Module 8 Flashcards by Christina Stafstrom

what is the musculoskeletal system comprised of

bones, joints, skeletal muscles and supportive CT

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what are supportive connective tissue

tendons, ligaments, and caritlage

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connect muscles to bones

tendons

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connect bones to eachother at the joint level

ligaments

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cushioning tissue within a joint

cartilage

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close to the center of the body

proximal

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away from the center of the body

distal

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moving the extremity laterally, away from midline

abduction

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moving the extremity medially, toward the midline

adduction

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rotating the extremity medially along its own axis

internal rotation

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rotating the extremity laterally along its own axis

external rotation

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moving the thumb outward to touch the little thumb

opposition

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review of related history

past history, trauma, surgery on bone, skeletal deformities, chronic illness

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current complaints

back, joint, muscular, skeletal complaints/pain, and injury

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family history

Congenital abnormalities or genetic disorders, scoliosis, arthritis

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personal and social history

employment, exercise, functional abilities, weight and height changes, tobacco and alcohol use, nutrition

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sports injury risk factors

poor conditioning, not warming up, intensity of competition, collision, rapid growth, overuse

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Main Risk Factors: Osteoarthritis

obesity, family history, lax ligaments with postural joint deformity, > 40 yrs old

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additional risk factors for osteoarthritis

race, light frame, post menopause, constant dieting, scoliosis, metabolic disorders, some drugs, smoking and alcohol

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equipment of musculoskeletal

Skin marking pencil, Goniometer, Measuring tape, Reflex hammer, Sphygmomanometer

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what do you check during inspection

Alignment, Contour, Symmetry, Height/weight, Gross deformity, Posture, weight bearing tolerance, and gait

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Affected foot/leg does not touch the floor

non weigh bearing

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Touches floor, but no weight placed

touchdown weight bearing

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30-50% of weight born

partial weight bearing

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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