Musculoskeletal Flashcards
42% of people who have osteoporosis are
men
Why is it a good idea to start osteoporosis screening and prevention in adolescence?
because women gain their greatest bone before they start their menstrual cycle
When you’re examining a joint, it has to be
at rest
Joints should not be tender to
palpation
active ROM should equal
passive ROM
Boggy joints
When the joint lining begins to grow abnormally, it may give a joint a mushy, doughy texture
If the patient can only move against gravity, assign Grade
3
Ask the patient to move actively against your opposing resistance; assign Grade ___ if the patient overcomes your opposing movement
5
3 movements of the TMJ
- hinge action which opens and closes the jaws
- gliding action for protrusion and retraction
- gliding for side-to-side movement of the lower jaw
swelling, tenderness, decreased ROM of TMJ indicates
some kind of inflammation or arthritis
The TMJ opens and closes about ____ times a day
2,000
2 tests for carpal tunnel:
- Phalen’s test
2. Tinel’s sign
median nerve provides sensation to
the palm of the hand, the palmar surface of the thumb, the 2nd and 3rd fingers and ½ of the 4th finger
carpal tunnel
sheath through the wrist where all of the extensor and flexor tendons come through – if you have carpal tunnel, you get numbness and tingling in all these areas
osteoarthritis (degenerative joint disease)
arthritis of aging
A patient who presents to clinic complaining of hand pain says she was told by a friend that it is most likely carpal tunnel syndrome. Upon assessing the patient, you note the following findings. Which would be suggestive of carpal tunnel syndrome?
A. Hand pain when holding both hands in acute extension
B. Numbness and tingling when tapping over the course of the radial nerve
C. Symptoms related to compression are evident in all of the fingers
D. None of the above
D.
depression
lowering a body part
elevation
raising a body part
retraction
moving a body part backwards and parallel to the ground
protraction
moving a body part forward and parallel to the ground
rotation
moving the head around a central axis
eversion
moving the sole of the foot outward at the ankle
inversion
moving the sole of the foot inward at the ankle
circumduction
moving the arm in a circle around the shoulder
supination
turning the forearm so that the palm is up
pronation
turning the forearm so that the palm is down
adduction
moving a limb towards the center/the midline
abduction
moving a limb away from the midline of the moving
extension
straightening a limb at a joint
flexion
bending a limb at a joint
muscles account for how much of our body weight?
40-50%
3 types of muscle
- skeletal
- smooth
- cardiac
skeletal muscle
voluntary, under our conscious control
each skeletal muscle is composed of bundles of muscle fibers and is attached to bones by tendons
bursae
small fluid-filled sacs lined by synovial membrane with an inner capillary layer of viscous fluid that provides a cushion between bones and tendons and/or muscles around a joint.
ligaments
fibrous connective tissue that connects bones to other bones
tendons
tough bands of fibrous connective tissue that connects muscle to bone and is capable of withstanding tension
cartilage
firm but flexible connective tissue that is softer and much more flexible than bone
non-synovial joints
bones are united by fibrous tissue or cartilage and are either immovable or slightly moveable
example of slightly moveable non-synovial joints
vertebrae
example of fibrous non-synovial joints
sutures in our skull that close off after 2-3 years of age
2 kinds of non-synovial joints
fibrous joints
cartilaginous joints
avascular cartilage
layer of resilient cartilage that covers the surface of opposite bone - avascular means it has no blood supply- gets nourishment from synovial fluid that circulates during the joint movement
very stable with slow cell turnover
3 types of synovial joints
ball and socket joints
hinge joints
condylar joints
2 main examples of ball and socket joints
hip
shoulder
3 main examples of hinge joints
hand, feet, elbows
2 main examples of condylar joints
knee and TMJ
joint (articulation)
union of two or more bones
functional units of the musculoskeletal system b/c they allow us to be mobile
4 functions of the musculoskeletal system
- supports the body and allows for movement
- encases and protects vital organs
- produces red blood cells in the bone marrow
- reservoir for storage of essential minerals like calcium and phosphorus
skeleton
bony framework of the body with 206 bones
bone characteristics
hard, rigid, very dense
cells are continually turning over and remodeling
3 kinds of interphalangeal joints
distal (DIP)
proximal (PIP)
metacarpophalangeal joints (MCP)
Over half the bones of the body are in
the hands and feet
swelling, heat, and redness are signs of
acute inflammation
What do we call pain that goes away when you rest?
intermittent claudification
myalgia
muscle aches
arthralgia
bone/joint pain
issues that are present bilaterally in arms could be
compression of the spinal column
example of a one joint (monoarticular) problem
gout
Order of musculoskeletal exam
Inspect, Palpate, Range of Motion, Muscle Tension
steps for ROM portion of physical exam
stabilize joint and ask for active range of motion
if you see any limitation, do passive ROM
active ROM should equal passive ROM
crepitation
a crackling or rattling sound
the Glenohumeral joint is surrounded by
the rotator cuff muscles
Heberden’s nodules
occur on the DIP
Bouchard’s nodes
occur on the PIP
Rheumatoid arthritis
autoimmune disease
Tender, painful, stiff joints (can affect any joint in the body)
symmetric involvement
Proximal interphalangeal (PIP) and metacarpophalangeal joints (MCP) involvement – DIPS are usually not involved
Boutonniere deformity
a deformed position of the fingers or toes, in which the joint nearest the knuckle (PIP) is permanently bent toward the palm while the farthest joint (DIP) is bent back away
Swan Neck Deformity
deformed position of the finger, in which the joint closest to the fingertip is permanently bent toward the palm while the nearest joint to the palm is bent away from it (DIP hyperflexion with PIP hyperextension)
Ulnar deviation
a hand deformity in which the swelling of the metacarpophalangeal joints (the big knuckles at the base of the fingers) causes the fingers to become displaced, tending towards the little finger
the knee joint is the articulation of which 3 bones?
femur, tibia, and the patellar (kneecap) bone
True or false: the knee joint is the largest in the body
True
suprapatellar pouch
the extension of the knee joint cavity above the patella, extends up as much as 6 cm behind the quadriceps muscle
2 landmarks of the ankle joint
medial malleolus and lateral malleolus
temporomandibular joint (TMJ)
articulation of the mandible and the temporal bone
You can feel the TMJ in
the depression that’s anterior to the tragus of the ear
spine has how many vertebrae?
33:
7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 3-4 in our coccyx
C7 and T1 are prominent at
the base of the neck
inferior or bottom angle of the scapula is normally between
T7 and T8
the imaginary line at the iliac crests is around
L4
intervertebral discs
elastic, fibrocartilaginous plates that constitutes about ¼ of the length of the column
each intervertebral disc center has a ____ made of soft mucoid material that has the consistency of toothpaste
nucleus pulposus
if compression is too great, disc can
rupture, and nucleus pulposus can herniate – this causes a great deal of pain
4 motions of vertebral column
flexion (bending forward)
extension (bending backwards)
abduction to either side
rotation
the large subacromial bursa helps during
abduction of the arms
Glenohumeral Joint is the articulation of the
humerus with the glenoid fossa of the scapula
3 bony articulations of the elbow joint
humerus bone, radius, and ulna of the forearm
olecranon bursa lies
between the olecranon process and the skin - can lead to a golf ball-size swelling on the elbow
palpable landmarks of the elbow joint
medial and lateral epicondyle of the humerus and then the large olecranon process of the ulna in between them
sensitive ulnar nerve runs between the
olecranon process and the medial epicondyle – when we bang on it, we get tingling down our hand
radius and ulna articulate with each other at the
radioulnar joints, one at the elbow and one at the wrist
midcarpal joint
articulation between the two parallel bones of carpal bones
flexor tendons of the wrists and hands are enclosed in
synovial sheaths coming up towards the fingers
hip joint
ball and socket joint that’s the articulation between the acetabulum and the head of the femur
you should be able to feel the entire ___ during the hip exam
iliac crest
ischial tuberosity lies under the ____ and is palpable when ____
gluteus maximus; the hip is flexed
greater trochanter of the femur is normally the width of
the person’s palm
where is the greater trochanter of the femur located?
below the iliac crest and halfway between the anterior superior iliac spine and the ischial tuberosity
medial and lateral meniscus
two wedge-shaped cartilages that cushion the tibia and the femur
knee joint is stabilized by which 2 sets of ligaments
cruciate ligaments
collateral ligaments
cruciate ligaments
crisscross within the knee and give anterior and posterior stability and help control rotation
collateral ligaments
connect the joint at both sides, give medial and lateral stability and prevent dislocation
infrapatellar fat pad
small triangular fat pad below the patella and behind the patella ligaments
ankle joint
tibiotalar joint, is the articulation of the tibia, fibula and talis
the ankle joint is a hinge joint that’s limited to
dorsiflexion and plantarflexion
eversion or inversion sprains of the angle can tear the
strong, tight medial and lateral ligaments that extend from each malleolus onto the foot
subtalar joint
joint distal to the ankle that permits inversion and eversion of the foot
foot has a very long longitudinal arch with weight bearing that’s distributed between
the two parts that touch the ground (metatarsals and calcaneus which is the heel)
toddlers have a ___ spine, which means
Lordotic ; belly is pushed forward
At birth, babies have a ___ shaped spine
C
In young childhood: Rate of muscle growth speeds up around __ years
2
In infancy, muscles are about __% of body weight
25
Scoliosis is a lateral curve of the spine that can be screened with a
scholiometer
Scoliosis is more dangerous if child is
pre-pubescent
3 ways to check for Hip Dysplasia in babies
Barlow maneuver (adduct hip, push thigh posteriorly) – if positive, hip goes out of socket
Ortolani maneuver (abduct thighs and apply downward measure) - if positive, “clunk” means unstable and that the hip has been reduced
Trendelenburg Gait - colateral side drops
Genu Valgum: “Knock-need” is a normal finding until ___ years
7
Genu Valgum: “Knock-need” is correctable until age
9
Genu Varum: “Bowlegged” is a normal finding until age
2.5-3
For Genu Varum “Bowlegged” refer if
the angle is acute
if there is 15cm between knees
3 causes of intoeing
- From the hip
(Femoral ante version - Caution on child’s seated position) - From the tibia
(Tibial tortion, Knees still face forward) - From the foot
(Metatarsus Adductus, Distal half of the foot points in)
Disappearing baby reflexes
Palmar grasp (disappears at two months)
Placing / stepping (disappears at 2-4 months)
Rooting / Sucking (disappears at 3-4 month)
Moro (disappears at 3-6 months)
Tonic Neck (disappears at 7-8 months)
Plantar Reflex (disappears at 8-10 months)
Babinski (disappears as baby beings walking, ~ 12 months
3 main Abnormal Childhood Reflexes
- Oppenheimer
- Chaddock’s
- Snouting
Oppenheimer Abnormal Childhood Reflex
Reflex hammer down interior calf
Positive (abnormal): Big toe fans out
Chaddock’s Abnormal Childhood Reflex
Reflex hammer moved distally along outer foot
Positive (abnormal): Big toe fans out
Snouting Abnormal Childhood Reflex
Reflex hammer placed on philtrum (upper lip)
Positive (abnormal): Lips and nose scrunch up
