Module 11 - Muscular System Portion Flashcards
Osteoblasts
Cells that form new bone
Osteoclasts
Cells that breakdown bone
Red Marrow is in ___ Bones
Flat
Yellow Marrow is in ___ Bones
Long
Long Bones
bones that are longer than they are wide
Flat Bones
thin bones that are often curved, like ribs
Red Marrow
Highly vascularized hematopoietic stem cells
Yellow Marrow
Fat
Short Bones
Bones approximately equal in length, width, and thickness
Irregular Bones
bones like that of the face with no characteristic shape
Compact Bone
dense bone
Spongy Bone
cancellous bones that are light, soft, and spongy in nature filling the inner layer of most bones and forming the epiphyses of long bones
Compact Bones
cortical bones that are heavy, tough, and compact in nature making the outer layer of most bones and forming the diaphysis of long bones
Epiphysis
the end part of a long bone
Diaphysis
shaft or central part of a long bone
Epiphyseal Plate
The area of growth in a long bone (could be interrupted by circulation issues)
Muscles account for ___% of the bodys weight
40-50%
3 Types of Muscles
Cardiac
Smooth
Skeletal
Cardiac Muscle
tissue that involuntarily controls heart movements through specialized pacemaker cells
Smooth Muscle
Involuntary Muscle
Skeletal Muscle
Voluntary Muscle
Tendons
Stabilizers connecting muscle to bone
Ligament
Stabilizers connecting bone to bone
Cartilage
Gel pad between bones offsetting wear and tear and bone erosion
Bursa
Disc shaped sacs filled with a synovial fluid for cushioning
Between bones or tendons/ major joints of the body
Eases friction
Bursitis
Inflammation and irritated synovial fluid composure and joint appearance / Bursa inflammation
Every joint has ____
flexion
Extension
movement that increases the angle between 2 body parts
Flexion
movement that decreases the angle between 2 body parts
Dorsiflexion
action of raising the foot upward toward the shin
Plantarflexion
action in which the top of your foot points away from your leg (opp of dorsiflexion)
Hyperextension
to extend so that the angle between bones of a joint is greater than normal
Abduction
the movement of limb or other parts away from the midline of the body, or another part
AB = Away from Body
Adduction
the movement of a limb or other part toward the midline of the body, or another part
AD = ADd toward
Circumduction
The movement of a body region in a circular manner, where one end of the body remains stationary while the other moves circularly
Internal Rotation
rotation toward the center of the body
External Rotation
rotation away from the center of the body
Pronation
Rotation of a body part toward the midline / Rotation of the hand and forearm so that the palm faces backwards or downwards (palm posterior up)
Supination
Rotation of forearm and hand so the palm faces forward or upward
Inversion
Turn the foot toward the midline of the body
Eversion
Turn the foot away from the midline of the body
TMJ
Temporal Mandibular Joint
A hinge and gliding joint for the jaw
It can retract or protract, retract, elevate, and depress the mandible
What kind of joint is TMJ
Hinge and Gliding
What kind of joint is the cervical spine?
Gliding
Cervical Spine
Gliding joint allowing for flexion, extension, hyperextension, hyperflexion, lateral bending, and lateral rotation
The Thoracic and Lumbar spine allow for what movements?
Flexion
Extension
Hyperextension
Lateral Bend
Rotation
What kind of joint is the shoulder and hip?
Ball and Socket
What sort of movement can shoulder and hip joints do?
Many since they are ball and socket joints - its like a baseball in a glove
Flexion, Abduction, Extension, Adduction, External and Internal rotation
What kind of joints are the elbow and knee
Hinge joints
What sort of movements can the elbow and knee do?
Extension
Flexion
Hyperextension
What kind of joint is the wrist?
condyloid joint
What sort of movements can the wrist do?
Flexion and Extension
Hyperextension
Ulnar and Radial Deviation
Ulnar Deviation
“Ulnar Drift”
Condition where knuckle bones swell and your fingers bend abnormally toward the ulnar (little finger) side
Radial Deviation
conditions where bones swell and your fingers bend abnormally toward the radial (thumb) side
What kind of joints are in the fingers and hands?
Hinge
Saddle
Condyloid
What movements can the hands and fingers do?
Fingers: Abduction/Adduction, Opposition/Reposition
Palmar: Adduction/Abduction
Hyperextension
Flexion
What kind of joints are the ankles?
Hinge
Gliding
Condyloid
What sort of movements can the ankles do?
Mainly dorsiflexion and plantarflexion
The feet can do eversion, inversion, abduction, and adduction
Special Musculoskeletal considerations for infants and children?
Cartilage Ossifies in adolescence
Epiphyses - closure around age 20
Scoliosis (Shoulder, hips) could be possible
Their Birth history is important to know for any issues
Genu varum
Genu valgum
Childhood illness with impact on bone growth
Genu Varum
Bow Leg (Birth issue or hip issue)
Genu Valgum
Knock knee (knees closer and feet apart)
Special musculoskeletal considerations for older adults?
After age 40, loss of bone matrix - Osteoporosis risk increases
Postural changes (Dowagers hump kyphosis, flexion of hips and knees)
Intervertebral disc dehydration
Atrophy of muscle mass and size lading to decreased agility, gait changes, potential balance issues
Greater risk for falls
Why does risk for osteoporosis increase with age?
Osteoclasts increase while osteoblasts decrease causing less formation and more absorption
Special musculoskeletal considerations for prenancy?
Increased hormone level
Increase mobility
Lordosis (r/t hormones)
Resultant upper cervical compensation
Possible pressure on ulnar and median nerves causing numbness and tingling in hands (carpal tunnel)
Lordosis
Inward/concave curve to the lumbar spine
May exaggerate in pregnancy and other areas need to compensate (like the cervical spine)
Information to gather during a musculoskeletal health history?
Musculoskeletal problems, pain, disease
Medications and OTC Meds
Accidents or Trauma
Nutrition
Personal Habits (Smoking and Caffeine)
Activity Limitations
Pain (Time of day, muscle cramping and soreness, bone deep dull throbbing, etc)
Weakness
Stiffness
Caffeine is linked to ____
osteoporosis
Smoking lowers ….
estrogen in both genders which usually helps bones keep calcium
What time of day is Rheumatoid Arthritis pain worse?
Morning
What time of day is Osteoarthritis pain worse?
Evening
Stiffness w/ Rheumatoid Arthritis means you should do what?
Rest
Stiffness w/ osteoarthritis means you should do what?
Movement
Proximal musculoskeletal weakness is usually caused by …
myopathy
Distal musculoskeletal weakness is usually caused by …
neuropathy
What sort of specific history information should be gathered during the musculoskeletal assessment?
Childhood history: cerebral palsy at birth
Family history (gout, arthritis, etc)
Bone Scan after age 65+
PMH
Past injuries
Recent Infections or Exposure to Toxins: Lyme, STI, HIV, neuropathy
Are immunizations current (Tetanus)
Allergies to milk, calcium, or Vit D
Medications being taken for musculoskeletal reasons
Anticonvulsants exasperate what musculoskeletal (MSSK) issue
Ataxia
Antidepressants exacerbate what MSSK issue
aches and pains
Antilipemic exasperates what MSSK issue
Rhabdomyolysis (Destruction of muscle tissue)
Corticosteroids exasperate what MSSK issue
Osteoporosis
Diuretics treat what MSSK issue
Cramping
Information relevant to the musculoskeletal system during the ROS?
Feeling
Weight
Fever
Rash
Hair Distribution
Glands
Respiratory or Cardio issues
Dry or Red eyes
STIs
menopause
numbness or tingling
diabetes
thyroid issues
bruises easily
abdominal pain
bowel problems
blood in the urine
Information important to the musculoskeletal system during a psychosocial profile?
Annual physical (did they go?)
typical body mechanics
typical day
nutrition habits
weight
hobbies, sports, recreation
type of work
coping mechanisms for stress
health promotion acitivties
stairs
living by themselves?
sexual activity
social supports
drugs
alcohol
smoking
exercise
sleep habits
shoes they wear
The purpose of the psychosocial profile is to get what?
a comprehension of ability and roles of their orthopedic status
Physical assessment order for the Musculoskeletal system?
Inspection –> Palpation
(No Percussion or Auscultation)
The musculoskeletal physical assessment should be ….
systematic
head to toe
comparing right and left
The general survey portion of the physical assessment should look for …
assess posture, gait, cerebellar function
measure limbs - length and circumference
assess joints and test movement
asses strength and ROM
test for shoulder, elbow, wrist, spine, hip, knee as indicated by history
check skin
___ is even more critical to a musculoskeletal and neurologic exam
Safety
Normal posture is …
Erect
Head midline
Shoulders over hips
normal spine curvature
What is the normal spine curvature?
Cervical - Concave
Thoracic - Convex
Lumbar - Concave
Sacral - Convex
Kyphosis
excessive back curvature
Scoliosis
lateral curvature of the spin
Lordosis
Exaggerated curvature of the LUMBAR spine (extreme)
seen in pregnancy
A normal gait inspection should check for …
- Base of support (feet distance)
- Stride length
- Gait pattern
Trendelenburg Gait
Lurch/Gait: lean to the weak side/hip when walking
Hemiplegic Gait
Circumduction of the issue side leg
also, adduction of shoulder, flexion of elbow, pronation of wrist, and thumb tucked under in cortical fist
Other side normal
Parkinsonian (Propulsive) Gait
Posture stooped over forward, and difficulty initiating gait
Once initiated, small steps occur with a tremor associated with it
As gait continues there might be a picking up of speed
When turning, they will need to slowly side step to turn
*Trouble starting up, then start going with trouble stopping
What gait is associated with muscle weakness and neurologic issues?
Trendelenburg Gait (Gluteal Muscle Strength Issues)
What gait is associated with parkinson’s disease?
Propulsive/Parkinsonian Gait
What gait is associated with CVA issues like stroke?
Hemiplegic Gait
Spastic Gait
Foot dragging walk
very stiff
Scissors Gait
Both extremities effected
both sides of internal rotated lower extremities are swinging/adducting inward during walk
Upper extremities held close up front for balance
Waddling Gait
Pelvic Girdle muscle weakness leads to you waddling similar to a penguin with larger steps
Assessment of balance tells you about …
cerebellar function
Romberg Sign test
Feet together, eyes open, doesnt sway when eyes closed = negative sign
Sways when eyes are closed = Positive sign
Pronator drift test
Checks for muscle weakness
Arms extended, hands palm up, close eyes and for for 20-30 seconds
Downward drift or pronation = + sign (contralateral brain damage)
Tandem Walking test
Test where people walk with toes to the back of the other foot
People with ataxia have trouble keeping balance
Deep knee Bend Test
being able to do a deep knee bend/squat without falling over
When checking ROM what should you check?
Passive and Active ROM
And note limitations on PROM
When viewing deformities you should think about what aspects of it?
Did it happen over time
Was it from sudden trauma
Does it affect ROM or ADLs
Areas to check ROM
TMJ
Cervical, thoracic, lumbar
shoulder
elbow
wrist
hands and fingers
hips
knees
ankles and feet
When checking joints, what sort of findings are concerning?
Edema
Heat
Erythema
Tenderness
Deformity
Crepitus
What is the range of the strenght scale?
0 to 5
What is 5 on a strength scale
Normal - active motion against full resistance
What is 4 on a strength scale
Slight weakness - active motion against some resistance
What is 3 on a strength scale
Average weakness - active motion against gravity
What is 2 on a strength scale
Poor ROM - Passive ROM (gravity removed, assisted by examiner)
What is 1 on a strength scale
Severe Weakness - slight flicker of contraction
What is 0 on a strength scale
Paralysis - no muscular contraction
Alongside strength scale, what else should you assess with each ROM assessment?
Pain
Drop Arm Test
Shoulder and elbow test
Abduct the arm and slowly lower it,
If the arm cannot be smoothly lowered –> Rotator cuff tear
Allen Test
Checks for radial and ulnar artery blood supply
Have them open nd close fist quickly then make fist and you press radial and ulnar arteries
Open hand, release radial artery and see if color returns
Do again with ulnar artery this time instead
Tests for Carpal Tunnel Syndrome
Phalens Test
Tinels Test
Phalens Test
Do wrist flexion (downward) and put wrists together and hold for 60 seconds
If there is numbness/tingling/pain/anesthesia/paresthesia = + sign for carpal tunnel
Tinels Test
Percuss the nerve of the inner wrist and if it elicits paresthesia then it is a positive sign for carpal tunnel *(due to irritated nerve)
Pain or Numbness in the first three and a half digits is a sign of …
Carpal tunnel syndrome
Edema that does not allow straightening of the fingers (Swans Neck) is a sign of …
Rheumatoid Arthritis
Herberdens and Bouchards nodes are a sign of…
Osteoarthritis
Herberden’s v Bouchard’s Nodes
H Nodes are more distal finger joint swellings and B nodes are more proximal
Ganglion Cyst
a fluid filled non cancerous lump often on the joints of the wrist or hands
The most common musculoskeletal problems are …
RA and OA
What causes RA?
Inflammation / Systemic Autoimmune Issue
What causes OA?
Wear and tear / Degenerative
Characteristics of OA
Developed slowly and worsens over time
Pain and Stiffness affecting hands fingers and knees (and maybe spine and hip)
1 Joint is Affected
One side is worse than the other
Morning Stiffness is less than 30 minutes
Destruction of cartilage occurred
Characteristics of RA
Rapidly develops
Pain, stiffness, swelling affecting mul. joints
Symmetrical/Bilateral
Morning stiffness occurs longer than 30 minutes
Fever, fatigue, malaise, weight loss, loss of appetite, edema, erythema, swelling
Signs for Spinal Evaluation
Kernigs Sign
Brudzinskis Sign
Milgram Test
Straight Leg Raise Test
Kernigs Sign
Positive sign is when patient is supine with the hip/knee flexed 90 degrees and leg straightened, and the knee cannot be fully extended without pain
Pain = positive sign = Nerve root irritation and potential meningitis
Brudzinkis Sign
Positive sign if the patient is supine, and you place a hand behind their head and flex it onto the chest and it causes their knees or hips to raise in flexion (or if it elicits pain)
Kernigs Sign and Brudzinskis sign can indicate what?
potential meningitis
Milgram Test
assesses for herniated spinal disc
patient is supine with legs straight and raised from table holding as long as possible
Positive sign for herniated disc if they cannot hold for longer than 30 seconds or experience lumbosacral pain
Straight Leg Raise Test
Assesses for herniated disc/sciatic nerve impingement
Patient is supine, raise leg high and dorsiflex the foot
Positive sign = pain
What tests have positives indicating herniated discs?
Milgram Test
Straight Leg Raise test
Spinal Stenosis
More common neck and lower back, and due to age related wear and tear
Symptoms: Pain, numbness, muscle weakness, bowel and bladder issues
Narrowing of spaces in spine thus pressuring nerves
Spondylolisthesis
Noted in more active people (gymnasts, football, etc) that put stress on the back bone
Vertebrae slips forward onto the one below it
extremely painful
Herniated disc
41 yo and older mostly (especially when you and poor body mechanics and obesity when younger)
Common cause of disability
problem with disk between spinal bones when the soft center of the disk pushes through the crack in the tougher exterior casing
Faber Test (Patrick Test)
Hip Evaluation Test
Assesses sacroiliac and/or hip joints (to see if they’re still intact)
Flexion ABduction External Rotation
Pain = + sign
(crosses leg over other leg to check for pain)
Trendelenburg Test
Sign: A positive side of gluteus Medius weakness will have the contralateral hip when you raise your one leg drop
Hip evaluation test
Ortolani Click Test
Congenital Hip Dysplasia (good to check for in infants/newborns)
Flex knees 90 degrees and abduct the leg outward
Positive sign = Click sound or sensation
hip evaluation test
Test for congenital hip dysplasia
ortolani click test
Test for gluteus medius weakness
Trendelenburg test
Lower Extremity Evaluation tests/ Tests to check for knee injury
Bulge Test
Patellar Ballottement
McMurrays Test
Drawer Test
Bulge Test
Tests for effusion or fluid on knee
gently palpate the knee, then push on medial and lateral side of knee with the back of hand
positive sign - fluid movement while moving hand
Patellar Test
tests for larger amounts of fluid in the knee
Move hands down the thigh to the patella and then gently percuss the kneecap
Positive sign - patella floats or bounces back post percussion - this indicates significant joint effusion
McMurrays Test
Used to assess medial and lateral meniscus (near ACL)
Supine, grab hip and knee at the heel, put hand on knee meniscus and externally and internally rotate and then extend leg
Positive sign - click or thud (NOT PAIN)
Drawer Test
Tests for ACL stability/tears
Supine patient, palpate bent knee and try moving tibia with hands
Positive sign if tibia moves more than 6 mm or if there is a soft/mushy feel
Important considerations for doing PROM with a patient
do NOT need a providers orders
do 2-3 x per day
face direction of movement and work slowly
support areas and joints to be moved
pay attention to patient non verbals
When doing PROM never …
exercise past the point of pain - only to the point of resistance
Indications to do PROM
Prevent Contractures
Maintain Joint Mobility
Simulate circulation
Contraindications to PROM
Acute Arthritis
Fractures
Joint dislocations
Acute Cardiac Conditions
Gout
type of arthritis causing burning pain, stiffness, and swelling in joints
common in men
from a buildup of uric acid crystals in the joints
May require medications or a diet change
lots of erythema (angry and inflamed) visible
What joint does gout most commonly occur in?
the great toe
Tophi
deposits of monosodium urate crystals that result in gout
Modifiable risk Factors for Osteoporosis
ETOH and Smoking
Low body mass index
insufficient exercise (Sedentary lifestyle)
Frequent falls
Diet: poor nutrition, Vit D Deficiency, eating disorder, low dietary calcium intake
Nonmodifiable risk factors for osteoporosis
Age
gender
FMH
previous f(x)
ethnicity
primary and secondary hypogonadism in men
menopause/hysterectomy
RA
long term glucocorticoid therapy
Osteoporosis is more common and least common in what populations?
Most common - white females
Lowest - AA males
___ is a contributing factor for hip fractures and malformed vertebrae
Osteoporosis
Muscular Dystrophy
Abnormal genes (mutations) lead to muscle degeneration, and most forms begin in childhood
Damaged muscle become progressively weaker, to the point most will need a wheelchair
Other symptoms include trouble breathing or swallowing
Many different forms exist
Treatment for Muscular Dystrophy
TERTIARY PREVENTION ONLY - mostly supportive
Medications
therapy
breathing aids
surgery may help maintain function, but life span is often shorter in these people
Nursing Diagnoses for the Musculoskeletal System
Pain
Altered mobility
risk for injury
disuse syndrome
adjustment, impaired
body image disturbance
self care deficit
knowledge deficit
impaired skin integrity
anxiety
depression
