Musculoskeletal System Flashcards
question topics to ask about the client:
- problems w/ joints
Pain, stiffness, swelling,
heat, redness, limited
mobility - history of joint injury
- problems w/ muscles
Pain, cramping, weakness - bone pain
Deformity, injury, limping,
gait, back pain, hip pain - Functional assessment (ADLs), ask about each
Bathing, toileting, dressing,
grooming, eating, mobility,
communicating - occupational hazards
- older adults
subjective assessment
assistive devices
women over 65 - osteoporosis screening
aging/older adults
- Get Up and Go exam
- Tinetti Test or Performance-Oriented Mobility Assessment (POMA)
Gait
- helps determine older adults at increased risk for falling
- monitor the time it takes for the person to rise from an armchair, walk 10 ft, turn, walk back, and sit down again
- healthy older adult older than 60 would manage this test in less than 10 seconds
Get Up and Go Exam
- measures an older adult’s gait and balance abilities
- examines step length and height, gait initiation, step symmetry and continuity, straightness of the path of travel while trying to walk in a straight line, trunk position, and base of support during the period of double support.
Tinetti Test or Performance-Oriented Mobility Assessment (POMA)
- Inspection
- Palpation
- Range of Motion
goniometer - Muscle Testing
physical assessment
- Size and Contour of all joints
- Color
- Swelling
- Masses or deformity
- Atrophy of muscles
- Abnormal: effusion, bursitis, arthritis, dislocation, subluxation, contracture, ankylosis, Hebrden’s nodes,
inspection
- palpate each joint
- heat
- tenderness
- swelling
- masses
palpation
- assess ROM for all joints
- be aware about the terms for each ROM
- active and passive motion
- never force a joint past pain or stiffness
- during ROM, you must listen for crepitation
ROM
model movements
active ROM
support distal joints
passive ROM
- Test strength of prime mover
- Repeat ROM with resistance
- Strength should be equal bilaterally
- Use grading system with assessment
- Document strength with resistance
Muscle testing
- chin to chest
- chin up
- ear to shoulder
- right to left flexion
Assessing Head and Neck ROM
flexion
chin to chest
extension
chin up
lateral bending
ear to shoulder
w/ resistance - cranial nerve XI - spinal
right to left flexion
- elbow
- carpal tunnel
- osteoarthritis
- Rheumatoid Arthritis
Arms, hands, and wrist
dislocation in a joint
mostly occurs in elbow
subluxation
Carpal tunnel
breakdown of cartilage around the lower thumb joint
thenar eminence atrophy
- wrist flexion sign
- assessing for carpal tunnel syndrome (CTS)
- sitting or standing
- examiner passively flexed the patient’s wrist maximally (but not overpressure), while maintaining the shoulder in neutral and elbow in extension.
- positive: patient experiences numbness or tingling throughout the median nerve distribution of the hand within 45 seconds
- abnormal: numbness and burning w/ carpal tunnel syndrome
Phalen test
- tingling or “pins and needles” feeling you get when your healthcare provider taps your skin over a nerve.
- May be an indicator that you have nerve compression or damage where they’re tapping
- positive: tapping your nerve causes a tingling sensation to radiate through that area of your body.
- negative: no tingling sensation; doesn’t mean it’s normal
Tineal sign
generalized swelling
Heberden nodules
Bouchard nodules
assessed via physical and history examination
Osteoarthritis
bilateral swelling - boggy tender MCPs
Rheumatoid Arthritis
- Olecranon Bursitis
- Goose Egg
- Rheumaoid Nodules
- Ankylosis
abnormal findings in arm
finding in elbow - goose egg - w/ trauma, gout, or RA
Olecranon Bursitis
sign of olecranon bursitis
Goose Egg
finding in ulna and elbow - raised firm nodules
Rheumaoid Nodules
severe RA - extreme flexion of wrist
Ankylosis
- Genu varum
- Genu valgum
- Bulge sign
- McMurray test
- Hallux valgus
- Ortolani maneuver
Hips and legs
bowleg
Genu varum
knock-knees
Genu valgum
fluid in suprapatellar pouch
Bulge sign
series of movements of knees and legs to diagnose a torn meniscus
positive for torn meniscus: hear or feel a “click”
McMurray test
a.k.a. bunion
pain and stiffness in big toe
Hallux valgus
infancy to 1 yr - hip dysplasia
Ortolani maneuver
- Scoliosis
- Lordosis
- Kyphosis
Spinal assessment
s curve of spine
Scoliosis
lumbar curvature
Lordosis
thoracic curvature
Kyphosis
high diet in calcium
smoking - reduces BMD
weight baring activity increases bone density
Osteoporosis screening: DEXA
women: 65
men: 70
Health promotion
measures available ROM at joint
measures an angle or permits the rotation of an object to a definite position
goniometer
small, pea-sized bony growths that occur on the joint closest to the tip of the finger, also called the distal interphalangeal joint
Heberden nodules
Bony bumps on the middle joint of the finger
Bouchard nodules
one of the abnormal findings of ROM
audible and palpable crunching or grating that accompanies movement
crepitation
occurs w/ TMJ inflammation and Arthritis
decreased ROM
tight stretch of the muscles and tendons
strain
stretching or tearing of ligaments
sprain
broken/shattered part of bone
fracture
scale from 0 to 5
muscle test grading
None
no visible or palpable contraction
0
Trace
visible or palpable contraction w/ no motion
1
Poor
Full ROM, gravity eliminated
2
Fair
Full ROM against gravity
3
Good
Full ROM against gravity, moderate resistance
4
Normal
Full ROM against gravity, maximum resistance
5
