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Health Assessment > Musculoskeletal (Exam 3) > Flashcards

Musculoskeletal (Exam 3) Flashcards

1
Q

Structure of MSK

A

bones (206), joints, muscles

5 types of connective tissue

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2
Q

MSK Function

A

support
movement
protection
manufacturing RBCs
reservoir for storage of essential materials

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3
Q

Bone

A

made of organic matrix and strengthened by deposits of calcium phosphates
continuous cellular remodeling

compact and cancellous

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4
Q

Compact (Cortical) Bone

A

hard outer layer, dense and tough

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5
Q

Cancellous (Trabecular) Bone

A

spongy inner layer, light and less dense

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6
Q

Muscle

A

600, account for 40-50% of body weight
movement is produced through muscle contraction

skeletal, smooth, cardiac

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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

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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

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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

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10
Q

Synovial Membrane

A

secretes synovial fluid which provides nourishment

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11
Q

Types of Synovial Joints

A

swivel/pivot joints
ball and socket
hinge
saddle
planar/gliding
condyloid

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12
Q

Types of non-synovial joints

A

fibrous
cartilaginous

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13
Q

Fibrous joints

A

immovable
united by interjacent fibrous tissue or cartilage

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14
Q

Cartilaginous joints

A

slightly moveable
separated by fibrocartilaginous discs

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15
Q

Connective tissues

A

tendons
ligaments
cartilage
bursae
meniscus
fascia

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16
Q

Tendons

A

connect muscle to bone

ex. achilles tendon to calcaneus

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17
Q

Ligaments

A

connect bone to bone

ACL, PCL, MCL, LCL (knee ligaments)

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18
Q

Cartilage

A

allows bones to slide over one another
reduces friction
prevents damage
absorbs shock

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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

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20
Q

Meniscus

A

cartilaginous disc between bones
acts as a cushion and absorbs shock

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21
Q

Fascia

A

flat sheets that line and protect muscle fibers
also attach muscle to bone
provides structure for nerves

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22
Q

Flexion

A

bending the limb at the joint
decreasing the angle between bones
brings bones together

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23
Q

Extension

A

straightening of the limb at the joint
increases the angle between bones
zero degrees

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24
Q

Rotation

A

turning of a joint around an axis

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25
Q

Lateral Flexion

A

lateral movements in the frontal plane

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26
Q

Abduction

A

movement away from the center of the body

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27
Q

Adduction

A

movement toward the center of the body

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28
Q

Circumduction

A

conical movement of limb extending from the joint at which the movement is controlled

combines flexion, extension, abduction, adduction

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29
Q

Inversion

A

movement of the sole towards the median plane so that the sole faces in a medial direction

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30
Q

Eversion

A

movement of the sole away from the median plane so that the sole faces in a lateral direction

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31
Q

Protraction

A

movement of body part forward and parallel to the ground

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32
Q

Retraction

A

movement of the body part backward and parallel to the ground

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33
Q

Elevation

A

raising a body part
movement in a superior direction

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34
Q

Depression

A

lowering a body part
movement in an inferior direction

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35
Q

Opposition

A

approximation of the thumb and 5th digit

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36
Q

Pronation

A

turning the forearm so the palm is down

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37
Q

Supination

A

turning the forearm so the palm is up

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38
Q

Dorsiflexion

A

dorsum of the foot
flexion of the ankle

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39
Q

Plantar flexion

A

plantar aspect of foot
extension of the ankle

step on the gas

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40
Q

Subjective Data: Past Medical History

A

fractures
injuries
falls
degenerative disease
stroke
infections
parathyroid problems
tumors/cancer

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41
Q

Subjective Data: Past Surgical History

A

joint replacement (ORIF, TKA)
surgical repair (ACL, meniscus)
spinal surgery

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42
Q

Subjective Data: Family History

A

any immediate family members with muscle, joint, or bone problems
autoimmune conditions

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43
Q

Subjective Data: Joints

A

pain
stiffness
swelling
heat
redness
limitation of movement

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44
Q

Subjective Data: Muscles

A

pain (cramps)
spasm
weakness

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45
Q

Subjective Data: Bones

A

pain
deformity
trauma (fractures, dislocations, sprains/strains)

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46
Q

Katz Index

A

used for ADLs

6=high (patient independent)
0= low (patient very dependent)

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47
Q

Localized Pain

A

monoarticular
trauma

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48
Q

Diffuse Pain

A

polyarticular
migratory
pattern of involvement

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49
Q

Systemic Pain

A

problems with joints, muscles, bones
fever, chills, rash
SLE, fibromyalgia

50
Q

Do not confuse crepitus with..

A

the normal discrete crack heard as a tendon or ligament slips over bone during motion

51
Q

Objective Data: Inspection

A

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
Q

Lordosis

A

inward curvature of the spine

lumbar and cervical

53
Q

Kyphosis

A

outward curvature of the spine

thoracic

54
Q

Scoliosis

A

lateral curvature of the spine

55
Q

Objective Data: Muscle Tonicity

A

inspect muscle tone

symmetry
atrophy?
denervation of muscle vs disuse atrophy
spasticity vs rigidity vs flaccidity

56
Q

5/5 Muscle Strength

A

normal; complete ROM, full resistance

57
Q

4/5 Muscle Strength

A

good; complete ROM, moderate resistance

58
Q

3/5 Muscle Strength

A

fair; complete ROM

59
Q

2/5 Muscle Strength

A

poor; complete ROM with joint support, cannot perform against gravity

60
Q

1/5 Muscle Strength

A

trace; muscle contraction detectable, no movement of joint

61
Q

0/5 Muscle Strength

A

no visible muscle contraction

62
Q

Objective Data: Palpation

A

bumps, nodules, deformities
swelling
temp/warmth
tenderness
spasm/hypertonicity

63
Q

Objective Data: ROM

A

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
Q

Crepitus

A

cracking or popping sound; feels like grating when palpating

65
Q

Inspecting the temporomandibular joint

A

symmetry
swelling
redness

66
Q

Palpating the temporomandibular joint

A

hand in front of tragus, open/close jaw
smooth and pain free movement
hinge and gliding joints

67
Q

AROM: Temporomandibular joint

A

protrusion
retraction
lateral deviation

68
Q

Strength of temporomandibular joint

A

oppose force during ROM
CN V

69
Q

Inspecting the spine

A

from side
from the posterior
have patient bend at waist (observe for rib hump)

70
Q

Palpating the spine

A

spinous process for bumps, tenderness, deformities, and crepitus

71
Q

AROM: Spine

A

flexion
extension
lateral flexion
rotation

72
Q

Strength of the Spine

A

strength against resistance

73
Q

Inspecting the shoulder

A

symmetry
swelling
atrophy

74
Q

Palpating the shoulder

A

muscle tone
palpable clicks or pops

75
Q

AROM: Shoulder

A

flexion
extension
abduction
adduction
internal rotation
external rotation
circumduction

76
Q

Strength of the shoulder

A

shrug shoulders (CN XI, spinal accessory)
full ROM against resistance

77
Q

Inspecting the elbow

A

olecranon bursa for swelling

78
Q

Palpating the elbow

A

support forearm, flexed to 70°
identify epicondyles (medial and lateral)
palpate for pain or tenderness

79
Q

AROM: Elbow

A

flexion
extension
pronation
supination

80
Q

Strength of the elbow

A

flex and extend against resistance

81
Q

Inspecting the wrist and hand

A

inspect fingers and joints for alignment, thenar wasting, scars, deformity

82
Q

Palpating the wrist and hands

A

palpate joints of the wrist and hand using thumbs while holding patients hand in yours

83
Q

AROM: Wrist and hands

A

flexion
extension
ulnar/radial deviation
finger abduction/adduction
opposition

84
Q

Strength of wrist and hands

A

ROM against resistance
grasp strength

85
Q

Inspecting the hip

A

inspect while standing and sitting
assess weight bearing

86
Q

Palpating the hip

A

palpate hip joints, iliac crest, and muscle tone

87
Q

AROM: Hips

A

flexion
extension
rotation (internal/external)
abduction/adduction

88
Q

Inspecting the Knee

A

inspect for swelling, tenderness, deformity, symmetry, lesions

89
Q

Palpating the knee

A

palpate patella
palpate tibial margins
clicking, popping, crepitus

90
Q

AROM: Knees

A

flexion
extension
hyperextension

91
Q

Strength of the knee

A

strength against resistance
squat and rise

92
Q

Inspecting the ankles and feet

A

inspect for swelling, tenderness, deformity, symmetry and lesions

93
Q

Palpating the ankles and feet

A

muscle tone
achilles tendon
interphalangeal joints
anterior/posterior ankle

94
Q

AROM: Ankles and feet

A

dorsiflexion
plantar flexion
inversion/eversion

95
Q

Strength of the ankles and feet

A

strength against resistance

“step on the gas”
“pull your foot up”

96
Q

Back Pain

A

most common MSK complaint
most vulnerable part of skeleton is L5-S1

97
Q

Falls

A

65+, falls are leading cause of injury related death

at least 95% of hip fractures among older adults are related to falls

98
Q

Falls are associated with..

A

poor balance
prior falls
poor muscle strength
unfamiliar environment
aging

99
Q

Fall Assessments/Intervention in hospitals

A

functional status
prior falls?
timed up and go

100
Q

Osteoporosis

A

bone reabsorption is faster than deposition; weakened bone increases risk for fracture

M: fractures, sudden pain, falls, kyphosis

101
Q

Risk factors for osteoporosis

A

small bone frame
younger age at menopause
sedentary lifestyle
tobacco use
alcohol
inadequate diet

102
Q

Osteoarthritis

A

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
Q

Rheumatoid arthritis

A

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
Q

Bursitis

A

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
Q

Joint Dislocation

A

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
Q

MSK Health Promotion and Teaching

A

diet
exercise
osteoporosis screening
fall prevention

107
Q

Diet

A

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
Q

Calcium intake

A

dairy
juices
breakfast foods
soy milk
vitamin D enriched foods

109
Q

Vitamin D deficiency

A

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
Q

Tobacco and alcohol use

A

smoking reduces bone mineral density (BMD)

excess drinking increases risk for falls

111
Q

Exercise

A

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
Q

Osteoporosis Screening

A

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
Q

Fall prevention: Cycle of falling

A
  1. fear of falling
  2. inactivity
  3. physical deconditioning
  4. increased risk of falling
  5. fall
114
Q

Pregnant Women

A

increased joint mobility from increased hormone production
increased mobility of pelvic joints cause changes in posture (lordosis compensates for enlarging uterus)

115
Q

Infants

A

fetus forms a cartilaginous skeleton by 3 months
all muscle fibers present at birth but lengthen with growth (continues until 21)

116
Q

Barlow maneuver

A

tests for developmental dysplasia of the hip in infants
may hear a “pop” with hip dislocation

117
Q

Ortolani maneuver

A

done at each visit until 1 year old
tests for developmental dysplasia of the hip

118
Q

Allis test

A

check for hip dislocation by comparing leg lengths in infants

119
Q

School age children

A

pes planus (flat feet) pathological pronation
toeing in (pigeon toed) walking on lateral side of foot
radial head subluxation (nursemaids elbow)

120
Q

Adolescents

A

growth hormone, adrenal androgens, testosterone (boys only) contribute to growth spurts
kyphosis common due to poor posture
sports related injuries

121
Q

Older Adults

A

decreased bone density
increased boney prominence
cartilage degeneration
joint stiffness
muscle atrophy
postural changes (hyperkyphosis)
functional assessment for ADLs

Health Assessment (19 decks)

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