musculoskeletal assessment Flashcards

1
Q

examples of subjective data

A

pain or discomfort, weakness, stiffness, limited movement, swelling/heat, deformity, lack of balance

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2
Q

examples of past medical history

A

MSK trauma, surgery, skeletal anomalies, chronic illness

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3
Q

how does chronic illness affect the bones

A

long term steroids can weaken the bones

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4
Q

health history tips

A

always obtain mechanism of injury, timing of pain, popping/clicking/grating, joint instability, swelling, effect on ADLs

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5
Q

what is the purpose of the MSK exam?

A

do assess function for ADLs and to screen for abnormalities

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6
Q

how should the physical exam be performed

A

head to toe, proximal to distal, bilateral comparison

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7
Q

what are the components of the MSK exam

A

inspection and palpation only

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8
Q

what should you inspect/palpate for

A
  • posture and gait
  • muscle characteristics (tone/bulk)
  • ROM
  • strength
  • joint exam
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9
Q

what is the joint exam looking for

A

tenderness, swelling, redness, heat, crepitus, reduced ROM

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10
Q

inspection of MSK includes…

A

size and contour of joint
inspection of skin and tissues for color change
swelling
any masses or deformity

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11
Q

palpation of MSK includes…

A

palpate each joint, including skin for temperature, muscles, bony articulations, and area of capsule
- joints are normally not tender

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12
Q

muscle strength testing

A

0/5- no muscle contraction
1/5- slight muscle contraction evident, no joint movement
2/5- full ROM with gravity eliminated (passive only)
3/5- full ROM with gravity
4/5- full ROM against gravity with some resistance
5/5- full ROM against gravity and full resistance

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13
Q

normal spinal curvature

A

thoracic convexity, cervical and lumbar concavity

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14
Q

abnormal spinal curvatures

A

scoliosis - lateral curve
kyphosis - hunchback
lordosis - exaggerated lumbar concavity
gait - smooth and rhythmic

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15
Q

balance and coordination tests

A

walk on heels, toes, tandem walk, sit and stand
rapid alternating movements (ex fingers to thumb and heel to shin)

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16
Q

what do balance abnormalities indicate?

A

neuro, MSK, or vestibular problems

17
Q

measuring extremities

A

muscle bulk and symmetry, strength and tone, range of motion

18
Q

expected extremities

A

symmetrical and even

19
Q

range of motion test

A

active and passive, if active ROM is full, no need to test passive
always ask patient to perform active first

20
Q

joint exam expected findings

A

bony structures aligned, full active and passive ROM, no swelling, tenderness, redness, warmth, or crepitus

21
Q

abnormalities that affect multiple joints

A

rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, osteoporosis

22
Q

shoulder abnormalities

A

atrophy, dislocated shoulder, joint effusion, tear of rotator cuff, frozen shoulder

23
Q

elbow abnormalities

A

olecranon bursitis, arthritis, rheumatoid nodules, epicondylitis

24
Q

spine abnormalities

A

scoliosis, herniated intervertebral disc

25
Q

wrist and hand abnormalities

A

ganglion cyst, colles’ fracture, carpal tunnel syndrome with atrophy of thenar eminence, ankylosis, dupuytren’s contracture

26
Q

knee abnormalities

A

osgood-schlatter disease
post-polio muscle atrophy
prepatellar bursitis
swelling of menisci

27
Q

ankle and foot abnormalitites

A

achilles tenosynovitis
tophi with chronic gout/acute gout
hallux vagus with bunion and hammer toes
plantar fascitis
ingrown toenail
plantar wart

28
Q

scoliosis exam

A
  • stand before examiner
  • anterior iliac symmetry
  • shoulder symmetry
  • bend at waist for spinal alignment and rib hump
29
Q

older adults MSK possibility

A
  • decreased bone mass
  • decreased height
  • decreased joint flexibility
  • sarcopenia
  • decreaased nutritional intake
  • osteoporosis - fractures
  • decreased strength and muscle bulk
  • decreased agility
  • calcium/vitmain D deficiency
30
Q

osteoporosis risk factors

A
  • female
  • over 50
  • thin
  • smoker
  • hypothyroid
  • alcohol use
  • calcium/vitamin D deficiency
31
Q

common diagnostic tests

A
  • CK, AST, ALT enzymes elevated with muscle injury
  • alkaline phosphatase elevated with bone injury
  • uric acid - elevated in gouty arthritis
  • x ray
32
Q

red flags in MSK assessment

A
  • inability to bear weight on extremity
  • joint out of alignment
  • sensory change distal to MSK injury
  • motor change distal to MSK injury
  • delayed cap refill or loss of pulse distal to injury
33
Q

intervention of joint assessment

A
  • PRICE
  • splint as it lays
  • do not remove protruding objects
  • clean dressing if open skin
  • monitor neurovascular status
34
Q

phalen’s and tinel’s tests test for what?

A

carpel tunnel syndrome

35
Q

phalen’s test

A

fingers falling, wrist flexion to maximum for 60 seconds
- abnormal finding; numb fingers

36
Q

tinel’s test

A

tapping over transverse carpal ligament, should not cause numbness

37
Q

symptoms of carpel tunnel syndrome

A

pain, anesthesia, paresthesia

38
Q

what to check for in neurovascular check

A

pain, sensation, skin temperature, cap refill, pulses, movement
6 P’s

39
Q

strain vs. sprain vs. fracture

A

strain - tendon and muscle
sprain - ligament
fracture - bone break