Musculoskeletal Flashcards
What are the skeletal muscle movements?
Flexion:
- Bending a limb in a joint
Extension:
- Straightening a limb in a joint
Abduction:
- Moving away a limb from away midline of the body
Adduction:
- Moving a limb toward the midline of the body
Pronation:
- Turning the forearm so that palm is down
Supination:
- Turning the forearm so that the palm is up
Circumduction:
- Moving the arm in a circle around the shoulder
Inversion:
- Moving the sole of the foot inwards
Eversion:
- Moving the sole of the foot outwards
Rotation:
- Moving the head in the central axis (Side to side)
Protraction:
- Moving a body part forward and parallel to the ground
Retraction:
- Moving a body part backward and parallel to the ground
Elevation:
- Raising a body part
Depression:
- Lowering a body part
Steps to performing the musculoskeletal system assessment and what to assess for?
- Inspection
- size and contour of the joint
- check for color, swelling, masses, or deformity
- Palpation
- note any heat, tenderness, swelling, or masses
- palpate the skin, muscles, bony articulations, joint capsule
- synovial membrane should not be palpable; when thickened it feels doughy or boggy
- Range of motion test
- active and passive should be the same in normal joints
- should not cause any tenderness, pain, or crepitation
- muscle testing
- should be equal bilaterally and should be able to fully resist force
- grade muscle strength
- 0 - no contraction
- 1 - slight contraction
- 2 - passive movement only
- 3 - full ROM with gravity
- 4 - full ROM with gravity; can resist some force
- 5 - full ROM with gravity; can fully resist force
- When doing muscle assessment we have to do a full head-to-toe assessment we compare both sides.
Inspection, palpation, ROM, and muscle strength test for TMJ and expected values?
Inspection
- should have no swelling; equal size
- Place the tips of your first two fingers in anterior of each ear (front), and ask the patient to open and close the mouth
palpation
- Smooth movement of jaw;
- no crepitus, tenderness, swelling, heat, masses
- always ask pt if they feel any tenderness
- Patient open their mouth and close it and clench it
ROM
- open/close mouth maximally (Vertical Motion)
- 3-6 cm
- move jaw from side to side (lateral deviation)
- 1-2 cm
- open mouth partially, and stick lower jaw out (Protrusion without deviation)
- n/a
Strength
- pt to clench teeth, and palpate temporalis and masseter muscle bilaterally
- should have equal size, strength, and firmness
- ask pt to move jaw side to side while applying resistance
- ask pt to stick jaw forward while applying resistance
Inspection, palpation, ROM and muscle strength test for the (Cervical spine) neck and expected values?
inspection
- neck should hold head upright
- Spine should be straight
palpation
- palpate the spinous processes, trapezius, Sternomastoid, and paravertebral muscles
- should not cause tenderness
- spasms, masses, atrophy, asymmetry, swelling, heat should not be present
ROM
- chin to chest (flexion)
- 45 degrees
- chin to ceiling (hyperextension)
- 55 degrees
- “no” (rotation)
- 70 degrees
- touch ears to shoulder (lateral Bending) (Tell the patient to not lift the shoulder)
- 40 degrees
strength
- test lateral flexion strength
- test rotation strength
Inspection, palpation, ROM and muscle strength test for shoulders and expected values?
inspection
- inspect and compare both shoulders posteriorly and anteriorly
- check size and contour of the joint and equality of bony landmarks
- inspect for redness, muscular atrophy, asymmetry, and swelling
palpation
- bilaterally palpate the clavicle, acromioclavicular joint, subacromial bursae, glenohumeral joint, greater tubercle of the humerus, biceps groove and the scapula
- palpate the pyramid axilla as well
- note for any spasms, tenderness, swelling, masses, heat,
ROM
cup hands over shoulders while pt performs first 2 ROM to check for crepitation
- forward flexion
- 180 degrees
- hyperextension
- 50 degrees
- internal rotation
- 90 degrees
- external rotation
- 90 degrees
- abduction
- 180 degrees
- adduction
- 50 degrees
strength
- test forward flexion
- test abduction strength
- test shrug strength while pt is sitting down
Inspection, palpation, ROM and muscle strength test for elbows and expected values?
inspection
- check the size and contour of elbow in both flexed and extended position
- both side of the elbow should be presenting hollow
- note for swelling, redness, and deformities
palpation
- go one elbow at a time; support elbow to create a 70 deg angle
- palpate the olecranon process and lateral and medial epicondyles
- tissues and fat pads feel fairly solid
- note for warmth, swelling, bogginess of synovial membrane, tenderness, nodules
ROM
- flexion
- 150-160 degrees
- extension
- 0 degrees
- pronation
- 90 degrees
- supination
- 90 degrees
strength
- test flexion strength
- test extension strength
Inspection, palpation, ROM and muscle strength test for wrist, hand, carpals, and phalanges and expected values?
inspection
- inspect both palmar and dorsal sides noting the position, contour and shape
- no swelling, nodules, redness, deformity
- skin looks smooth, knuckle wrinkles present (otherwise would indicate swelling)
- Muscles are full, with the palm showing a rounded mound proximal to the the thumb (thenar eminence) and a smaller rounded mound proximal to the little finger
- Make sure the wrist is align to the hand
palpation
- palpate each joint in the wrist and hands
- palpate each metacarpophalangeal joint and interphalangeal joint
- Use thumb and index finger to palpate the interphalangeal joints by pinching it
-Make sure metacarpal has depression on the joint surfaces - joints should have no swelling, warmth, nodules, tenderness, and synovial thickening
ROM
Palmar flexion
- 90 degrees
- Hyperextension
- 70 degrees
- bend at fingers up
- 30 degrees
- bend at fingers down
- 90 degrees
- ulnar deviation
- 55 degrees
- radial deviation
- 20 degrees
- spread fingers apart (abduction)
- 20 degrees
- ask pt to make a fist
- ask pt to touch thumb to each finger and at base of pinky
strength
- test muscle strength in palmar flexion with forearm supine
Inspection, palpation, ROM and muscle strength test for hips and expected values?
inspection
- inspect the hip joint together with the spine as the patient stands
- Noting the Pts iliac crests, gluteal folds, and equal-sized buttocks to be symmetrical
- Ask the patient to walk couple of steps to check their Gait a smooth even gait will indicate that they have equal leg length and functional hip motion
palpation
- Palpate the pelvis of the Pt in a supine position
- should feel stable, symmetrical, and no tenderness and no crepitation
ROM
- flexion with knee straight
- 90 degrees
- flexion with knee bent
- 120 degrees
- internal rotation
- 40 degrees
- external rotation
- 45 degrees
- abduction
- 40-45 degrees
- adduction
- 20-30 degrees
- ask pt to stand up and test hyperextension while you stabilize hips
- 15 degrees
Inspection, palpation, ROM and muscle strength test for knees and expected values?
inspection
- Pt is in a supine position
- Inspect the lower leg alignment should extend the same axis as the thigh
- Inspecting the contour and shape of the knee
- The knee should present hollow either side of patella
- should have no swelling, redness, nodules, asymmetry, atrophy, and lesions (lesions appear in psoriasis)
palpation
- Start high on the anterior thigh about 10 cm above the patella at the quads; both quads should be symmetrical, nontender
- use grasping motion
- muscles and soft tissues should feel solid, smooth, no warmth, tenderness, synovial thickening, and nodularity
- Also palpating the suprapatellar pouch
ROM
- flexion
- 130-150 degrees
- extension
- 0 degrees
- hyperextension
- 15 degrees
- test extension strength by asking pt to squat
- ask pt to sit back down, and test flexion strength by pulling leg while pt tries to flex kneexxx
Inspection, palpation, ROM and muscle strength test for spine and expected values?
inspection
- spine should be straight, upright, and in-line with gluteal cleft when looking from behind
- shoulders and iliac crests should be equally elevated as well
- from the side, the natural spinal curves should be present
- there should be equal spaces between the arms and the lateral thorax
- Patient’s knees and feet should be aligned with the trunk and should be pointing forward
palpate
- palpate the spinous processes, paravertebral muscles
- no swelling, nodularity, tenderness, warmth, spasm
ROM
- flexion
- 75-90 degrees
- extension
- 0 degrees
- hyperextension
- 30 degrees
- lateral flexion, while you stabilize pt’s hips
- 35 degrees
- rotation, while you stabilize pt’s hips
- 30 degrees
Inspection, palpation, ROM and muscle strength test for ankles and feet and expected values?
inspection
- inspect bilaterally
- feet should point forward and be in-line with the lower legs and thighs
- toes should all point forward
- no redness, swelling, nodularity, edema (especially in the lateral and medial malleoli, and tibia)
- note if pt is flat-footed or has normal arches
- skin has even colouring and no lesions
- check for calluses or bursar reactions
-examine shoes
palpation
- grasp foot with both hands, and palpate using both thumbs
- ankles should show no signs of edema, swelling, warmth, tenderness, nodularity
- toes should have no nodules, swelling, warmth, tenderness,
- use a pinching motion for interphalangeal joints
ROM
- point toes to floor (plantar flexion)
- 45 degrees
- point toes to ceiling (dorsiflexion)
- 20 degrees
- inversion
- 30 degrees
- eversion
- 20 degrees
strength
- test plantar flexion strength
- test dorsiflexion strength
- ask patient to spread toes and to clench them
