musculoskeletal system Flashcards
what does the musculoskeletal system?
consist of body’s 206 bones, joints, and muscles
what do we need the musculoskeletal system for?
needed for support to stand, protecting inner organs (brain, spinal cord, heart), produce red blood cells in bone marrow and for storage of essential minerals such as calcium and phosphorus
what are the components of the musculoskeletal system?
- bones
- joints
- nonsynovial joints
- synovial joints
- ligaments
characteristcs of bones?
- hard
- rigid and very dense
- cells are continually turning over and remodelling
- bones have the ability to re-heal themselves and to produce osteocytes
what are joints?
place of union of two or more bones
what are nonsynovial joints
-bones that are united by fibrous tissue and are immovable (eg, vertebrae)
what are synovial joints?
- are freely moveable
- cavity is filled with a lubricant: synovial fluid which allows sliding of opposing surfaces and enables movement. ball and socket joint is an example. fluid can accumulate and cause pain
what are ligaments?
are fibrous bands running directly form one bone to another that strengthen the joint and helps prevent movement in undesirable directions
-harder to heal than bones (takes 6-12 months) and never fully regenerate
what percent do muscles account of the bodies weight
40-50%
what are the three types of skeletal muscle?
- skeletal
- smooth
- cardiac
how are skeletal muscles attached to the bone?
they are attached by a tendon, a strong fibrous cord
what are all the movements of the skeletal muscles?
- flexion / extension
- abduction / adduction
- pronation / supination
- circumduction
- inversion / eversion
- rotation
- protraction / retraction
- elevation / depression
what is flexion?
bending a limb at a joint
extension?
straightening a limb at a joint
what is abduction?
- moving a limb away from the midline of the body
- like being “abducted” -taken away from body
what is adduction?
- moving a limb toward the midline of the body
- thought of as “adding” arm
what is pronation?
-turning the forearm so that the palm is down
what supination?
turning the forearm so that the palm is up
what is circumduction?
moving the arm in a circle around the shoulder
what is inversion?
moving the sole of the foot inward at the ankle
what is eversion?
moving the sole of the foot outward at the ankle
what is the more common way to role an ankle?
rolling the ankle on eversion is more common than inversion
what is the rotation?
rotation: moving the head around the central axis
- is important with neck pain- usual rotation is 45 degrees
what is protraction?
-moving a body part forward and parallel to the ground
what is retraction?
-moving a body part backward and parallel to the ground
what is elevation?
raising a body part
what is depression?
lowering a body part
what are some subjective data questions to ask about the MSK?
- Joints: any problems with joints? any pain? is pain aggravated by movement, rest, position, weather? Is a pain relieved by ice or heat?
- Muscles: Any problems with the muscles such as pain or cramping?
- Bones: Any pain? is pain affected by movement? any accidents or trauma?
- Functional assessment: do problems with ur joints (muscle, bone) impose any limits on your ADL’s?
- Self-care: behaviour: occupation hazards? Daily amount of protein and calcium? Any medications for MSK system? (aspirin, anti-inflammatory, or muscle relaxants?
what should u encourage post-menopausal women to increase?
-calcium intake
is rheumatoid arthritis genetic?
yes. it is passed on
how is muscle and joint pain described?
dull and aching
what is important to remember about assessing MSK pain?
- always ask PQRST
- always asses the joint above and below areas of pain to see if pain radiates anywhere
- ask if there are any functional limitations with pain, trouble getting into the shower, stairs? important for old ppl and also young athletes. inquire about how it impacts thier life
what time of day is rheumatoid arthritis worse?
worse in the morning or arising
what time of the day is osteoarthetitis worst?
its worst late in the day
what time of the day is tendinitis worse?
worse in the morning and improves during the day
what is the temporomandibular joint?
the connection of the mandible and temporal bone
- assessed by feeling motion and smoothness of joint
- an audible or palpable snap or click occurs in many healthy people as the mouth opens
- pain in this area is very difficult to treat
- surgical procedure for a MSK injury is often last resort due to poor outcomes
how many bones are stacked in the vertical column?
33
what order of the spine from top to bottom?
cervical, thoracic, lumbar, sacrum, coccyx
how many cervical bones?
7
how many thoracic?
12
how many are lumbar?
5
how many sacrum?
5, fused together (middle of hips)
how many are coccyx?
4, fused
what are the discs (between spinal bones) made of?
(elastic fibrocartilaginous plates)
-each disc center has a nucleus pulposus made of soft, semifluid, mucoid material that has the consistency of toothpaste
purpose of the discs?
they cushion the spine like a shock absorber to help it move
what can happen if the compression on a spinal disc is too great?
it can rupture and the nucleus pulposus can herniate out of the vertebral column, compression of the spinal nerves causing pain
how to assess the cervical spine?
- inspect the alignment of the head and neck
- palpate the spinous processes and the sternomastoid, trapezius and paravertebral muscles
- they should feel firm, with no muscle spasm or tenderness
what could neck pain when putting the chin to the chest indicate?
meningitis
most neck pain is related to what?
the muscle, not bone related
what is used to treat muscle spasms?
-muscle relaxants, or valium (benzodiazepines)
what is the Glenohumeral joint
the connection of the humerous with glenoid fossa of the scapula
-ball and socket action allows great mobility of the arm
what are the muscles and tendons that stabilize the shoulder called?
- they are called rotator cuff
what is crepitation?
a grating or crackling sound or sensation (as that produced by the fractured ends of a bone moving against each other or as that in tissues affected with gas gangrene)
-is a abnormal finding- its an audible and palpable crunching that accompanies movement- found in rheumatoid arthritis
what is used to look for tears?
ultrasound
-MRI is not the right imagine to begin with
what is included in a shoulder assessment?
- inspect and compare posteriorly and anteriorly
- if pt reports shoulder pain, ask them to point to it, pain from a local cause is reproducible during the exam by palpation
- test ROM (ask them to cup one hand over the shoulder during the ROM to note any crepitation
- be aware the shoulder pain can be referred pain from hiatal hernic, chest pain, or pleural area
what does the elbow joint contain?
- contains three bony articulations of the humerus, radius and ulna, of the forearm
- this hinge action moved the forearm on one plane, allowing flexion and extension
what is included in inspection of the elbow?
- inspect the size and contour of the elbow in both flexed and extended positions
- looks for deformity, redness, or swelling
what is the wrist an articulation of?
its the connection of the radius (on the thumb side) and a row of carpal bones
what enables finger flexion and extension?
-the metacarpophalangeal and the interphalangeal
whats included in the wrist and hand assessment?
- normally no swelling or redness, deformity or nodules are present
-palpate the sides of the interphalangeal joints; normally no synovial thickening, tenderness, warmth or nodules are present
-Henerdens and Bouchard’s nodes are hard and nontender and occur with osteoarthritis .
.
what is the hip joint the articulation between
its between the acetabulum and the head of the femur
-ball-and -socket action enables a wide ROM
what can be palpated when the hip is flexed?
the ischial tuberosity
what can be palpated when the person is standing (femur)
the greater trochanter
what is included in the hip assessment?
- inspect the hip, note symmetrical levels of iliac crests, gluteal folds, and equal-sized buttocks
- a smooth, even gait reflects equal leg lengths and functional hip motion
- in the supine position the joints should feel stable and symmetrical, with no tenderness or crepitation
what is the knee joint the articulation of?
connection of the three bones- the femur, tibia, and the patella (kneecap)
what is the largest and most complex joint in the body?
the knee joint
how many ligaments is the knee joint stabilized by?
two
what is the cruciate ligament?
its the ligament that crisscross within the knee and provides anterior and posterior stability and help control rotation
what is the collateral ligament?
-connects the joint at both sides, they provide medial and lateral stability and prevent dislocation
what included in the knee assessment?
- inspect the knees shape and contour
- normally, distinct concavities (hollows) are present on either side of the patella
- check them for any sing of fullness or swelling
- the muscles and soft tissue should feel solid, and the joint should feel smooth, with no warmth, tenderness, thickening or nodularity
- when swelling is present, you need to distinguish whether it is soft tissue swelling or increased fluid in the joint
what is the ankle the articulation of?
- the connection of the tibia, fibula and talus
- is its a hinge joint, limited to flexion and extension
what are the two bony prominences on either side of the ankle?
the medial malleolus and the lateral malleolus
what are the ligaments of the ankle and what do they help with?
strong, tight medial and lateral ligaments extend from each malleolus onto the foot
-these help the lateral stability of the ankle: although they may be torn in eversion or inversion sprains of the ankle
what position should the pt be in when assessing pts ankle and feet
-inspect while pt is in a sitting, non-weight bearing position
how should weight be diversed amongst the foot?
-weight beating should be borne on the middle of the foot, from the heel, among the midfoot, to between the second and third toes
what is hallux valgus?
(seen in old ppl)
-when the distal part of the great toe is directed away from the body midline
what growth is rapid during infantsy?
bone growth
how does bone grow occur?
the long bones grow in two dimensions
- they increase in width or diameter by deposition of new bony tissue around the shafts.
- lengthening occurs at the epiphyses (growth plates)
- any trauma or infection at this location puts the child at risk of bone deformity
what age does epiphyses close at?
age 29
what is development dysplasia of the hip? (DDH)
refers to a number of congenital abnormalities of the hip joint, including dislocated hip and subluxation of the hip
-risk factors for DDH include having a first degree relative with DDH, breech delivery, and evidence of joint instability
what developmental changes with older adults?
postural changes
decreased height is the most noticeable
what is decreased height in old adults caused by?
its caused by shortening of the vertebral column
-caused by loss of water content and thinning of teh intervertebral discs
what is Rheumatoid arthritis?
- chronic, systemic inflammatory disease of joints and surrounding connective tissue
- inflammation of the synovial membrane leads to thickening, which limits motion
- can be symmetrical or bilateral
- pain is often worse mornings
- more common in females
what is rheumatoid arthritis characterised by?
-characterised by heat, redness, swelling and painful motion of the affected joint
what is swan-neck deformity?
Swan neck deformity is a deformed position of the finger, in which the joint closest to the fingertip is permanently bent toward the palm while the nearest joint to the palm is bent away from it (DIP flexion with PIP hyperextension).
- occurs with chronic Rheumatoid arthritis
- accompanies by ulnar drift from fingers
what is osteoarthritis?
- noninflammatory, localized, progressive disorder involving deterioration of articular cartilages and subchondral bone and formation of new bone at joint surfaces
- nearly all adults older than 60 show some signs of this on x-ray
- commonly affects hands, knees, hips, and lumbar and cervical segments of the spine
what can help osteoarthritis?
- PRP injections, volatren or other NSAID creams
CBD oils, creams and gels
-calcium and vitamen D supplements
what is osteoporosis?
- decrease in skeletal bone mass occurring when rate of bone resorption is greater than that of bone formation
- the weakened bone state increases risk for stress fractures, especially at wrist, hip and vertebrae
- occurs primarily in postmenopausal women
what is epicondylitis?
- also known as tennis elbow
- chronic, disabling pain at lateral epicondyle of humorous
- occurs with activities combining excessive pronation and supination of forearm with an extended wrist (racket sports or using screwdriver)
what is carpal tunnel syndrome?
- caused by interference with motor function as result of compression of the median nerve inside the carpal tunnel
- caused by chronic repetitive motion
- symptoms include pain, burning sensation and numbness
what is acute gout?
-acute episode of gout usually involves first the metatarsophalangeal joint
Gout is a type of arthritis. It occurs when uric acid builds up in blood and causes inflammation in the joints. Acute gout is a painful condition that often affects only one joint. Chronic gout is the repeated episodes of pain and inflammation. More than one joint may be affected.
-primarily in men older than 40
what is acute gout associated with?
associated with elevated serum levels of uric acid and consist of swelling, heat, and extreme tenderness
-elevated uric acid is caused by diet high in purines (meats, scallops)
tx for acute gout?
- NSAIDS, colchicine
- allopurinaol reduces the production of uric acid
