Muscolskeletal Flashcards
A complete musculoskeletal examination is appropriate for??
people with articular disease, a history of musculoskeletal symptoms, or any problems with ADL’s
Completely musculoskeletal exam overview
- Head-to-toeProximal-distal
- Order of examination:
o Inspection- size and contour of every joint. Inspect the skin and tissues over the joints for color, swelling, and any masses or deformity
o Palpation- each joint including its skin for temperature, muscle, bony articulations, and area of joint capsule. Normally synovial fluids are not palpable
o ROM
o Muscle testing
Range of motion
Active ROM (voluntary)- start with this first
Passive ROM (involuntary)- proceed to this if active ROM is limited
Articular disease
- inside the joint capsule swelling and tenderness around the whole joint
- it limits all planes of ROM in both active and passive motion
Extraarticular disease
- Outside of joint capsule- tendon, ligament, nerve
- Produces swelling, tenderness to that one spot in the joint and affects only certain planes of ROM, especially during active
What is best for preventing osteopersosi
Fast walking
Objective data: hip
- Inspect for symmetry at levels of iliac crest, gluteal folds, and equal buttocks. A smooth even gait reflects equal leg lengths and functional hip movement
- Palpate the hip joints in supine position. Should feel stable and symmetric, with no tenderness or crepitus
- Limitation of abduction of hip while supine is the most common motion dysfunction found in hip disease
- Limited internal rotation of hip is an early and reliable sign of hip disease
Objective data: knee
- Inspection the person should remain supine with legs extended. Inspect lower leg alignment, should extend in the same axis as the thigh. Inspect knees shape and contour
- Palpation with the knee in supine position with complete relaxation of quadriceps. Start 10cm above patella. Note the consistency of the tissues. The muscles should be solid and the point smooth with no warmth tenderness
- When swelling occurs you need to distinguish between soft tissue swelling or increased fluid in the joint
Bulge sign
- Assess swelling in the suprapatellar pouch.
- Confirms presence of small amounts of fluid as you try to move the fluid from one side of the joint to the other
- Occurs with very small amounts of effusion 4-8 ml from fluid flowing across the joint
Ballottement
o Reliable when larger amounts of fluid are present.
- Use your left hand to compress the suprapatellar pouch to move any fluid into the knee joint.
- Push up on the patella and hold top of patella/femur with other hand.
- If you tap the patella and hear a tap it means it has bumped the epicondyles of the femur due to being suspended in lots of fluid
Objective data: spine
- Inspect for symmetry ad noting equal horizontal positions from shoulders scapulae, iliac crest, and gluteal folds
- Palpate the spinous processes
- Exaggerated lumbar lordosis is common in obese
- Palpate the paravertebral muscles
- Chronic axial skeletal pain occurs with fibromyalgia
- Lateral tilting and forward bending occur with a herniated nucleus pulposus
- Check ROM flexion of 75-90 degrees, smoothness and symmetry of movement. Low back should have concave shape in flexion
Aging adult
- Decrease in height more apparent in 8th-9th decade.
- Lengthening of arm-trunk axis
- Decrease in peripheral fat, increase in fat over abdomen and hips
- Get Up and Go Test performance > 10 second w/ hx of falls and mobility problems= increases risk for future falls
- Functional Assessment Perform with those older adults who have advanced aging changes, arthritic changes, or musculoskeletal changes
If person has chronic disability or crippling illness assess for:
o Self-esteem disturbance o Loss of independence o Body image disturbance o Role performance o Social isolation
Functional assessment components
o Bathing o Toileting o Dressing o Grooming o Eating o Mobility o Communicating
