Musculoskeletal assessment Flashcards
What is the musculoskeletal system
- Bones, muscles, and joints
- controlled by the nervous system
- contains calcium and phosporus
Purpose of the musculoskeletal system
provide structure and movement for body parts
Structure and Function: Bones
- Provide structure, protection, serve as levers, store calcium, and produce red blood cells
- 206 bones in the body
- Long bones, Short bones, Flat bones, irregular bones
- bones are constantly building and remodeling w/ osteoclast and osteoblast
- bones contain red and yellow bone marrow
- living tissue, needs blood supply
Long bone examples
humerus & tibia
Short bone examples
metatar(car)pals & filanges
Flat bone examples
Sternum & ribs
Irregular bone examples
vertebrae & sacrum
Osteoclast
- clean up crew
- breakdown old bone
Osteoblast
- building crew
- build new bone
Structure and function: Joints
- place where two or more bones meet
- 3 types of joints: Synarthoses, Amphiarthroses, and synovial
purpose: provide range of motion - needs further investigation if joint has a color change or joint deformity*
Synarthrotic Joints
- Connects two bones with fibrous connective tissue
- immovable
- ex. sutures between skull bones
Amphiarthrotic joints
- Joining of bone together via cartilage
- ex. vertebrae
Diarthroses(Synovial) joints
- Bones attach together via ligaments
- Have a space between bone-filled synovial fluid
- ex. shoulders, wrist, knees
How does the musculoskeletal system stay attached?
- Cartilage, Ligaments, and Tendons
Cartilage
- smooth, elastic connective tissue that cushions around the joint
- rib cage, nose, vertebral discs
Tendons
- Fibrous connective tissue attaches muscles to bone
- MUSCLE TO BONE
Ligaments
- Fibrous tissue that connects most moveable joints
- Allow freedom of movement but strong to prevent overextension
- BONE TO BONE
Structure and Function: Muscle
- Skeletal muscles attaches to bone via tendons
- 3 types: skeletal, smooth, and cardiac
Skeletal muscle
Purpose: movement, posture, body heat
- surrounds skeletal system(bones)
Smooth muscle example
- digestive system
Cardiac muscle example
- muscles surrounding the heart
Motor Nervous system
- controls the movement of the musculoskeletal system
- Autonomic: controls involuntary muscles
- Somatic: controls voluntary skeletal muscles
What is the purpose of osteoclast
- To breakdown old or damaged tissue
Which type of joint provides the greatest range of motion and protects the joint with a fluid-filled space
Synovial
Which connects muscles to bone
Tendons
Health history of Musculoskeletal assessment
- Past health history
- family history
- lifestyle and health practices
- ADL’s
- Medication
Exercise can increase bone density T or F,
Low calcium can increase bone density T or F
True, False
Steps of Musculoskeletal assessment
- Posture
- Gait
- Bone structure
- Muscle function
- Joint mobility
Considerations for assessment
- ensure client has the ability to participate and follow directions
- ensure they are healthy enough to safely participate, adapt as nec.
- provide clear, simple directions
- Demonstrate movements first
Passive ROM
Someone helping moving muscles
Active ROM
Independently moving muscles
Steps of assessment: Joints
- inspect: size, shape, color, symmetry
- Palpate: for edema, heat, tenderness, and pain
- Test each joint’s ROM
- Demonstrate and ask client to return demo
Steps of assessment: Muscles
- Test muscle strength by asking client to move extremity through full ROM against resistance
- Will apply resistance with our hands
- DO NOT FORCE
Steps: Posture and body alignment
- observe: cervical thoracic and lumber curve from the side and from behind
- Note: symmetry, differences in height, buttock crease midline, iliac crest height symmetry
-Palpate: along the spinous process - Note: tenderness and pain
What things can cause posture problems?
- slouching
- sitting all-day
- being overweight
- bad shoes
- muscle weakness
- visual difficulties
- poor core muscles
assessment: Spine
- Assess spinal curvature while standing and while bending at the waist
- look for scoliosis, kyphosis, and lordosis
Assessment: Gait
- observe posture, sitting and standing
- observe gait
- look at base of support, weight bearing stability, foot position, stride and cadence, arm swing, posture
- baseline is what is normal for the patient
Assessing Balance
- Walk heel to toe
- Walking on heel
- Drop knee bend
- Hop on one foot
- Romberg test
- DO NOT ASSESS IF PATIENT CAN’T WALK*
Assessing Coordination
- Finger-thumb opposition
- Supinating and pronating hand rapidly
- Rhythmic toe tapping
- Run the heel of one foot down the shin of the other leg
- if one can’t do maybe a cerebellum disorder*
Expected findings: coordination
movements are preformed smoothly and in a coordinate way
Developmental variations: coordination
Older adults may present with decreased coordination due to slower nerves and loss of muscle tone
Assessment: TMJ
- Flex and extend
- move side to side
- protrude and retract
ROM: Neck
cervical spine ROM
- Flexion: touch chin to chest
- Hyperextension: look up
- Rotation: turn head side to side
- Lateral bending: bring ear towards shoulder on each side
ROM: Spine
Thoracic spine ROM
- Flexion: ask client to bend forward and touch toes
- Extension: ask client to bend backward
- Lateral flexion: ask client to bend sideways
- Rotation: ask client to turn each way, legs straight
Assessment: Shoulder
- Inspect: symmetry, color, swelling/masses
- Palpate: tenderness or swelling
ROM
Shoulder ROM
- Flexion: straight arms above head
- Hyperextension: Straight behind back
- Abduction: arms straight, above to make triangle
- Adduction: arms straight, down and across body
- Circumduction
- external: bring arm to shoulder level and bend at elbow at right angle, move up, fingers pointed upward
- internal: bring arm down so finger are downward - repeat with resistance to test strength
Steps of assessment: elbows
- inspect: size, shape, deformities, swelling, redness
- palpate: tenderness, nodules
ROM: Elbows
- Flexion: With arm straight and palm supine bring palm toward the face
- Extension: Keep palm supine and bring palm down
- Supination and pronation: bring elbows to sides and make 90 degree angle with elbow, SOUP PLEASE
- repeat with resistance
assessment: Wrist
-Inspect: size, shape, deformities/nodules, swelling, and redness
- Palpate: tenderness and nodules
ROM: Wrists
- Flexion: palm down, make a 90 degree angle downward, KITTIE PAWS
- Extension: hold out hand with palm down, extend hand up and make 70 degree angle upward, STOP
Steps of assessment: Hands
- Inspect: size, shape, symmetry, swelling, and color
- Palpate: palpate each finger, note tenderness/ nodules
ROM: Hands
- Abduction: Spread fingers
- Adduction: Bring fingers together
- Flexion: Make a fist
- Extension: Extend the hand
- Hyperextension: Hold hand prone and extend fingers upas far as they can go
Assessing Strength: Hands
- hold out two fingers and have patient squeeze
- measure bilaterally to compare strength on each side
ROM: Thumb
- Extension: thumb up and away from fingers
- Flexion: thumb to touch base of small finger
Opposition: bring thumb to each finger on same hand
Assessment: Hips
- Inspect: symmetry, shape of hips, for a thoracic curve or lumbar curve
- Palpate: stability and tenderness
ROM: Hips
- Have client lay down*
- Flexion: raise extended leg
- Extension: Bend knee up to chest with opposite leg extended
- Rotation: Turn bent knee inward, then outward
Assessment: Knees
- Inspection: Size, symmetry, swelling, deformities, alignment
- Palpate: Begin 10cm above patella, use fingers and thumb to move downward over and around the knees
- note: tenderness, warmth, consistency, and nodules
ROM: Knees
- Ask client to stand*
- Flexion: bend knee, bringing foot up towards butt
- Extension: Straighten the knee> kick someone
- repeat with resistance
Assessment: Ankles and feet
- Inspection: note position, alignment, shape, color
- palpation: palpate ankles, feet, and toes
- Note: tenderness, swelling, bony prominences, nodules
ROM: Ankles and feet
- Dorsiflexion: point toes up
- Plantar flexion: point toes downward
- Eversion: Turn soles outward
- Inversion: Turn soles inward
- Adduction: Turn foot inward
- Abduction: Turn foot outward
- repeat with resistance
Pediatric Considerations: Newborn/ infant
- Assess the clavicle of newborn, often breaks during birth
- Infants learn to sit up by 8 mo
- Spine will have a single C shape for first 3 mo
- Cervical spine curve begin 3-4 mo
- should be able to move all extremities
- Legs appear bowed but should be able to straighten them
Pediatric Considerations: Toddler
- Walk with a wide gait, swayed walk, protruding abdomen
- lumbar spine will develop, as walking advances 12-18mo
- Leg bowing will decrease by 2-3 y.o. or as the add more weight
- Flat arch is normal
Pediatric Considerations: Child
- S-shaped spine similar to adults
- Flexible spine, good muscle tone
- Gait and leg appearance similar to adult
- foot arch develops
Pediatric Considerations: Adolescents
- Assess back, hips, and shoulder height
- Screening for scoliosis should begin in middle school and through high school
Older Adult considerations
- loss of bone density
- articulating cartilage deterioration
- changes in muscle and redistribution of fat
- joint stiffness
- kyphosis and decrease in height
- vertebral changes and inflexibility
- cartilage breakdown> reason height decreases
Osteoporosis
- a decrease in bone density due to osteoclast activity outpacing osteoblast
- bone resorption increases
- calcium absorption decrease
- Production of osteoclasts decreases
1/10 people over age 50 have osteoporosis
Osteoporosis mostly occurs in men T or F
False, it mostly occurs in women
Osteoporosis two main risk factor groups
Uncontrollable risk factors and Modifiable risk factors
Uncontrollable risk factors
- age, sex, genetics, family history
- menopause/hysterectomy, RA, long-term glucocorticoid therapy
Modifiable risk factors
-Alcohol, smoking, caffeine use, low BMI, poor nutrition, eating disorders
- low calcium intake, insufficient exercise
Osteoporosis: Primary prevention
- Balanced diet
- Mineral supplements> if levels are low
- Weight-bearing exercise
- Avoiding tobacco
- Alcohol in moderation
Osteoporosis: Secondary prevention
- Osteoporosis screening
Decreased estrogen levels after menopause increase risk of osteoporosis T or F
TRUE
Health promotion activities
- Healthy diet
- Weight management (mobility is key)
- Activity> increased activity increases bone density
- Fall preventions
- Avoid smoking and drinking alcohol
Abduction
Move away from midline
adduction
Move towards midline
Circumduction
Move in a circular motion
Pronation
Turning down
Supination
Turning up
Internal rotation
turning toward body
external rotation
turning away from body
Inversion
Moving inward
Eversion
Moving outward
Extension
Straightening extremity by the joint
flexion
Bending the extremity at the joint (which decreases the angle at the joint)
ex. bending your arm
Hyperextension
Joint bends more than 180 degrees
Protraction
Moving forward (so moving your head forward at the neck)
Retraction
Moving backward (so moving head backward at the neck)
Rotation
Turning a bone on its own long axis
Dorsal flexion
Toes draw up toward the ankle
Plantar flexion
Toes point away from the ankle
