Musculoskeletal System (complete) Flashcards
What are the components of the musculoskeletal system?
Bones (axial and appendicular)
Cartilage
Joints
Bursae
Ligaments
Tendons
Muscles
How many bones are there? How many of each type?
Axial - 80; skull, ribs, vertebral column
Appendicular - 126; limbs, shoulders, feet, hands, wrist
What are the functions of bone
- provides structure
- provides protection
- enables voluntary movement
- stores minerals: calcium
- produce blood cells: hematopoiesis
Components of bone structure
Epiphysis - muscle attachment
Diaphysis - Shaft
Metaphysis - between epiphysis and diaphysis
Epiphyseal plate - growth plate
Periosteum - thin membrane
Info about bones
have a dynamic metabolism, with continuous turnover and remodeling
connective tissue
How are bones classified
long, short, flat or irregular
What are joints
articulations; connect two or more bones, allowing mobility
What are the types of joints
Synovial joints
Nonsynovial joints
- cartilaginous and fibrous
What are synovial joints
freely moveable, opposing bones are separated and enclosed in a joint cavity filled with synovial fluid
ex: knee, shoulder
What are nonsynovial joints
joined by fibrous tissue or cartilage; immovable or slightly moveable
cartilaginous and fibrous
What is cartilage? what does it do
- it is a connective tissue
- allows bones to glide over each other
- covers the opposing bone surface
What are bursae
fluid-filled sacs
What are ligaments? what do they do
- fibrous bands that go from one bone to another
- help strengthen joint
What do tendons do
connect muscle to bone
What are the three types of muscle
skeletal, smooth, cardiac
Developmental considerations in pediatrics
concern for damage to epiphyseal plate (growth plate)
Developmental considerations in pregnancy
- hormones increase joint mobility
- lordosis
What is lordosis
a condition where the lower back has an exaggerated inward curve
can cause the buttocks to appear more prominent
Developmental considerations in older adults
- osteoporosis
- postural change
– decreased height
– kyphosis - loss of height and sub-Q fat
- decreased fat in periphery with re-deposition to abdomen and hips
- bony prominences become more obvious
- decreased muscle and bone strength
What is kyphosis
spinal deformity that causes the upper back to curve abnormally
rounded or hunched appearance
Implications of decreased muscle strength and bone strength in older adults
- increased risk for weakness which leads to reduced ability to function
- person less willing to walk
– results in immobility issues - walking: one of the most important methods of sustaining independence
Types of spinal abnormalities
kyphosis, lordosis, scoliosis
Focused questions to ask on
- pain: location, pattern, radiating, quality, severity
- warmth
- redness or swelling
- stiffness: intermittent or continuous
- movement limitations: issues with ROM
- remitting or exacerbating factors
Objective components of assessment
inspection
palpation
- tone
ROM
muscle testing
What is included in inspection
- joint: size and contour
- color
- swelling
- deformity including masses
- crepitus
What is included in palpation
- temperature
- swelling
- masses
- only an abnormal synovial membrane is palpable (inflamed or warm)
Where to assess skeletal muscles
- head/neck
- temporomandibular joint (TMJ)
- spine
- upper extremities: shoulder, elbow, wrist, hand
- lower extremities: hip, knee, ankle, foot
Assessment with landmarks
- find the landmarks
- begin at the most proximal joint of extremity
- move distally with grasping movements: any abnormal findings?
- incorporate passive ROM: support the joint
What is the temporomandibular joint (TMJ)
formed by the fossa and articular tubercle of the temporal bone and the condyle of the mandible
Functions:
- hinge: open and close
- gliding: protrusion and retraction
- gliding: side-to-side at lower jaw (lateral)
Pain locations with the spine
if pain is midline -> over the spinal processes of the vertebrae
if pain is off the midline -> in the paraspinal muscles surrounding the spine
Shoulder information
ball-and-socket
rotator cuff
- four muscles
- tendons
- glenohumeral joint
palpable landmarks:
- acromion process
- greater tubercle
Elbow
three bony articulations
- hinge action
landmarks:
- medial epicondyle (humerus)
- lateral epicondyle (humerus)
- olecranon process (ulna)
Wrist and Hand
- radiocarpal joint
- condyloid action
– flexion
– extension
– side to side
Hip
less mobility than shoulder but stronger; has greater weight bearing ability
landmarks:
- anterior superior iliac spine (ASIS)
- ischial tuberosity
- greater trochanter
Possible hip movements
flexion
extension
abduction (AWAY)
adduction
external/internal rotation
Knee
largest joint in the body
three bones involved:
- femur
- tibia
- patella
hinge joint
landmarks:
- patella
- tibial tuberosity
- quadriceps muscle
- ligament supports
Ankle and foot
- total weight of the body is transmitted through the ankle and foot
- balance the body and absorbs the impact of walking
- hinge joint
– tibia, fibula, talus - landmarks:
– medial malleolus
– lateral malleolus
What is active ROM
the individual moves a body part on their own without assistance
What is passive ROM
when someone or something else moves the body part for the individual
What is muscle testing
- muscle strength is graded on a scale of 0 to 5
- assesses person’s ability to resist gravity
Muscle testing/strength grading scale: 0 to 5
5: Active movement against full resistance without evident fatigue.
4: Active movement against gravity and some resistance
3: Active movement against gravity
2: Active movement of the body part with gravity eliminated (planar motion)
1: A barely detectable flicker or trace of contraction
0: No muscular contraction detected
Joint movements (just list of movements)
flexion
extension
abduction
adduction
pronation
supination
circumduction
inversion
eversion
rotation
protraction
retraction
elevation
depression
What is a goniometer
an instrument for the precise measurement of angles, like within joints
Musculoskeletal abnormalities
- inflammatory conditions (rheumatoid arthritis)
- degenerative conditions (osteoarthritis; osteoporosis)
- dislocation
- subluxation
- fracture
- effusion
- torn rotator cuff
- tennis elbow
- carpal tunnel syndrome
- scoliosis
What is subluxation
incomplete or partial dislocation of joint or organ
Soft tissue injuries
Sprain: ligament damage from twisting
- 1st, 2nd, or 3rd degree
Strain: excessive muscle stretch, sheath, or tendon
- usually in large muscle groups
- when severe, patient may have hemarthrosis
Management of soft tissue injury
- usually soft tissue injuries are self-limiting
- RICE
- surgical repair if severe
- x-ray to r/o fracture
What is hemarthrosis
bleeding into joint spaces
Assessing for the 6Ps with injury
- pulses
- pallor
- pain
- paresthesia
- paralysis
- poikilothermia
What is poikilothermia
inability to regulate core body temperature
What is paresthesia
burning or prickling sensation usually in hands, arms, legs or feet
burning, itching, tingling, prickling, numbness, pins, needles, heat or cold
Degenerative conditions: Osteoarthritis
-Most common joint disease
- Slowly progressive, non-inflammatory disorder
- Cartilage damage
– Secondary synovitis
- Aging women
- Systemic and local signs and symptoms
Degenerative conditions: Osteoporosis
- bone becomes porous
- progressive and chronic
- 80% women in those diagnoses
- high risk for fracture
- “silent disease”
– back pain - monitor bone mineral density (BMD)
Osteoarthritis (DJD)
- bone ends rub together
- thinned cartilage
Rheumatoid arthritis
- swollen inflamed synovial membrane
- bone erosion
Knee pain
Swelling
- from fluid accumulation
– bulge sign
– ballottement
Meniscal tears
What is the bulge sign in fluid accumulation in knee pain
simple physical exam that can help identify people at higher risk for developing OA
To perform:
- gently press inside of patella
- move hand up
- press firmly on outside of knee
- if inside of knee bulges out after applying pressure on the outside, this is a positive bulge sign
What is ballottement in fluid accumulation in knee pain
AKA patellar tap test
medical procedure that can help determine if there is excess fluid in the knee joint
To do: (patient lying on back with knee extended)
- push down on front of leg to move fluid to the knee
- gently tap patella while applying pressure with other hand
Positive result: if patella floats or bounces - indicates excess fluid in knee joint
always compare to opposite knee
Carpal tunnel syndrome
relates to median nerve problem
Phalen test: patient holds wrists flexed and backs of hands pressed together for 30-60 seconds
- positive result: pain, tingling, or numbness in thumb, index, middle and half of ring finger
- positive results indicates pressure being applied to median nerve in wrist
Promoting bone health / preventing OA
Diet
- milk, fish, greens, soy
- calcium supplements
- vitamin D
Exercise
- weight training
- lifestyle changes
Annual exam
- measure height
- bone density tests
