Musculoskeletal System Flashcards
Joint types
fused: in skull ireggular and flat
Ball and socket
shoulder and hip
hinge
elbow and fingers and knee and toes
Gliding
wrist hand ankle foot
Plane
vertibrae
condyloid
wrists
Spine bones
33 total 7 am cervical 12 pm thoracic 5 pm lumbar 1 am coccyx
Abduction
move from midline
adduction
move to midline
pronation
rotation from anatomical neutral
supination
rotation to anatomical neutral
eversion
bending away moving from midline (ankle)
inversion
bending toward midline (ankle)
Dorsiflexion
upward flex of foot
plantarflexion
down flex of foot
flexion
moving toward body
extension
moving away from body
elevation
movement that raises a part in its plane (shoulder shrug)
Tendons
力 to joint
Ligament
力 to 力
Strain
tendon injury
Sprain
ligament injury
Hand vs foot bones
Carpels and tarsals
力(muscle/musculoskeletal) diagnostics
CPK xray MRI CT scan DEXA (dual energy xray absorptiometry) for mineral density (osteoperosis)
Creatine phosphokinase (CPK) blood tests
shows increased CPK ↑ protein levels → 力 injury secondary to 力 disease (dystrophy), strenuous exercise
力 HH
Family 力 disease surgical H (limited ROM) Past (chronic) Nutrition (▲weight= ▲stress on joints) Pain (numbness, edema, ▲skin color)
力 dystrophies
progressive 力 weakness
Osteoarthritis (OA)
progressive
wear down of protective cartilage
affects distal interphalangeal joins
Osteoporosis
progressive loss of bone density
Rheumatoid Arthritis (RA)
progressive inflammatory autoimmune that attacks metacarpophalangeal synovial joints in hands and feet
Risk factors for RA
smoking, genetics, 40-60 yrs, woman
OA riskfactors
woman, joint injuries, obesity, malnutrition, sedentary lifestyle, contact sports (length and type)
力 Assessment sequence
Inspection
palpation
ROM
strength
5 Ps of 力 problems
Pain paralysis paresthesia pallor pulsations
paresthesia
burring, tingling, prickling
Serious, needs further assessment and should notify HCP
Inspecting the gait
Person may need assistive walking help
have walk to and from me
assess joints ROM limps swing pain
N: 1.5 m for adults w/o problems
swing and step are contralateral
no loss of balance w/each step
Limping with gait →
力 weakness, bone pain, injury to (力,tendon, ligament) or deformaty
Alterations in gait (↑, ↓ and no) indicate
↑ loss in ligamentous or bony support in joint
↓ edema or injury
None: frozen/fused joint
Ataxia
unsteady gait
from injury, pain or cerebellar function
Diplegic gait (Scissors gait)
Legs swing across midline to compensate for lack of motion
common w/cerebral palsy
Shuffling gait
Problem with balance, Parkinson’s (characteristic), ↓lower extremity strength
Foot drop
weakness or paralysis of 力 in lower leg or inabliiy to control plantar flexsion of the ankle (cant bring foot to neutral)
→peroneal nerve injurst or 力/nerveological disroder
Assessing Posture steps
While walking/sitting (Shoulders even, head over axial, head in relation to trunk.)
ask about back pain or ROM
Ask to rotate and tilt head
Ask to flex neck and look up
bend forward/ back and side to side for spinal curvature and ROM
Posture normal
shoulder width apart at stand; even with no sloping
upright, looking forward, and head centered
wt evenly distributed
ROM symmetrical fluid and w/o pain
Posture abnormal
Pain, tingling, numbness, ROM limits, asymmetry
caused by 力 weakness/tightness/injury, develop(ing/ed) deformity in bones
Vertebral column Inspection and Palpation
Check spine at stand with posture note deviations from ant-post plane
have them bend forward check spine with 2-3 fingers
note devi from lateral plane
Look for deviations from ant-post or lateral planes, tenderness (bony/ligament problem), protrusions (displacement of vertebrae), or drop offs
Scoliosis
S or C shaped curvature in the lateral plane of spine
Kyphosis
hunchback curvature in thoracic spine
can affect thorax contents
Lordosis
↑lower back arch curvature
Inspection and Palpation of the upper extremities
I & Palp (2-3 fingers): shoulders elbow wrist and fingers and joints – Assess for tenderness, depressions, bulges and ▲temperature
N: Sym, no rounding straight arms, slight bend in elbow, wrists aligned w/ arm, slight flexion in fingers
Upper extremities I & P findings for 力
A: Shoulder rounding (力 tightness in front over back),
Elbow straightened/hyperextension=loss of bony structure or flexed=serious joint problem,
bony/nerve damage to ROM
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▲temp= joint infection/disease
missing finger= trauma/disease process
Upper extremities Tenderness →
incurs to bone, 力 , tendon, ligament
Upper extremities depressions →
dislocated joint, joint subluxation (partial dislocation), or significant 力 injury
Upper extremities Protrusions →
disloci/subluxed joint, fracture, Ca++ buildup in 力, type of arthritis (Bouchard’s nodes, Heberden’s nodes)
Bouchard’s nodes
bony enlargements of proximal interphalangeal joints (PIP), common in people with OA and RA
Heberden’s nodes
bony enlargements of distal interphalangeal joints
common in people with OA
Upper extremities ROM tests
Check the 10 cardinal motions where applicable w/o then w/resistance
At: shoulders, elbow, wrists, fingers
For ROM, fluidity, pain, strength
Tinel’s sign
for Carpel tunnel syndrome: Palm up and fingers at natural curl, tap median nerve at wrists (thumb side)
Tingling or pain radiating to thump, index or middle finger is positive
Phalen’s test
flex both wrists in and fingers extended pointing down (╦) and press together for 1 min
Positive if tingling or numbness in the palmar aspect of the fingers
Expected Shoulder ROM
Flextion vs Extenstion: 180 (1π) vs 45-60 (1/4π to 1/3π)
Abduction vs adduction: 150 vs 10-20 (180-10-20)=150)
Rotation internal vs external: 70-90 vs 90
(shoulder extension (backward) at -80º )
Elbow and forearm expected ROM
Flexion vs extension: 150 vs 0
Pronation vs Supination: 70 vs 85
Wrist expected ROM
Flexion vs extension: 90 vs 70
Deviation radial vs ulnar: 20 vs 50
Muscle Strength scale
0: unable to contract in gravity eliminated position
1: Able to contract slightly
2: Able to move joint in gravity eliminated position
3: Able to move joint against gravity
4: Able to move joint with some resistance through ROM
5: Able to move joint in full ROM
Upper extremities ROM abnormal
Anything less than ROM angles→ injury, surgery, disease, neurological
Carpel tunnel syndrome
Strength ≤4 → muscle weakness from injury or deconditioning
Pain →injury note as (4/5 with pain)
Carpel tunnel syndrome
Compression of median nerve that runs from forearm to palm caused by repetitive movements
Inspection and Palpation of the Lower extremities
Sitting or in supine - Hip, knee, ankle, foot, toes
Assess for tenderness, depressions, bulges and ▲temperature, weight on both sides, no hip bent forward, straight upper legs
knees bent forward slightly, ankle perpendicular to lower leg, and foot (forward, aligned with knee, with slight arch at median)
Lower extremities abnormal
Uneven wt bearing, shortened extremity (injury, disease, surgery), defomities
Unusual Flexion → joint, tightness, bony/opposing muscle injury, bony buildup, disease, a loose body
Unusual Laxness → poor ligaments, opposing muscle injury
General edema: circulatory problem (note this)
Hallux Valgus
Bunion
lateral deviation and enlarged joint of the great toe
Hammertoe
permanent contracted-toe deformity proximal interphalangeal joint of 2-4th toe can be affected
Lower extremities
Check the 10 cardinal motions where applicable w/o then w/resistance
Hip, knee, ankle, foot, toes
For ROM, fluidity, pain, strength
Expected hip ROM
Flexion vs extension: 120 vs 20
Abduction vs adduction: 45-50 vs 10-20
Expected Knee ROM
Flexion vs Extension: 130- 150 vs 0-(-3)
Expected Ankle ROM
Plantar vs Dorsi- flexion: 50 vs 20
In vs e- version : 20 vs 15
Musculoskeletal HP 2020
Prevent OA, OP, RA, back pain via exercise, diet (Ca++, Mg, vit D, P), weight, posture
