Musculoskeletal System Flashcards
What should you ask if someone presents with an injury?
“Has this ever happened before, how was it treated?”
When does the evaluation of a musculoskeletal injury happen?
- The moment you first lay eyes on the patient
*observe them when they’re unaware
If a patient has full AROM is there a reason to do PROM
No
If there is restricted AROM is there a reason to test PROM
Yes
*is the motion due to pain or physical restriction
How must you test limbs
Compare bilaterally
What can warmth indicate while palpating
Infection
*always need to rule out
What tends to be warmer proximal or distal limbs?
Proximal
*bc distal has terminal blood supply
What does bogginess feel like
- Spongy
- Mushy
- Often present with infection
When beginning to palpate what side should you palpate first
- Work towards the painful area, dont start there
*examine contralateral side first
How to document ROM
- FROM/ROM intact
- Record if any movement or plane is limited
- Record degree of limitation
What are the two types of ROM
AROM
*patient is moving limb
PROM
*provider is moving limb for patient
What factors influence ROM
- Patients willingness to move
- Muscular strength
- Motor control
- Osteoligamentous stability (any torn ligaments)
- Available joint motion (contracture, bone spurs)
How does instability occur
- Results from deficiency in a joint stabilizing structure
*joint can dislocate
*joint may move in an unnatural way
What is laxity
looseness of a joint, but may not be serve enough to cause instability
*double jointed
What are the grade 0-2 of strength
0 = no muscular contraction detected
1 = barely detectable flicker or trace of contraction
2 = active movement of the body part with gravity eliminated
What are grades 3-5 of strength
3 = active movement against gravity (cant move against pressure)
4 = active movement against gravity and some resistance
5 = “normal” active movement against full resistance without even dent fatigue
What is the correct way to document strength
Full or 5/5
What is the most active joint in the body
Temporomandibular joint
*opens and closes up to 2,000 times /day
How is the TMJ formed
- By the fossa and articular tubercle of the temporal bone and the condylomata of the mandible
- Midway between the external acoustic meatus and Zygomatic arch
What is the muscles of mastication innervated by>
CN V
What type of joint is the TMJ
Condylar synovial joint
*fibrocartilaginous disc
*synovial membrane
What does swelling, tenderness and decreased ROM of the TMJ indicate
Arthritis
How to palpate the TMJ
- Place index fingertips anterior to tragus
- As patient open mouth, fingertips will drop into the joint spaces
*asses for smoothness of motion, clicking, or snapping
How to test for ‘glide’ ‘hinge’ ‘protrusion and retraction’
Glide = upper portion
Hinge = lower portion (open and close jaw)
Protrusion and retraction = jut the jaw forward
How to test for lateral movement of the jaw and how many fingers should fit vertically in the mouth
Lateral = move jaw side to side
Three fingers should fit
*bottom teeth should be in front of top teeth with mandibular protrusion
What to palpate when inspecting the spine
- Vertebral processes and para spinal musculature
What is kyphosis, lordosis, and scoliosis
Kyphosis = excessive curvature of the thoracic spine
Lordosis = excessive curvature of the lumbar spine
Scoliosis = lateral “s” shape curvature of the spine with twisting
What is normal curvature of the neck
Cervical lordosis
What causes poker straight neck
Inflammation of the neck muscles
How to test ROM of the cervical spine
Flexion
*chin to chest
Extension
*tilt head back as far as possible
Lateral flexion
*touch ear to shoulder
Rotation
*look over shoulder and touch chin to shoulder
What to test first with the cervical spine
Asses ROM then asses motion against resistance for strength testing
What type of normal curvature does the thoracic spine have?
Mild kyphotic curvature
*20 to 40 degrees