musculoskeletal and nuero Flashcards
development competence of infants and children
Growth plates close at 20 years old
developmental competence with pregnancy
Low back strain – lordosis
developmental competence of the aging adult
Osteoporosis – decreased estrogen
* To reduce risk: physical activity, maintain health body weight, recommended dose of calcium and vitamin D
Height decreases and kyphosis
Loss of muscle mass
subjective data of musculoskeletal and neuro
Joints: pain, stiffness, swelling, heat, redness,
limitation of movement
Knee joint (if injured)
Muscles: pain (cramps) or weakness
Bones: pain, deformity, trauma (fractures,
sprains, or dislocation)
Functional assessment (ADLs)
Patient-centered care
preparations for the physical exam
Purpose of musculoskeletal examination is to assess function for ADLs and to screen for abnormalities
Take an orderly approach: head to toe, proximal to distal, and from midline outward
Perform bilateral comparison
Be aware of normal and abnormal findings
Order: Inspection, palpation, ROM (active to passive), strength
objective data for the shoulder
Shoulder
Pain can be from local cause or referred
Local pain is reproducible and more likely
musculoskeletal
objective data for the elbow
Elbow
Palpate slightly flexed with support
Full extension can usually r/o fracture
objective data for the wrist and hand
Wrist and Hand
Swelling bilateral or unilateral?
Carpal tunnel syndrome tests
objective data for the hip
Hip
Gait smooth and even?
objective data of the knee
Knee
Bulge sign
Signs of osteoarthritis
Signs of ligament or meniscal injuries
objective data of the ankle and foot
Ankle and Foot
Swelling, pain or inflammation?
objective data of the spine
Check ROM of spine:
Touch toes
* If you suspect spinal curvature during inspection, this may be more clearly seen when person touches toes
Bend sideways and backwards
Twist to one side then the other
These maneuvers reveal gross restrictions only; movement is still possible even if some spinal fusion has occurred
health promotion and patient teaching
Focus on the following areas:
Diet to protect and maintain healthy bones calcium & vitamin D
Smoking cessation
Alcohol intake pattern
Exercise promotion
Osteoporosis Screening
Fall prevention
Rheumatoid Arthritis vs Osteoarthritis
Osteoarthritis (OA) is a degenerative condition caused by wear and tear of joint cartilage, while rheumatoid arthritis (RA) is an autoimmune disease where the immune system attacks the joint lining
common musculoskeletal abnormalities
- Dislocated shoulder
- Tear of rotator cuff
- Olecranon bursitis
- Epicondylitis
- Carpal tunnel syndrome
- Gout
- Developmental dysplasia of hip
Musculoskeletal Examination
Inspection
Size and contour of joint
Skin color and characteristics
Palpation of joint area
Skin, muscles, bony articulations, and joint capsules
ROM
Active
Passive (if limitation noted in active ROM is present)
Muscle testing
Inspect and Palpate Motor System: Muscles
Size
Inspect all muscle groups for size noting bilateral comparison.
Strength
Test muscle groups of extremities, neck, and trunk
Tone: normal tension in relaxed muscles
Persuade the person to relax completely and move each extremity smoothly through a full range of motion; normally note mild, even resistance to movement
Involuntary movements
Normally none occur; if present, note location, frequency, rate, and amplitude; note if movements can be controlled at will
the coordination assessments
Rapid Alternative Movements (RAM)
Thumb-to-finger
Finger-nose-finger test
Heel-to-shin test
the types of balance tests
Observe their gait
Heel-to-toe walk (tandem walking)
Romberg
sensory assessments
Pain
Hypoalgesia
Analgesia
Hyperalgesia
Light touch
Hypoesthesia
Anesthesia
Hyperesthesia
kinesthesia
position
stereognosis
tactile discrmination
graphesthesia
“read” number on the skin
extinction
touch felt at the same time
deep tendon reflexes and grade
Limb needs to be supported and muscles
relaxed
Reflex response graded on 4-point scale:
4 = very brisk, hyperactive with clonus, indicative of disease
3 = brisker than average, may indicate disease
2 = Average, normal
1 = diminished, low normal, or occurs with reinforcement
0 = no response
the types of deep tendon reflexes
Biceps
Triceps
Brachioradialis
Quadriceps (knee jerk)
Achilles (ankle jerk)
Positive “Babinski” Reflex
Normal in infants up to 2 years old
Abnormal finding in adults
Technique: stroke finger up lateral edge and
across ball of foot, toes should “fan out”
myoclonus
short series of jerks at regular
intervals
chorea
sudden, quick, jerky movement at
irregular intervals
tremors
Tremors – rhythmic involuntary contractions,
disappear while sleeping
seizures
Seizure disorders – epilepsy
+ LOC
Tonic phase – muscle rigidity
Clonic phase – violent muscular contractions
Postictal – deep sleep, fatigue, confused
romberg test
The patient stands with their feet together and eyes open.
The patient closes their eyes and stands still for 30 seconds.
The examiner observes the patient’s ability to maintain balance
a positive test is when they lose balance with the eyes closed
