Musculoskeletal Assessment Flashcards
What are the types of connective tissue found in this assessment?
cartilage tendons ligaments bursae meniscus fascia
What types of bones are there?
compact
cancellous
What types of joints are there?
fibrous
cartilaginous
synovial
Define Synovial Joints.
freely movable because they have bones that are separated from each other and are enclosed in a joint cavity. This cavity is filled with a lubricant (synovial fluid). Just like grease on gears, synovial fluid allows sliding of opposing surfaces, and this sliding permits movement.
Define Bursa.
an enclosed sac filled with viscous synovial fluid, much like a joint. Bursae are located in areas of potential friction (subacromial bursa of the shoulder, prepatellar bursa of the knee) and help muscles and tendons glide smoothly over bone
What is the difference between ligaments and tendons?
Ligaments are fibrous bands running directly from one bone to another that strengthen the joint and help prevent movement in undesirable directions.
Tendons are a strong fibrous cord that attaches skeletal muscle to bone
Flexion
bending a limb at a joint
Extension
straightening a limb at a joint
Abduction
moving a limb away from the midline of the body
Adduction
moving a limb toward the midline of the body
Pronation
turning the forearms so that the palm is down
Supination
turning the forearm so that the palm is up
Circumduction
moving the arm in a circle around the shoulder
Inversion
moving the sole of the foot inward at the ankle
Eversion
moving the sole of the foot outward at the ankle
Rotation
moving the head around a central axis
Protraction
moving a body part forward and parallel to the ground
Retraction
moving a body part backward and parallel to the ground
Elevation
raising a body part
Depression
Lowering a body part
Discuss the TMJ
- the articulation of the mandible and the temporal bone
- permits the jaw function for speaking and chewing
What 3 motions does the TMJ allow for?
- hinge action to open and close the jaws
- gliding action for protrusion and retraction
- gliding for side-to-side movement of the lower jaw
Discuss the Spine
- 33 vertebrae
- 7 cervical
- 12 thoracic
- 5 lumbar
- 5 sacral
- 3 or 4 coccygeal vertebrae
- has four curves
- intervertebral disks (absorbs shock, helps with movement)
What types of movement can the spine allow?
Flexion (bending forward)
Extension ( bending back)
Abduction (to either side)
Rotation
What is the rotator cuff? (shoulder)
a group of four powerful muscles and tendons that support and stabilize the glenohumeral joint (of the shoulder)
What is the glenohumeral joint? (shoulder
-the glenohumeral joint in the articulation of the humerus with the glenoid fossa of the scapula. Its ball-and-socket action allows great mobility of the arm on many axes.
What is the Subacromial bursa? (shoulder)
helps during abduction of the arm so that the greater tubercle of the humerus moves easily under the acromion process of the scapula
Discuss the elbow.
permit pronation and supination of the hand and forearm
Discuss the Wrist and Carpals.
Radiocarpal joint
- thumb and carpals joint
- its condyloid action permits movement in two planes at right angles: flexion and extension, side to side deviation
Midcarpal Join
- between the two parallel rows of carpals
- allows for flexion, extension, and some rotation
Metacarpophalangeal and interphalangeal Joints
-permit finger flexion and extension
the flexor tendons of the wrist and hand are enclosed in synovial sheaths
Discuss the Hip
- ball in socket
- permits wide ROM on many axes
Discuss the knee.
- largest joint of the body
- hinge joint
- permits flexion and extension of the lower leg on a single plane
- its synovial membrane is the largest in the body
- menisci provide cushion for the tibia and femur
Discuss the Ankle and Foot.
Tibiotalar Joint
- hinge joint
- dorsiflexion (flexion) and plantar flexion (extension)
Subtalar Joint
-permits inversion and eversion of the foot
How does the spine curve?
- in a double S shape
- cervical and lumbar curves are concave (inward/anterior)
- thoracic and sacrococcygeal curves are convex
Musculoskeletal systems of infants and children
- 3 months gestation : scale model of skeleton made out of cartilage
- bone growth occurs rapidly during infancy and steadily during childhood
- epiphyses (growth plates) where lengthening of the bones occur
- at birth spine has single C shape
Musculoskeletal systems of pregnant women
- increased hormones can cause increased mobility of the joints (think of pelvis/pubic symphysis and birth)
- Lordosis (curvature in back which compensates for enlarging Fetus)
- anterior flexion of the neck and slumping of the shoulder girdle are other postural changes that compensate for the Lordosis.
- back pain, nerve pressure
Musculoskeletal systems of the aging adult
- osteoporosis/ decreased bone density
- increased bony prominences
- cartilage degeneration
- joint stiffness and lax ligaments
- muscle atrophy
- kyphosis
- get shorter/postural changes
Compare the bones of men to the bones of women.
men have larger and stronger bones than women
Who has the highest risk of developing problems from loss of bone density?
Caucasian women (osteoporosis)
What age group is more prone to injuries? why?
children, teenagers
related to risky behavior
What subjective data should be collected during the musculoskeletal assessment.
- Joints (pain, stiffness, swelling, heat, redness, limitation of movement)
- Muscles (pain, cramps, weakness)
- Bones (pain, deformity, trauma: fractures, sprains, dislocations)
- Functional Assessment (activities of daily living)
- Self-care behaviors
Smoking increases the risk of what musculoskeletal issue?
increased risk of developing vertebral fracture
Alcohol increases the risk of what?
osteoporosis because alcohol raises parathyroid hormone with affects calcium activity in the body
What is osteomyelitis ?
inflammation/infection of the bone
why is a history of polio significant ?
can cause one leg to be shorter than the other, walk with a limp
what is myalgia?
felt as cramping or aching feeling
Compare the timings of the pains experienced with RA, Osteoarthritis and tendinitis.
RA pain is worse in the morning when arising
Osteoarthritis is worse later in the day
Tendinitis is worse in the morning and improves during the day
Movement increases most joint pain except in…
RA, in which movement decreases pain
Compare how RA and other musculoskeletal illnesses affect specific joints.
RA involves symmetric joints, other musculoskeletal illnesses involve isolated or unilateral joints.
When does RA stiffness occur?
during the morning and after rest periods
What may decreased ROM be due to?
joint injury to cartilage or capsule
or
to muscle contraction
what kind of illnesses is myalgia often seen with?
viral illnesses
what does the functional assessment do?
screens the safety of independent living, the need for home health services, and quality of life
What are some common musculoskeletal symptoms?
pain/discomfort weakness stiffness or limited movement deformity lack of balance and coordination
What do we inspect during a musculoskeletal assessment?
posture gait and mobility balance coordination extremities (size, shape, and limb measurements only if there is an issue)
What do we palpate during a musculoskeletal assessment?
Joints
- contour
- size
-ROM
Muscles
-tone
-strengthAtony
lack of normal muscle tone or strength
Hypotonicity
diminished tone of skeletal muscles
Spasticity
hypertonic, so the muscles are stiff and movement awkward
Fasciculation
involuntary twitching of muscle fibers
Tremors
involuntary contraction of muscles
Describe the rating scale for muscle strength
5/5 100% Normal
-complete ROM against gravity and full resistance
4/5 75% Good
-complete ROM against gravity and moderate resistance
3/5 50% Fair
-complete ROM against gravity
2/5 25% Poor
-complete ROM with the joint supported; cannot perform RPM against gravity
1/5 10% Trace
-muscle contraction detectable but no movement of the joint
0/5 0% Zero
-no visible muscle contraction
Describe how you would collect objective data of the TMJ
Inspection
-symmetry, swelling, and redness
Palpation
-joint while having the patient open and close jaw
ROM
-open mouth, push jaw forward, move from side to side
Muscle strength
-do the above while exerting force
Describe how you would collect objective data of the Cervical Spine
Inspection
-observe for concave curve of the cervical spine
Palpation
- for the spinous process C7
ROM
- touch chin to chest
- look up toward the ceiling
- touch each ear to the shoulder
- turn chin to shoulder
Muscle Strength
-rotate neck against the resistance of hand
Describe how you would collect objective data of the shoulder
Inspection
-comparison of each shoulder for size and contour
Palpation
-note any muscular spasm, atrophy, swelling, heat or tenderness
ROM
-forward flexion, extension, hyperextension, adduction, abduction, internal and external rotation
Muscle Strength
-shrug shoulders, flex forward and upward and abduct against resistance
Describe how you would collect objective data of the Elbow
Inspection
-size and contour while extended and flexed
Palpation
-with joint flex to 70 degrees - olecranon process and medial lateral epicondyles
ROM
-Flex, extend pronate and supinate
Muscle Strength
-while applying resistance flex and extend
Describe how you would collect objective data of the wrist and hand
Palpation
-each joint using thumbs
ROM
-flexion and extension, radial ulnar deviation and thumb opposition
Muscle Strength
-perform ROM with resistance
Describe how you would collect objective data of the Hip
Inspection
- while standing assess for symmetry
- while Supine assess for swelling, lacerations, lesions, deformity, size of muscle and symmetry
Palpation
-while supine palpate hip joints, iliac crest, and muscle tone
ROM
-flexion, extension, abduction, adduction, internal rotation, external rotation
Muscle Strength
-pressure upon flexion and abduction
Describe how you would collect objective data of the knee
Inspection
-standing and sitting for contour and shape
Palpation
-while flexed and quad for muscle tone; palpate patella
ROM
-flexion and extension
Muscle Strength
-apply pressure upon extension
Describe how you would collect objective data of the ankle and foot
Inspection
-sitting and standing for symmetry, swelling, lacerations, deformity
Palpation
-each joint
ROM
-dorsiflexion, plantar flexion, eversion and inversion flexion, hyperextension and extension of the toes
Muscle Strength
-dorsiflexion and plantar flexion against resistance
Describe how you would collect objective data of the thoracic and lumbar spine
Inspection
-while standing inspect from the side for normal S pattern
Palpation
-spinous processes
ROM
-flexion, extension, hyperextension, and lateral flexion
