Musculoskeletal System Flashcards
Structure of bones
206 bones (compact and spongy)
Axial (head/trunk); appendicular (extremities/shoulders/hip) skeleton
Periosteum: covers bones; consist of osteoblasts (form bone) and osteoclasts (breakdown bone)
Tendons: attach skeletal muscle to bones; ligaments: attach bone to bone
Types of muscle
- Skeletal (striated; voluntary)
- Smooth
- Cardiac
Skeletal muscle actions
Abduction: away from midline
Adduction: toward midline
Circumduction: circular pattern
Inversion: soles of the feet face inwards
Eversion: soles of feet face outward
Extension: straightening movement that increases angle between body parts
Hyperextension: excessive movement of joint in one direction
Dorsiflexion: raising foot upwards towards the shin
Plantarflexion: top of foot points away from leg
Pronation: face down
Supination: face up
Protraction: moving an anatomical part forward
Retraction: moving an anatomical part in the posterior direction
Internal rotation: rotation towards midline
External rotation: rotation away from midline
Structure of joint
Type of joint:
- Fibrous: joints held together by fibrous connective tissue (fixed/immovable; skull)
- Cartilaginous: joint where bones are entirely joined by cartilage (ribs)
- Synovial: joint between bones that move against each other (limbs)
Bursae: small pouches of synovial fluid that provide protection to joint; bursitis (inflammatory infection of bursae)
Gender/ethnic variations
Men have denser bone than women; women have reduced bone density post-menopause (d/t decreased estrogen)
Caucasians have denser bones than Chinese, Japanese, Eskimo; however, less dense than African-Americans
Age variations
Infants: rapid growth; C-shaped spine (greater curvature)
Toddlers: wide base of support; common: postural lordosis (inward curve), bowlegs (genu varum), knock-knee (genu valgum)
Adolescents: continued rapid bone growth precedes muscle/ligament growth resulting in tall/lanky appearance; joint pain associated with growth spurts
Pregnant: wide base of support (gait changes esp. in last trimester), postural lordosis, lower back pain
Older adults: altered sense of position in space (increased fall risk), joint stiffening, reduced bone density and muscle mass/strength; kyphosis (decreased height and gait changes)
Subjective assessment
CC/HPI: Pain
PMHX: Co-morbidities (osteoporosis), open wound injuries, vaccinations (tetanus/Tdap), anemia, DM, lupus; female health r/t menopause
FHX: Gout, rheumatoid arthritis, osteoporosis
Lifestyle and health practices: Physical activity, diet, meds. (corticosteroids inhibit Ca2+ absorption and increase bone breakdown), difficulties with ADLs, tobacco/alcohol use
Objective assessment preparation
WIPE
Equipment: Tape measure, goniometer (measure ROM), skin marking pencil
Muscle strength
Compare inadequacies bilaterally (neurological or musculoskeletal issues)
Ratings:
5: Active motion against full resistance (Normal)
4: Active motion against some resistance (Slight weakness)
3: Active motion against gravity (Average weakness)
2: Passive ROM; gravity removed and assisted by examiner (Poor ROM)
1: Slight flicker of contraction (Severe weakness)
0: No muscular contraction (Paralysis)
Gait
Assess for fall risk; observe gait (stride, weight-bearing ability, arm swing) and base
Ex.: Shuffling gait with Parkinson disease
TMJ
Assess for clicking/popping/grating, ROM; inspect and palpate mouth opened wide/closed, seated upright
Ex.: Crepitus, difficulty chewing with severe arthritis
Sternocalvicular joint
Assess for tenderness/pain, swelling/redness while seated
Cervical, thoracic, lumbar spine
Inspect: (1) Cervical ROM for pain/discomfort (trauma, whiplash, falls, wrong sleeping position); (2) Meningitis (impaired ROM, neck pain; h/o fever, chills, HA); (3) Cervical strain (impaired ROM, neck pain); (4) Compression FX (pain/tenderness of spinal processes and paravertebral muscles); (5) Cervical disc degeneration (impaired ROM/pain that radiates to back/shoulders/arms)
Palpate spinous processes and paravertebral muscles for tenderness/pain (degenerative disc disease s/t osteoarthritis)
Test ROM
Straight leg test: lower back pain indicative of herniated disc (performed by raising legs while supine)
Measure leg length (variations indicative of scoliosis)
Shoulders/arms
Inspect and palpate symmetry, abnormalities/deformities, atrophy (lack of use aeb nerve/muscular damage), tenderness/heat (bursitis)
Test ROM (shoulder protraction/retraction, abduction/adduction)
Elbows
Inspect for size/shape/deformities/redness/swelling
Test ROM
Bursitis (“golfer’s elbow” trauma/injury to olecranon process)
Wrists
Inspect and palpate; test ROM
Abnormalities:
1. Anatomic snuff box: triangulation-shaped depression above the wrist by thumb (normal finding)
CARPAL TUNNEL SYNDROME; (2) PHALEN test: numbness/pain when bending wrist against one another); (3) TINEL’S sign: tingling/shock/radiating pain of median nerve, S/S: Thenar atrophy (muscular atrophy below thumb)
- Ganglion cyst: fluid-filled sac in joints/tendons (often in wrist; Tx: drained/aspirated)
- Tenosynovitis: inflammation of the fluid-filled sheath of the wrist
Hands and fingers
Inspect and palpate; abnormalities r/t rheumatoid arthritis (RA) or osteoarthritis; bony prominences/nodules
Test ROM (abduction/adduction, flexion, hyperextension/extension; muscle strength/resistance)
Abnormalities:
1. Ulnar deviation: joints in the wrist and hand shift/bend toward the ulnar
- Acute rheumatoid arthritis: an AUTOIMMUNE disease that causes joint pain/damage; S/S: Fatigue, low-fever, low appetite; Chronic RA: associated with (1) ulnar deviation, (2) swan neck, and (3) boutonniere (greater angle than swan)
- Osteoarthritis: degeneration of protective cartilage causing joint damage/pain (non-autoimmune); S/S: Heberden’s nodes (hard bony lumps in finger joints)
Hip
Inspect and palpate while standing; assess for symmetry/curvature, buttocks equal in size, tenderness/discomfort/crepitation
Test ROM (abduction/adduction, flexion, knee extension/flexion)
Do NOT test ROM with hip replacement unless specified
Knees
Inspect and palpate for tenderness/warmth, pain/injury; test ROM
Assessments:
1. Bulge test: edema/bulge/depression of soft tissue after displacement of accumulated fluid (indicative of joint diffusion)
- Ballottement test: detects synovial fluid build-up after pushing down on patella
Ankles and feet
Inspect position/alignment/shape/skin; palpate for tenderness/heat/swelling/nodules; test ROM (inversion/eversion, abduction/adduction, dorsiflexion/plantar flexion
Feet and toe abnormalities
- Acute gouty arthritis: build-up of uric acid crystals (tophi); painful/reddened/hot/swollen; pain in evening, hypersensitivity
- Flat feet
- Callus: NON-painful thickened skin over pressure points
- Corn: PAINFUL thickened skin over pressure points
- Hallux vagus (or bunion): inward lateral deviation of big toe; inflamed/enlarged/painful bursae
- Hammer toe
- Plantar wart: tiny grouped dark spots under callus (caused by HPV)
Osteoporosis
Uncontrollable risk factors: Age, gender, FHX, previous FX, Caucasian, menopause/hysterectomy, long-term glucocorticoid (corticosteroid) therapy, RA, primary/secondary hypogonadism in men
Modifiable risk factors: Alcohol, smoking/second-hand smoke, LOW BMI, poor nutrition, vitamin D deficiency, eating disorders, low dietary calcium intake, insufficient exercise (sedentary lifestyle), frequent falls
Older adult considerations
Osteomalacia (bone softening), osteoporosis, and loss of bone density (increase risk for bone FX, esp. of wrists, hip, vertebrae)
Joint stiffening conditions may be misdiagnosed as arthritis
Osteoporosis is common (bone breakdown surpasses bone formation; decreased Ca2+ absorption and decreased osteoblasts)
Impaired position in space; increased thoracic curvature (increased fall risk)
