Muscleoskeletal Flashcards
Define the 4-point grading scale for deep tendon reflexes.
4+ Very brisk, hyperactive with clonus, indicative of disease
3+ Brisker than average, may indicate disease, probably normal
2+ Average, normal
1+ Diminished, low normal, or occurs only with reinforcement
0 No response
Which vertebral level is assessed when eliciting each of these reflexes: Biceps reflex Triceps reflex Brachioradialis reflex Quadriceps reflex Achilles reflex
Biceps reflex: C5-C6 Triceps reflex: C7-C8 Brachioradialis reflex: C5-C6 Quadriceps reflex: L2-L4 Achilles reflex: L5-S2
Denver II
method of screening for evidences of slow development in infants and preschool children. The test covers four functions: gross motor, language, fine motor-adaptive, and personal-social.
physiologically why is “crampy” associated with muscle pain?
clotication arteriole insufficiency causing pain with movemoent dur to muscle ichemia
Claudication
Pain, commonly in the legs, caused by too little blood flow, usually during exercise. Often indicates peripheral artery disease.
What can morining vs night pain indicate?
Morning (pain from not using)
Night (pain from prolonged use): OA
Dislocation:
loss of contact between 2 bones in a joint
Subluxation:
misalignment of two bones in a joint (partial dislocation)
Contracture:
shortening of muscle leading to decreased ROM (usually results from prolonged immonbility)
Crepitation:
audible and palpable crunching or grating that accompanies movement
Myaliga
Ostealgia
Arthralgia
“-aliga” = pain
muscle, bone, joint
Cephalocaudal
means head to toe
During inspection and palpation of the musculoskeletal system, what are you appreciating?
color, swelling, deformities, masses, alignment, thenderness, pain, crepitus, heat, spasms (muscles)
This is the same for all joints!!
How is muscle strength appreciated?
though passive ROM
Grading scale out of 5 (5=normal, 0= no movement)
How is CN XI tested?
turning head against resistance, shoulder shrug
Spinal column:
inspection
assess
ROM
- inspect- normal S shape standing, curved when bent at waist
- assess- spinal movement with measuring tape (+2”)
- ROM- flex/ extend (forward/ back); rotational; lateral bend
Shoulders:
ROM
muscle strength
- ROM: add/ abd (rotator cuff injury); internal (hands behind head)/ external rotation (hands at small of back); flex (bring arms straight up)/ extend (bring back down/ hyperflexion (behind)
- muscle strength (performed against resistance!): shoulder shrug (CN XI); add/ abd
Elbows:
ROM
muscle strength
-ROM: flex/ extrend; supinate/ pronate
-muscle strength (performed against resistance!)
while supporting pt. elbow with one hand: flex (biceps)/ extrend (triceps)
Wrists and Hands:
ROM
muscle strength
2 tests for carpal tunnel
- ROM: spread fingers and make a fist; touch thumb to each finger and base of pinky
- muscle strength: Finger grips, wrist flexion/ extension/ hyperflexion (performed against resistance!)
-Phalen: hold hands dorsal surface of hands together for 60s
-Tinel Sign: tap on medial nerve
Paresthesia= positive for carpal tunel
Hips:
ROM
muscle strength
- Pt. should be supine
- ROM: flex/ extension (bring knee up, then back straight); internal/ external rotation (knee bent rotate away, then toward the midline); abd/ adducction (straight leg to side and back to midline)
- Muscle Strength: straingth led raise
Leg and Knees: Palpation/ inspection ROM Muscle strength Length
- Palpation/ inspection: signs of fluid accumulation- Bulge Sign or Ballottement of Patella
- ROM: flex/ extension (bring heel back, then back to ground); Hyperextension
- Muscle strength: hamstring and quads
-Length: True- anterior iliac spine to medial malleolus;
Apparent- umbilicus to medial malleolus (abnormalities caused by pelvic)
Ankels and Feet:
ROM
Muscle strength
- ROM: dorsi/ plantar flexion; eversion/ inversion; equal and bilateral flexion/ extension of toes
- Muscle strength: walk on toes/ heels; foot pushes/ pulls
Developmental Competence: INFANTS shape of spine congenital dislocation (3 tests) ROM motor development
-C shaped spine
- Ortolani’s Manueuver (most reliable): abduction, will hear and see dislocation
- Barlow: adduction
- Allis: knee height
- ROM: through spontaneouls movement and responces to reflexes (may signal fractures)
- Denver II: motor milestones
Developmental Competence: Pregnancy
shape of spine
joints
-Lordosis
- Paresthesia; carpal tunnel
- Estrogen relaxes ligaments leading to joint instability
Developmental Competence: Older Adults
sape of spine
ADLs
Muscle strength
- Kyphosis
- Decreased height due to loss of water content and thinning of intervertebral disks
- slower at performing ADLs
- muscle strength slightly lower than adult, shoulf not be <4/5 bilaterally
When are CMS checks done for muscleoskeletal
- 6 P’s
- checks that arteries are oxygenating the lower extremities
- checks are done distal to the site of injury
- eg: after a femur break, check the toes
Osteoporosis
what is it
what is this caused by
primary vs secondary treatment
NOT a normal part of aging! But caused by factors associated with aging
- Loss of bone density
- caused by decline in estrogen related to Ca deficit, vit. D; lack of impact exercise
- Primary: fast walking
- Secondary: bone density screening (DEXA- examines density)
RA: what is it what is this caused by common clinical findings advanced stage findings
Rheumatoid Arthritis
- Inflammation of connective tissue, bilateral
- Chronic autoimmune disease (gradual onset)
- Findings: bilateral pain, edema, stiffness (espically in the morning)
- Ulnar deviation, swan-neck, boutonniere
OA: what is it what is this caused by common clinical findings Heberden's Nodes Bouchard's Nodes
OsteoArthritis
- Noninflammatory degenerative change in articular cartilage, unilateral or bilateral
- caused by repetitive movement; affects weight bearing joints
- Findings: stiffness, swelling, hard/ bony nontender protuberances, limited ROM
- Heberden’s Nodes: in distal IP joints
- Bouchard’s Nodes: in proximal IP joints
Gout: what is it what is this caused by common clinical findings: acute chronic
- A type of arthritis
- caused by increased serum uric acid due to increased productin and/ or decreased excretion (diet, renal function)
- Acute: severe throbbing joint pain; limited ROM
- Chronic: >1 attack/ yr; Tophi (uric acid deposits on ear pinna, subcutaneous tissue, or joints); kindney stones may cause flank pain and CVA tenderness
Herniated Nucleus Pulposus: what is it what is this caused by common clinical findings How to test
- Herniated/ slipped disk:
- Caused by lifting, twisting etc
-Clinical findings: L5/S1 most common: may cause lateral tilting and forward lean; numbness or radiating pain in leg.
Cervical herniation: arm pain and paresthesia
- Lasegue Test: Passive straight leg raise cause sciatic pain (the slipped disk puts pressure on spinal nerve); confirm by lifting the pt opposite leg, and notice pain in 1st leg
- DTRs may be depressed
Scoliosis:
shape of spine
clinical findings
-S shaped spine from posterior view
-Depends on severity: uneven shoulder and hip levels; rib or flak asymmetry.
Lungs, spine, pelvis may be compromised
Carpal Tunnel Syndrome what it is cause clinical findings 2 tests
-Occures when medial nerve is compressed
-caused by repetitive movements or hand/ arms, injury, systemic disorders (RA, gout, hypothyroidism).
May also occure with fluid retention that occures with pregnancy and menopause.
- clinical findings: Parethesia in hands (often at night)
- Phalen’s, Tinel’s
