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Health Assessment > Musculoskeletal System > Flashcards

Musculoskeletal System Flashcards

1
Q

What are we going to ask when we have a patient that comes in with joint pain?

A 
Joint 
Pain  (OLDCART)
Mechanism
Stiffness-think osteoarthritis(unilateral, wear and tear discrete, geriatrics), bone spurs, cartilage not a lot of nerve fibers.
Edema
Erythema/heat
Deformity
Decreased movement
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2
Q

Rheumatoid Arthritis

A

bilateral, systemic, inflammatory,hands and smaller joints, edema, erythema, thickening of synovial membrane, distorted, deformity, late stage or fractures, dislocations or subluxations, come out all the way.

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3
Q

ligament

A

bone to bone.

sprain a ligament

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4
Q

tendon

A

bone to muscle

strain a tendon or a muscle

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5
Q

muscle

A

Myalgia-statins for cholesterol can cause these. zithro cause achilles tendon rupture
Muscle weakness

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6
Q

Past health history/family history

A

Past Health History
Orthopedic surgery
Autoimmune disorders
Fractures-osteoporosis prone to these in vertebrae, hip, low bone density
Medications
Alcohol use
Smoking history - these last two impair healing

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7
Q

Gait/balance

A 
Ambulates on own, steady gait
Ambulates on own, unsteady gait
Ambulates with assistance, cane
Ambulates with assistance, walker
Walker and wheelchair
Wheelchair only
Bedfast
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8
Q

Range of Motion (ROM)

Active Vs. Passive

A

Active vs. Passive ROM
Active: Patient moves joints through ROM
Passive: You move relaxed joints through ROM

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9
Q

Upper and Lower extremities ROM

A 
Normal:
Full ROM
Abnormal:
Limited ROM
Immoble: contracture-post stroke-hypertension of muscle, pt should be doing passive stretching, tendon shortens needs to wear splint
Flaccid- no tone
Contractured
-if not moving properly do full assesment
-if moving well do not
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10
Q

Shoulder ROM

A 
Flexion
Extension
Abduction
Adduction-full goes all the way across body
External Rotation
Internal Rotation
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11
Q

Elbow ROM

A

Flexion
Extension
Supination
Pronation

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12
Q

Wrist/hands/fingers ROM

A 
Wrist
Wrist Flexion
Wrist Hyperextension
Radial deviation
Ulnar deviation
Fingers
Finger flexion
Finger hyperextension
Finger abduction
Make a fist
Finger opposition
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13
Q

Hip ROM

A 
Flexion
Hyperextension
Internal rotation
External rotation
Abduction
Adduction
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14
Q

Knee ROM

A

Flexion
Extension
Extension can also be demonstrated by success in rising from low chair or rising from squat without support

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15
Q

Ankles/feet ROM

A 
Plantar flexion-down
Dorsiflexion-up
Eversion-toe down
Inversion-pinky down
Toe flexion
Toe extension
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16
Q

Spine ROM

A 
-Cervical
Flexion
Extension	
Left Rotation
Right Rotation
Left Lateral Flexion
Right Lateral Flexion
-Lumbar
Flexion
Hyperextension
Left Rotation
Right Rotation
Left Lateral Flexion
Right Lateral Flexion
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17
Q

Postoperative-Orthopedic

A

document which joint

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18
Q

The C in CMS

A 
C = Color/Circulation
Color
Expected color, cyanotic, mottled, reddness
Capillary Refill
Brisk, sluggish
<3 seconds
Temperature
Warm to touch, cool to touch
Peripheral pulses
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19
Q

The M in CMS

A

M = Movement/Motor

Able to move fingers, able to move toes

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20
Q

The S in CMS

A

S = Sensation

Sensation to touch intact, numbness/tingling to touch, no sensation to touch

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21
Q

Postoperative-Orthopedic Special Tests: Homan’s sign

Plantar/flexion Pain

A

presence of calf pain, sharply dorsi flex foot.

-Pain/no pain

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22
Q

Additional assessments

A 
Inspection/Palpation of Extremities
Muscle Testing of Extremities
Inspection/Palpation of Spine
Specialized Testing
Drop Test- RTC Tear Assessment
Carpal Tunnel Assessment
Scoliosis Assessment
Straight Leg Raise-Herniated Disc Assessment
23
Q

Shoulder Inspection: size, contour, color, and swelling

A

Size and Contour
Size/Length
Shortened limb, amputation
Contour: Deformity or masses
Fractures, dislocations, subluxations, contractures, ankylosis
Color or swelling
Color
Erythema, ecchymosis, cyanosis
Swelling-osteoarthritis could have swelling
Excess joint fluid, thickening of synovial lining, inflammation of soft tissue, or bony enlargements

24
Q

Shoulder-Palpation-Pain

A
  • Clavicle
  • acromioclavicular joint(most susceptable football players FOOSH injury “fall on outstretch hand”) -subacromial bursa area
  • greater tuberacle of humerus-rotator cuff tear at insertion
  • biceps groove-tenderness inflammed biceps groove, popeye arm ruptured tendon, biceps tendon bulging muscle.
  • anterior aspect of glenohumeral joint
  • scapula-chk wing feel for tenderness
25
Q

Shoulder-Palpation-Temp.

A

Temperature

Inflammation-feel for warmth

26
Q

Shoulder-Palpation-Masses or Swelling

A

Crepitus-Bone on bone, hand over joint move joint, listen for sound through passive ROM.

27
Q

Shoulder Muscle Testing

A 
Muscle Testing
Muscle testing- Repeat motions with ROM, but apply resistance
Flexion
Extension
Abduction
Adduction
External Rotation-These last two bent arm 90 deg. angle totate arm and try to push inward
Internal Rotation
Muscle strength 5/5 bilaterally
28
Q

Drop arm test (specialized testing)

A

Drop Arm Test
Have patient fully abduct their arm, then ask to slowly lower it to their side.
Positive- Arm drops to side from a position of about 90º abduction
Negative- Able to lower arm all the way to side slowly and smoothly

29
Q

Elbow-Inspect= size, contour, color, and swelling

A
  • make sure no edema
  • bursitus red warm swollen at the tip
  • gouty arthritus- epicondyles come in contact, fingers wont fit in groove.
  • assess for tenderness
  • feel over groove and bursa sac
30
Q

lateral epicondyl

A

tennis elbow, excessive pronation/supination ext of elbow and wrist

31
Q

medial epicondyl

A

golfers elbow. palmer flexion of the wrist

32
Q

Elbow-Palpate-Pain

A

Pain
Olecranon process, olecranon bursa area, grooves on side of olecranon process
With thumb in lateral groove and index and middle finger in medial groove palpate either side of olecranon process

33
Q

Elbow- Muscle Testing

A 
Muscle Testing
Flexion
Extension
Supination
Pronation
34
Q

Wrist/hands/fingers: inspect: size, contour, color, or swelling

A
  • osteoarthritis
  • PIP joint: Bouchards- hard non tender2-3mm bony overgrowth
  • DIP-Herbendens nodes
  • RA: painfull swelling stiffness in joint
  • Swan neck-flexion, contracture-later stage RA
  • ulnar deviation-stretching & muscle imbalance
35
Q

Wrist/hands/fingers: Palpate Pain, Temp, Masses or Swelling

A

Wrist
Support hand with fingers under it and palpate wrist with both thumbs
Fingers
Use thumb and index finger in pinching motion to palpate sides of interphalangeal joints.
Temperature
Masses or swelling

36
Q

Wrist/Hand muscle testing

A

-Isolate writst, lock down forearm
-Wrist
Wrist Flexion
Wrist Hyperextension
Ulnar deviation
Radial deviation
- Hand
Finger flexion
Finger hyperextension
Finger abduction
Make a fist
Finger opposition- no resistance

37
Q

Specialized Testing: Carpal Tunnel
Thenar eminence atrophy
Phalen’s Test

A

Have pt hold both hands back to back while flexing at wrists at 90 degrees.
Normal: No symptoms in hands after 60 seconds (-)
Abnormal: Numbness and burning along median nerve distribution within 60 seconds (+)

38
Q

Specialized Testing: Carpal Tunnel

Tinel’s Sign

A

Directly percuss over median nerve at wrist
Normal: No symptoms with percussion (-)
Abnormal: Burning and tingling along median nerve distribution (+)

39
Q

Hip-palpate-muscle testing

A 
Palpate-push over greater trochanter, bursa CMS test
Pain
Temperature
Masses or swelling
Crepitus
 Muscle Testing-lay down prone
Flexion
Hyperextension
Abduction
Adduction
External rotation
Internal rotation
40
Q

Knee- Inspect

A 
Inspect
Gait
Size and Contour
Lower leg alignment
Should extend in same axis as thigh
Genu varum (bowleg)
Genu valgum (knock knee)
Color or swelling
41
Q

Knee- Palpate for pain

A

Pain
Tibiofemoral joint, joint line, patella

42
Q

Knee-Temp-Masses, Swelling

Muscle Testing

A

Temperature-heat
Masses or swelling
Crepitus-you would feel in knee, bend and straighten, hear grading. popping isn’t crepitus. chondralmalasin is usually crepitus
Muscle Testing-pt. lying down or sitting on edge of bed
Flexion
Extension

43
Q

Hammer Toes

A

PIJ inflammation, improper fitting shoes

44
Q

Haluxvalgus

A

turn signal, prominance of first metatrsal, bunion.

-improper fitting shoes

45
Q

Gout

A

MTP, redness swelling, increased uric acid, men in their 40’s

46
Q

Ankles/Feet Palpate for pain

A

-Ankle-not as much crepitus in ankle- palpate metatarsals too!
Grasp heel with fingers while palpating ankle with thumbs

47
Q

Ankle/Feet Muscle Testing

A 
Ankle
Plantar flexion
Dorsiflexion
Eversion
Inversion
Foot
Toe flexion
Toe extension
48
Q

Inspect The Spine

A

Inspect
Upright spinal column
From the side: cervical concavity, thoracic convexity, lumbar concavity
Posture erect with normal spinal curvature; no lateral deviation noted

49
Q

Normal curvature of the spin

A
  • Cervical(concave)-Posterior
  • Thoracic(convex)-Anterior
  • Lumbar(concave)-Posterior
  • Sacral(convex)-Anterior
  • These are shock absorbers
50
Q

Specialized Testing-Scoliosis Testing

A

Scoliosis screening:
Standing from behind assess for symmetrical alignment of the shoulders, the iliac crests, and the skin creases below the buttocks
-put hands on top of illiac crest, are hands symmetrical?
-take fingers run up spine for deviations
-hands on shoulder blades are thy symmetrical
Have bend over and touch toes and assess for lateral curvature
-creases in buttocks should be @ symmetrical height
-lateral thoracic excessive

51
Q

Kyphosis

A

excessive thoracic

52
Q

Lordosis

A

excessive lumbar

53
Q

Spine-Palpate

A

Palpate
Spinous processes-use thumb palpate each vertebrae, do you feel pain?
Muscles:palpate for tenderness, cervical strains
Cervical:
Sternomastoid and trapezius muscles
Lumbar:
Paravertebral muscles spasms-hard knot

54
Q

Herniated Lumbar Disk

A

Straight Leg Raise
With knee extended and patient supine raise affected leg just short of point where it produces pain then dorsiflex foot.
Positive: Sciatic pain (sharp pain radiating down the leg) when leg raised 30-60 degrees
Highly suggestive of presence of herniated nucleus pulposus

Health Assessment (4 decks)

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