Module 8 Flashcards
what is the musculoskeletal system comprised of
bones, joints, skeletal muscles and supportive CT
what are supportive connective tissue
tendons, ligaments, and caritlage
connect muscles to bones
tendons
connect bones to eachother at the joint level
ligaments
cushioning tissue within a joint
cartilage
close to the center of the body
proximal
away from the center of the body
distal
moving the extremity laterally, away from midline
abduction
moving the extremity medially, toward the midline
adduction
rotating the extremity medially along its own axis
internal rotation
rotating the extremity laterally along its own axis
external rotation
moving the thumb outward to touch the little thumb
opposition
review of related history
past history, trauma, surgery on bone, skeletal deformities, chronic illness
current complaints
back, joint, muscular, skeletal complaints/pain, and injury
family history
Congenital abnormalities or genetic disorders, scoliosis, arthritis
personal and social history
employment, exercise, functional abilities, weight and height changes, tobacco and alcohol use, nutrition
sports injury risk factors
poor conditioning, not warming up, intensity of competition, collision, rapid growth, overuse
Main Risk Factors: Osteoarthritis
obesity, family history, lax ligaments with postural joint deformity, > 40 yrs old
additional risk factors for osteoarthritis
race, light frame, post menopause, constant dieting, scoliosis, metabolic disorders, some drugs, smoking and alcohol
equipment of musculoskeletal
Skin marking pencil, Goniometer, Measuring tape, Reflex hammer, Sphygmomanometer
what do you check during inspection
Alignment, Contour, Symmetry, Height/weight, Gross deformity, Posture, weight bearing tolerance, and gait
Affected foot/leg does not touch the floor
non weigh bearing
Touches floor, but no weight placed
touchdown weight bearing
30-50% of weight born
partial weight bearing
50% but < 100%
weight bearing as tolerated
what do you compare during inspection and palpation
contralateral sides
a discrepancy of what between the two contralateral parts is abnormal
> 3 cm
how do you inspect and palpate muscles
Contract muscle isometrically
Then relax muscle
Then contract again
Watch for any involuntary movements
without inducing movement
isometric muscle contraction
Flaccidity
Decreased muscle tone
hypotonicity
Increased muscle tone
Often noted with extreme flexion or extension
Spasticity
partial dislodgment of the bone from its place in the joint cavity
subluxation
dislodgment of one bone out of the joint cavity
dislocation
when do you stop ROM exercises
if person complains of pain
what should you never do to a joint
push a joint beyond its anatomic angle
how do you determine exact ROM
goniometer
as you test ROM what should you also test for
muscle strength
how do you grade muscle strength
0(none) to 5+(normal)
how do you palpate the Temperomandibular Joint
Place the tips of your index fingers directly in front of the tragus of each ear
Ask the person to : Open and close the mouth and Move the jaw side-to-side
what do you palpate the TMJ for
Clicking
Popping
Pain
what do you check the strength of in the TMJ
Strength of temporalis and masseter muscles and CN Trigeminal
what do you inspect the cervical spine for
Alignment
Symmetry of skin folds and muscles
what are the ROM for cervical spine
Forward flexion
Hyperextension
Lateral bending
Rotation
what do you check the strength of in the cervical spine
sternocleidomastoid and trapezius muscles and CN Spinal accessory
what do you inspect for in thoracic and lumbar spine
scoliosis, lordosis, kyphosis, list
Leaning of the spine
May be from herniated lumbar disc/painful paravertebral muscles
list
Excessive concavity of the lumbar spine
“Swayback”
lordosis
Excessive convexity of the thoracic spine
Forward and downward hunching of head, neck, shoulders
“Hunchback”
kyphosis
Lateral curvature of the spine
Becomes accentuated on forward flexion at the waist
scoliosis
what do you palpate the thoracic and lumbar spine for
Palpate the spinal processes and paravertebral muscles
for Nodules and Tenderness
what is the ROM for thoracic and lumbar spine
Forward flexion
Hyperextension
Lateral bending
Rotation
what do you inspect the shoulders for
contour
what is the ROM of the shoulders
Shrugging shoulders Forward flexion Hyperextension Abduction Adduction Internal and external rotation
what does muscle strength of the shoulders test for
shrugging shoulders (CN spinal accessory), forward flexion, and abduction
how do you inspect the elbows
in flexed and extended position for Contour and Carrying angle (5-15°)
what do you palpate on the elbows
the extensor surfaces for tenderness, warmth, nodules
what is the ROM of the elbows
Flexion
Extension
Pronation and supination
how do you test muscle strength in elbows
flexion and extension
what do you inspect hands and wrists for
Contour
Position
Shape
Number and completeness of digits
how do you test for Tinel’s sign
Strike the median nerve
Tingling or prickling sensation radiating from wrist to the hand especially to the thumb, index and middle fingers
Positive sign is associated with carpal tunnel syndrome
how do you test for Phalen’s sign
Wrist flexed and dorsum of hands pressed together
Hold for 1 minute
Sensations of numbness and paresthesia in palmar aspects of hand, especially the first 3 fingers
Positive sign is associated with carpal tunnel syndrome
what are the ROM for hands and wrists
Metacarpophalyngeal flexion (180°) and extension (30°)
Thumb opposition
Forming a fist
Finger abduction and adduction
Wrist hyperextension (70°) and flexion (90°)
Radial (20°) and ulnar movement (55°)
how do you test muscle strength of hands and wrists
Wrist extension and hyperextension
Finger abduction and adduction
Hand grip
what do you inspect hips for
for symmetry and level of gluteal folds
what do you palpate the hips for
Instability
Tenderness
Crepitus
what are the ROM for hips
Flexion (120°), extension (90°), and hyperextension (30°)
Abduction (45°) and adduction (30°)
Internal (40°) and external (45°) rotation
how do you check muscle strength of hips
Knee in flexion and extension
Abduction and adduction
what do you inspect the knees for
for natural concavities
what do you palpate on the knee
the popliteal space and joint space
what is the ROM for knees
Flexion (130°)
Extension (0-15°)
how do you check muscle strength of knees
Flexion
Extension
how do you inspect feet and ankles
during weight bearing and non weight bearing for
Contour, Alignment, Size, Number of toes
what do you palpate in the feet and ankles
the Achilles tendon and each metatarsal joint
what is the ROM for feet and ankles
Dorsiflexion (20°) and plantar flexion (45°)
Inversion (30°) and eversion (20°)
Flexion and extension of the toes
how do you check muscle strength of feet and ankles
Plantar flexion
Dorsiflexion
what abnormalities do you look for in newborns
syndactyly, polydactyly, signs of hip location, simian crease
Single crease across entire palm
Associated with Down syndrome
simian crease
when Should infants be able to lift the head and trunk from the prone position
2 months
Kyphosis of the thoracic and lumbar spine is normal until when
the infant can sit without support
About 7 months
all babies are what
flat footed
developmental variations in children
Young children have a protuberant belly and lumbar curvature
Watch alignment especially
Feet often slightly invert until about 30 months
Caution parents about reverse tailor sitting
abnormalities in children
genu varum and genu valgum
“Bow leg”
Measure distance between knees when ankles are together
genu varum
“Knock knee”
Measure distance between ankles when knees are together
genu valgum
developmental variations in adolescents
May have slight kyphosis and rounded shoulders
Bone growth is complete by age 20
pregnancy variations
Postural changes
Increased lordosis
Increased mobility and instability of sacroiliac joints
Pregnancy waddle
Symptoms of carpel tunnel syndrome related to fluid retention
older adult variations
Joint agility can be grossly assessed by functional ADLs
Posture
Increased kyphosis, especially with osteoporosis
Reduction in total muscle mass
