Musculoskeletal (Exam 3) Flashcards
1
Q
Structure of MSK
A
bones (206), joints, muscles
5 types of connective tissue
2
Q
MSK Function
A
support
movement
protection
manufacturing RBCs
reservoir for storage of essential materials
3
Q
Bone
A
made of organic matrix and strengthened by deposits of calcium phosphates
continuous cellular remodeling
compact and cancellous
4
Q
Compact (Cortical) Bone
A
hard outer layer, dense and tough
5
Q
Cancellous (Trabecular) Bone
A
spongy inner layer, light and less dense
6
Q
Muscle
A
600, account for 40-50% of body weight
movement is produced through muscle contraction
skeletal, smooth, cardiac
7
Q
Skeletal Muscle
A
voluntary! primary focus of MSK
produce movement across a joint
composed of bundles of muscle fibers called fasciculi
muscles are connected to bones by tendons
8
Q
Joints
A
site of articulation/union of 2+ bones
functional unit of MSK
allow for mobility which is needed for ADLs
synovial and nonsynovial
9
Q
Synovial Joints
A
freely moveable
bones are separate from each other and enclosed in joint cavity
surface of bones within joint cavity are lined with resilient cartilage and are avascular
joint cavity is lined with synovial membrane
surrounded by fibrous capsules and are supported by ligaments
10
Q
Synovial Membrane
A
secretes synovial fluid which provides nourishment
11
Q
Types of Synovial Joints
A
swivel/pivot joints
ball and socket
hinge
saddle
planar/gliding
condyloid
12
Q
Types of non-synovial joints
A
fibrous
cartilaginous
13
Q
Fibrous joints
A
immovable
united by interjacent fibrous tissue or cartilage
14
Q
Cartilaginous joints
A
slightly moveable
separated by fibrocartilaginous discs
15
Q
Connective tissues
A
tendons
ligaments
cartilage
bursae
meniscus
fascia
16
Q
Tendons
A
connect muscle to bone
ex. achilles tendon to calcaneus
17
Q
Ligaments
A
connect bone to bone
ACL, PCL, MCL, LCL (knee ligaments)
18
Q
Cartilage
A
allows bones to slide over one another
reduces friction
prevents damage
absorbs shock
19
Q
Bursae
A
fluid-filled sacs in areas of friction, found within synovial joints
acts as a cushion for bones
located in knee, shoulder, elbow, hip
20
Q
Meniscus
A
cartilaginous disc between bones
acts as a cushion and absorbs shock
21
Q
Fascia
A
flat sheets that line and protect muscle fibers
also attach muscle to bone
provides structure for nerves
22
Q
Flexion
A
bending the limb at the joint
decreasing the angle between bones
brings bones together
23
Q
Extension
A
straightening of the limb at the joint
increases the angle between bones
zero degrees
24
Q
Rotation
A
turning of a joint around an axis
25
Lateral Flexion
lateral movements in the frontal plane
26
Abduction
movement away from the center of the body
27
Adduction
movement toward the center of the body
28
Circumduction
conical movement of limb extending from the joint at which the movement is controlled
**combines flexion, extension, abduction, adduction**
29
Inversion
movement of the sole towards the median plane so that the sole faces in a medial direction
30
Eversion
movement of the sole away from the median plane so that the sole faces in a lateral direction
31
Protraction
movement of body part forward and parallel to the ground
32
Retraction
movement of the body part backward and parallel to the ground
33
Elevation
raising a body part
movement in a superior direction
34
Depression
lowering a body part
movement in an inferior direction
35
Opposition
approximation of the thumb and 5th digit
36
Pronation
turning the forearm so the palm is down
37
Supination
turning the forearm so the palm is up
38
Dorsiflexion
dorsum of the foot
flexion of the ankle
39
Plantar flexion
plantar aspect of foot
extension of the ankle
**step on the gas**
40
Subjective Data: Past Medical History
fractures
injuries
falls
degenerative disease
stroke
infections
parathyroid problems
tumors/cancer
41
Subjective Data: Past Surgical History
joint replacement (*ORIF, TKA*)
surgical repair (*ACL, meniscus*)
spinal surgery
42
Subjective Data: Family History
any immediate family members with muscle, joint, or bone problems
autoimmune conditions
43
Subjective Data: Joints
pain
stiffness
swelling
heat
redness
limitation of movement
44
Subjective Data: Muscles
pain (cramps)
spasm
weakness
45
Subjective Data: Bones
pain
deformity
trauma (*fractures, dislocations, sprains/strains*)
46
Katz Index
used for ADLs
6=high (*patient independent*)
0= low (*patient very dependent*)
47
Localized Pain
monoarticular
trauma
48
Diffuse Pain
polyarticular
migratory
pattern of involvement
49
Systemic Pain
problems with joints, muscles, bones
fever, chills, rash
SLE, fibromyalgia
50
Do not confuse crepitus with..
the normal discrete crack heard as a tendon or ligament slips over bone during motion
51
Objective Data: Inspection
**COMPARE BILATERALLY**
posture
body alignment
spinal curvature?
patient stands erect, bends forward at the waist, arms hang free at sides
position of knees-patient standing erect w/feet together
symmetry and shape of muscles and joints
surgical scars from joint surgeries
52
Lordosis
inward curvature of the spine
**lumbar and cervical**
53
Kyphosis
outward curvature of the spine
**thoracic**
54
Scoliosis
lateral curvature of the spine
55
Objective Data: Muscle Tonicity
**inspect muscle tone**
symmetry
atrophy?
denervation of muscle vs disuse atrophy
spasticity vs rigidity vs flaccidity
56
5/5 Muscle Strength
normal; complete ROM, full resistance
57
4/5 Muscle Strength
good; complete ROM, moderate resistance
58
3/5 Muscle Strength
fair; complete ROM
59
2/5 Muscle Strength
poor; complete ROM with joint support, cannot perform against gravity
60
1/5 Muscle Strength
trace; muscle contraction detectable, no movement of joint
61
0/5 Muscle Strength
no visible muscle contraction
62
Objective Data: Palpation
bumps, nodules, deformities
swelling
temp/warmth
tenderness
spasm/hypertonicity
63
Objective Data: ROM
ASSESS BILATERALLY AT SAME TIME
active vs passive ROM (*don’t apply force, stop with any resistance*)
listen and feel joint (*crepitus*)
verbal and nonverbal cues
64
Crepitus
cracking or popping sound; feels like grating when palpating
65
Inspecting the temporomandibular joint
symmetry
swelling
redness
66
Palpating the temporomandibular joint
hand in front of tragus, open/close jaw
smooth and pain free movement
hinge and gliding joints
67
AROM: Temporomandibular joint
protrusion
retraction
lateral deviation
68
Strength of temporomandibular joint
oppose force during ROM
CN V
69
Inspecting the spine
from side
from the posterior
have patient bend at waist (*observe for rib hump*)
70
Palpating the spine
spinous process for bumps, tenderness, deformities, and crepitus
71
AROM: Spine
flexion
extension
lateral flexion
rotation
72
Strength of the Spine
strength against resistance
73
Inspecting the shoulder
symmetry
swelling
atrophy
74
Palpating the shoulder
muscle tone
palpable clicks or pops
75
AROM: Shoulder
flexion
extension
abduction
adduction
internal rotation
external rotation
circumduction
76
Strength of the shoulder
shrug shoulders (*CN XI, spinal accessory*)
full ROM against resistance
77
Inspecting the elbow
olecranon bursa for swelling
78
Palpating the elbow
support forearm, flexed to 70°
identify epicondyles (*medial and lateral*)
palpate for pain or tenderness
79
AROM: Elbow
flexion
extension
pronation
supination
80
Strength of the elbow
flex and extend against resistance
81
Inspecting the wrist and hand
inspect fingers and joints for alignment, thenar wasting, scars, deformity
82
Palpating the wrist and hands
palpate joints of the wrist and hand using thumbs while holding patients hand in yours
83
AROM: Wrist and hands
flexion
extension
ulnar/radial deviation
finger abduction/adduction
opposition
84
Strength of wrist and hands
ROM against resistance
grasp strength
85
Inspecting the hip
inspect while standing and sitting
assess weight bearing
86
Palpating the hip
palpate hip joints, iliac crest, and muscle tone
87
AROM: Hips
flexion
extension
rotation (internal/external)
abduction/adduction
88
Inspecting the Knee
inspect for swelling, tenderness, deformity, symmetry, lesions
89
Palpating the knee
palpate patella
palpate tibial margins
clicking, popping, crepitus
90
AROM: Knees
flexion
extension
hyperextension
91
Strength of the knee
strength against resistance
squat and rise
92
Inspecting the ankles and feet
inspect for swelling, tenderness, deformity, symmetry and lesions
93
Palpating the ankles and feet
muscle tone
achilles tendon
interphalangeal joints
anterior/posterior ankle
94
AROM: Ankles and feet
dorsiflexion
plantar flexion
inversion/eversion
95
Strength of the ankles and feet
strength against resistance
“step on the gas”
“pull your foot up”
96
Back Pain
most common MSK complaint
most vulnerable part of skeleton is **L5-S1**
97
Falls
65+, falls are leading cause of injury related death
at least 95% of hip fractures among older adults are related to falls
98
Falls are associated with..
poor balance
prior falls
poor muscle strength
unfamiliar environment
aging
99
Fall Assessments/Intervention in hospitals
functional status
prior falls?
timed up and go
100
Osteoporosis
bone reabsorption is faster than deposition; weakened bone increases risk for fracture
**M: fractures, sudden pain, falls, kyphosis**
101
Risk factors for osteoporosis
small bone frame
younger age at menopause
sedentary lifestyle
tobacco use
alcohol
inadequate diet
102
Osteoarthritis
deterioration of joint cartilage and new bone; onset older than 50 in women, 40-50 in men
*localized, progressive, noninflammatory*
**stiffness worse later in the day, rest relieves pain**
bouchard node, heberden node
103
Rheumatoid arthritis
chronic inflammation of synovial membrane leads to thickening and fibrosis; onset 20-40
*systemic, autoimmune, inflammatory, bilateral and symmetrical*
**stiffness worse in the morning**
swan-neck, boutonnière, ulnar deviation
104
Bursitis
inflammation of bursa; can follow injury, infection or rheumatic condition
*more common in shoulders, elbows, and hips*
**swelling, tenderness, and increased pain with movement**
105
Joint Dislocation
ends of bones slip out of usual position, usually sports related injury; requires med intervention (manipulation and meds)
**severe dislocation can cause tearing of muscles, ligaments and tendons**
*pain, swelling and immobility of affected joint*
106
MSK Health Promotion and Teaching
diet
exercise
osteoporosis screening
fall prevention
107
Diet
decrease risk of osteoporosis by eating a diet rich in dark green leafy and deep yellow veggies
*tell patient to “eat the rainbow”*
**diet low in fried foods helps to lower fat mass and promote bone mass acccrual**
108
Calcium intake
dairy
juices
breakfast foods
soy milk
vitamin D enriched foods
109
Vitamin D deficiency
regulates Ca and P in body; plays an important role in maintaining proper bone structure
**low vitamin d has been associated with muscle weakness thus falls and frailty**
110
Tobacco and alcohol use
smoking reduces bone mineral density (BMD)
excess drinking increases risk for falls
111
Exercise
physical activity delays and prevents bone loss (avoid sedentary lifestyle!)
2-3 days a week up to 5 days a week for 30 min.
112
Osteoporosis Screening
DEXA SCAN; women should get a bone mineral density scan by age 65, men by 70
*BMD measurement by DEXA is best predictor of future hip fracture risk*
**FRAX-computerized fracture risk algorithm developed by WHO**
113
Fall prevention: Cycle of falling
1. fear of falling
2. inactivity
3. physical deconditioning
4. increased risk of falling
5. fall
114
Pregnant Women
increased joint mobility from increased hormone production
increased mobility of pelvic joints cause changes in posture (*lordosis compensates for enlarging uterus*)
115
Infants
fetus forms a cartilaginous skeleton by 3 months
all muscle fibers present at birth but lengthen with growth (*continues until 21*)
116
Barlow maneuver
tests for developmental dysplasia of the hip in infants
may hear a “pop” with hip dislocation
117
Ortolani maneuver
done at each visit until 1 year old
tests for developmental dysplasia of the hip
118
Allis test
check for hip dislocation by comparing leg lengths in infants
119
School age children
pes planus (flat feet) **pathological pronation**
toeing in (pigeon toed) **walking on lateral side of foot**
radial head subluxation (*nursemaids elbow*)
120
Adolescents
growth hormone, adrenal androgens, testosterone (*boys only*) contribute to growth spurts
kyphosis common due to poor posture
sports related injuries
121
Older Adults
decreased bone density
increased boney prominence
cartilage degeneration
joint stiffness
muscle atrophy
postural changes (*hyperkyphosis*)
functional assessment for ADLs
