Musculoskeletal Flashcards
When examining, use what kind of assessment organization techniques?
- cephalocaudal: head to toe organization
- comparing one side to another
If pt presenting w/ joint pain, asses what first?
joint that doesn’t feel pain then the one that does for comparison and comfort
ROM (in general: AROM, PROM, Goal, When to do, Assessing for)
- AROM: pt can do it themselves
- PROM: nurse does it for them
- Goal: know if movement limited
- When to do: if pt presents w/ crepitus → do AROM & PROM tests
- Assess for:
- Pain
- Limited ROM
- Spastic movement
- Stability of joint
- Deformity
- Contractures
Muscle Strength: comparing one side of limbs to other (Grades 0 - 5)
- 0: no evidence of muscle contraction
- 1 (trace): evidence of slight muscle contraction, no movement though
- 2 (poor): full ROM but passive
- 3 (fair): full ROM & active but w/ no resistance
- 4 (good): full ROM & active but w/ some resistance
- 5 (norm): full ROM & active w/ full resistance
Low Back Pain In General
- Most common CC
- Rarely emergency in exceptions of…
- presenting w/ lower extremity weakness
- presenting w/ incontinence
- male and presents w/ impotence
Mechanical Lower Back Pain
- What: Aching pain in lumbosacral area that may radiate to lower leg
- Cause: work-related
- Acute & self-limiting
- Risk factors: heavy lifting, obesity, poor conditioning
Sciatica (Radicular) Lower Back Pain
- What: Shooting pain below knee (usually lateral leg or posterior calf)
- Associated S&S: paresthesia and weakness
- Cause: herniated discs
- Aggravated by: sneezing, coughing, straining during bowel movements
Chronic Back Stiffness
- Causes:
- Ankylosing spondylitis
- Diffuse idiopathic skeletal hyperostosis
- Other inflammatory diseases
Pain Referred From Abdomen or Pelvis
- What: Deep, aching pain, varying w/ origin
- Cause: digestive tract issues or endometriosis
Fx: Traverse
horizontal bone break straight through bone
Fx: Compound
Bone exposed through skin ⇒ big infection risk ⇒ life-threatening
Fx: Linear
vertical break along side of bone
Fx: Oblique Non-Displaced
slash or parallel bone beak but still aligned
Fx: Oblique Displaced
- slash or parallel bone break but bone moved out of alignment
- Commonly seen in kids
Fx: Greenstick
- bone bends and cracks a little
- not a full break at all
Fx: Stress
- Small crack in a bone caused by repeated stress or overuse
- Common in athletes
Fx: Impacted
bone breaks and broken ends are driven together by pressure
Fx: Avulsion
small piece of bone breaks away from main part of bone due to physical trauma
Fx: Segmental
at least two fracture lines separate segment of bone
Fx: Torus
incomplete bone fracture that occurs when bone bulges out instead of breaking
Vertebral Compression (What & Can be seen in)
- What: 2 bones coming together and breaks/crush against each other
- Can be seen in pts w/ osteoporosis ⇒ leads to height loss
Osteoporosis (what, S&S, risk factors, results in, health promotion)
- What: loss of bone density
- S&S: generally asymptomatic (usually caught w/ screening)
- Risk factors:
- Age: older > younger
- Gender: women > men
- Lower BMI
- Lack of weight-bearing exercises
- Ca+ or Vit D deficiencies
- Steroids can also affect bone density
- Proton pump inhibitors long-term use can cause osteoporosis
- Results in:
- Kyphosis
- Loss of Height
- Spontaneous Fx
- Health Promotion
- Ca+ supplement in postmenopausal women
- Avoiding falls
OA
- Degenerative joint disease
- Not an inflammatory condition
- Decrease cartilage
- Pain increases w/ activity
- Relieved by rest
- Pain at end of day after day’s movement
- Unilateral
- More common in weight-bearing joints
- Ie. hips, knees, fingers (distal interphalangeal (DIP) joint, proximal interphalangeal (PIP) joint)
- S&S:
- Crepitus !!!
- Heberden’s nodes (DIP)
- Bouchard’s nodes (PIP)
- Can be tender
- Sxs not as severe
- Greatest risk factor: old age
- Common in aging process
RA
- Autoimmune disease
- Inflammatory condition
- Inflammation of connective tissue (typically synovium)
- Pain increases w/ rest
- Waking up in morning in pain because of long period of resting/sleeping & need to move for hrs for pain to subside
- BIL joints affected
- More common in smaller joints
- Ie. hands (metacarpal phalanges [MCP]), wrist
- S&S:
- Ulnar deviation
- Swan-neck deformities
- Rheumatoid nodules
- Edematous joints
- Erythematous joints
- Systemic Sxs: Malaise & Fever
- Risk factor: other autoimmune diseases
More common in adults > kids & women > men
Gout (what, cause, S&Ss, onset, risk factors, common location, avoiding triggers of)
- What: another type of arthritis
- Cause: increase in uric acid
- S&S:
- Erythema
- Edema
- Stiffness of affected joint(s)
- Onset: sudden, comes and goes ⇒ give anti-inflammatory meds
- Very painful !!!
- Risk factors:
- Gender: men > women
- EtOH
- Renal disease
- Obesity
- Common location: great toe because of warm, moist environment
- Sometimes so painful and can’t bear weight on affected toe
- Avoid Triggers: Avoid purine foods
- Red meat
- Seafood
- Nuts
Spinal Column Deformities (measurement meaning, tx)
- How deviated spine is matters because if you have anything less than 5* ⇒ nothing can be done abt it
- Major deviations to point of internal thoracic cage organ changes ⇒ needs surgery or braces to straighten column
Kyphosis
- What: exaggerated outward or convex curvature of thoracic spine (hunchback)
- Results in: increase in anteroposterior diameter of chest ⇒ barrel chest
- Common in: aging
Lordosis
- What: deviation in lumbar region where lower back has exaggerated inward curve
- Common in: kids and pregnant women
Scoliosis
- What: lateral curvature of spine appearing as asymmetrical rise in thoracic region, lumbar region, or both
- Results in: elevation of one shoulder, unequal leg length changes
- Common in: children and adolescents w/ neurologic or musculoskeletal abnormalities
- Scoliosis in young child is unusual and abnormal
- Mild scoliosis in older child uncommon
- Notes:
- < 5 measurement not concerning → just monitor
Osteomyelitis (what, causes, S&Ss, Tx)
- What: inflammation or swelling of bone tissue (bone infection)
- From infection somewhere else in body that spread to bone
- Causes: bacteria, fungi, etc.
- S&S:
- Bone pain
- Night sweats
- Flu-like Sxs
- 4 signs of inflammation: Swelling, Warmth, Tenderness, Redness
- Tx: surgical removal of bone + antibiotics
Age-Related Considerations: Infants & Children (All Norm)
- Ligaments stronger than bones till adolescence
- More common to get fractures than sprains when you’re younger but the opposite when older
- Torus (buckle) and greenstick (incomplete) Fx most common
- More common to get fractures than sprains when you’re younger but the opposite when older
- Congenital hip dysplasia
- Assess in infants: lay them down and move hips ⇒ if you hear/feel clunking ⇒ need ultrasound and is treatable
- In adolescence → rapid growth results in decreased strength and flexibility (important to remain active)
- Bone growth complete ~20 yo (after that you start losing bone density)
Age-Related Considerations: Pregnant Women (All Norm)
- Ligaments relax and cartilage softens around pelvis (~12-20 wks) to accommodate for fetus
- Increased lordosis that can cause back pain
- Helps shift center of gravity as uterus continues to grow ⇒ increases fall risk
- Increased stress on muscles and ligaments of lower back ⇒ leads to very common finding on low back pain (LBP)
Age-Related Considerations: Older Adults (All Norm)
- Loss of bone density (~30% by 80 yo)
- Decreased cartilage around joints
- If you have enough degradation of cartilage → called osteoarthritis (degenerative joint disease)
- Decreased muscle mass
- Increased risk of Fx in weight-bearing joints (likely because of decreased cartilage)
- Important to maintain active lifestyle, healthy weight, balanced diet to slow progression of these changes
How to Document General OBJECTIVE Findings
- Pt sitting erect, appears comfortable
- Gait smooth and coordinated
- FROM (full ROM) observed in cervical spine, back, BUE & BLE w/o pain
- Strength 5+ in all muscles
- Vertebral column straight, shoulders aligned
Spasticity
Increased resistance that worsens at extremes of range
Rigidity
Increased resistance throughout ROM and in both directions
