joint (ball and socket)
- Rotator cuff
- Subacromial bursa – Assists during abduction of the arm
- Acromion process – Very top of the shoulder
- Great tubercle of humerous – Second bump of the humerous
- Coracoid process – Surrounds the joint of the scapula
Structure of Elbow - Terminology
- Humers
- Radius
- Ulna
Structure of Wrist/Carpal joints - Terminology
- Radiocarpal joint – articulation of the radius (thumb side)
- Midcarpal joint - involved in Flexion, Extension, some rotation
- Metacarpophalangeal/Interphalangeal joints - Finger extension
Structure of the Knee - Terminology
- Femur
- Tibia
- Patella (kneecap)
- Largest joint in the body
Structure of Ankle/foot
- Terminology
- Tibiotalar joint – articulation of the tibia, fibula and talus – hinge joint limited to flexion and extension
- Medial/lateral malleolus – bony prominence that promote stability if the ankle joint
Health History of MSK
1) Joint pain/problems
2) Knee joint
3) Muscles
4) Bones
5) Function Assessment (ADL’s)
6) Self-Care behaviors
How do we test active ROM?
- Voluntary movement, performing the movements on your own
- Appropriate control
- Stabilized
- Recognizing limitations
How do we test passive ROM?
- Limited movements that may require assistance
- Muscles are relaxed when you move the body
- Anchor the joint with one hand while your other hand slowly moves to its limit
Process of Rating Muscle Strength
- Instruct the patient to repeat the motions you tested for active ROM
- Ask the patient to flex (tighten/contract) the muscle and hoe as you apply opposing force
- Muscle strength should be equal bilaterally
Muscle grading scale
5 – Full ROM against gravity, full resistance - Normal
4 – Full ROM against gravity, some resistance - Assessment good
3 – Full ROM with gravity - Assessment fair
2 – Full ROM with gravity eliminated - Assessment is poor
1- Slight Contraction - Assessment is trace
0 - No Contraction - Assessment is zero
Inspection - Normal Findings
- Size
- Joints
- Contour
- Muscle tone
- Smooth skin
- Even tone
- Noting deformities, masses, swelling and discoloration
Inspection - Abnormalities
- Swelling
- Deformities
- Lesions
- Abrasions
- Scar tissue
- Contracture
- Dislocations
- Discoloration
Palpation - Normal findings
- Even skin texture
- Temperature
- Moisture
- Muscles
- Bony articulations
- Area of the joint
- Should not feel synovial fluid
Palpation - Abnormalities
- Swelling
- Tenderness
- Heat
- Palpable fluid
ROM - Abnormalities
- Limited ROM
- Articular disease – swelling, tenderness around the joint
- Extra-articular disease– specific tendon, ligament, swelling and tenderness
- Crepitation
Temporomandibular joint - Normal Findings
- Vertical motions
- Lateral motions
- Protrusion of lower jaw
- Use two fingers to assess
Temporomandibular joint- Abnormalities
- Swelling
- Crepitus
- Pain
Cervical Spine - Normal Findings
- Straight alignment
- Erect head
- Firm
- Symmetrical head shape
Cervical Spine - Abnormalities
- Tenderness
- Asymmetry
- Pain
- Limited ROM
- Swelling
- Cannot maintain flexibility
Shoulders - Normal findings
- Symmetry
- Equality
- Joint capsules intact
- Equal size and contour
Shoulders - Abnormalities
- Redness
- Muscular atrophy
- Deformity
- Inequality
- Swelling
- Tenderness
- Limited ROM
- Asymmetry
- Crepitus
- Pain
- Atrophy
Elbow - Normal Findings
- Equal size and contour
- Flex of 70 degrees
- Equal movement
Elbow - Abnormalities
- Swelling
- Heat
- Redness
- Subcutaneous nodules
- Rheumatoid arthritis
- Raised
Wrist and Hand - Normal findings
- Skin
- Equal position
- Equal contour and shape
- Smooth knuckles
- Full muscles
Wrist and Hand - Abnormalities
- Ganglion cysts
- Redness
- Swelling
- Tenderness/pain
- Loss of ROM
- Limited motion and pain on movement
- Arthritis
Hip - Normal Findings
- Symmetry of the ileac crests, gluteal folds and equal sized buttocks
- Even gait
- Stability
Hip - Abnormalities
- Pain with palpation
- Crepitation
- Limited motion
- Pain with motion
- Limited internal rotation of the hip
- Limitation of abduction of the hip in supine position
Knee - Normal findings
- Even coloring
- Even contour and alignment
- Distinct concavities on either side
Knee - Abnormalities
- Redness
- Swelling
- Tenderness/pain
- Shiny/atrophic skin
- Lesions
- Deformities
- Bowlegs
- Knock knees
- Synovial effusion
Ankle and Foot - Normal findings
- Equal position
- Equal contour
- Even skin tone
- Straight toes
- Smooth ankles
Ankle and Foot - Abnormalities
- Hallux valgus - Deformities
- Hammertoes
- Swelling/inflammation
- Calluses and ulcers
- Tenderness
- Limited ROM
- Pain with motion
Spine - Normal findings
- Equality
- Straight/vertical line
- Firm muscles
- Normal ROM
- Gluteal cleft
Spine - Abnormalities
- Nucleus pulposus
- Tenderness
- Spasms
- Fibromyalgia
- Limited ROM
- Pain with motion
- Kyphosis
- Scoliosis
Joint Disorders
- Rheumatoid arthritis
- Anklyosing spondlyitis
- Osteoarthritis
- Osteoporosis
Shoulder Disorders
- Atrophy
- Dislocated shoulder
- Joint effusion
- Tear
- Frozen shoulder
- Subacromial bursitis
Elbow Disorders
- Olecranon bursitis (goose egg)
- Gout
- Subcutaneous nodules
- Tennis elbow
Wrist/Hand Disorders
- Ganglion cyst
- Carpal tunnel syndrome
- Anklyosis
- Dupuytren Contracture
- Swan neck
- Ulnar deviation
- Acute Rheumatoid arthritis
- Gout
- Polydactyl
- Syndactyl
Knee Disorders
- Synovial thickening
- Swelling
- Muscular atrophy
- Osgood- Schlatter disease (painful swelling)
Ankles and Foot Disorders
- Achilles tendon
- Gout
- Hallux Valgus - deformity due to rheumatoid arthritis
- Callus
- Ingrown toenail
- Plantar wart
Spinal Disorders
- Scoliosis
- Nucleus pulpous - L4-S1 and will have sciatic pain
