NUR 362 - MUSCULOSKELETAL Flashcards
Components of the Musculoskeletal System
bones muscles joints tendons ligaments cartilage bursa
Normal Physiologic Function of Musculoskeletal System
alignment and posture balance coordinated movements protection production storage
Bone
specialized connective tissue
hard, rigid, dense
Joint
union of two or more bones
non-synovial (immovable and slightly movable)
synovial (freely movable due to separation from fluid-filled cavity)
Cartilage
cushions the bones and gives smooth surface to facilitate movement
Ligaments
connect bone to bone
give bone structure to form the joint
Bursa
fluid filled sac
any place where there’s a joint
Tendon
connect muscle to bone
helps with function of ROM
Muscular Strength - 0
no muscular contraction detected
Muscular Strength - 1
barely detectable flicker or trace contraction
Muscular Strength - 2
active movement of body part with gravity eliminated
Muscular Strength - 3
active movement of body part against gravity
Muscular Strength - 4
active movement of body part against some resistance
Muscular Strength - 5
active movement of body part against full resistance without fatigue
ADLs
bathing dressing eating grooming mobility (transfers, ambulation, toiling)
Palpation of musculoskeletal system
heat tenderness swelling crepitus nodules AROM/PROM muscle strength
TMJ Palpation
tips of first two fingers and ask person to open/close mouth
palpate contracted temporals and masseter muscles as person clenches
compare size, firmness, strength
TMJ ROM
open/close - against resistance tests trigeminal nerve (V)
protraction/retraction
lateral movement
Cervical Spine Inspection
alignment of head and neck
spine should be straight and head erect
Cervical Spine Palpation
spinous processes for tenderness
sternomastoid, trapezius and paravertebral muscles
Cervical Spine ROM
flexion/extension
rotation
lateral bending
against resistance tests spinal nerve (XI)
Shoulder Inspection
swelling
deformity
abnormal positioning
Shoulder Palpation
acromioclavicular joint scapula acromion process greater tubercle coracoid process
Shoulder ROM
flexion/extension abduction/adduction circumduction internal/external rotation depression/elevation - shrug against resistance tests spinal nerve (XI)
Elbow Inspection
size and contour in flexed and extended position for swelling, deformity, or abnormal positioning
olecranon process for present hollows on either side
Elbow Palpation
elbow flexed at 70 degrees
medial and lateral epicondyle
olecranon process
Elbow ROM
flexion/extension
supination/pronation
Hand Inspection
smoothness of motion, surface contour, alignment of wrist and fingers, bony deformities
Hand Palpation
distal radius and ulna at wrist eight carpal bones MCP PIP DIP joints anatomical snuffbox
Hand ROM
hand flexion/extension radial/ulnar deviation fingers flexion/extension abduction/adduction thumb flexion/extension abduction/adduction opposition
Carpal Tunnel Syndrome Features
pain or numbness of the first three fingers of the hand, but not in the palm, especially at night
loss of sensation in distribution of the medial nerve: palmar surface of thumb, index, middle, and medial 4th fingers
Assessment for carpal tunnel
weak abduction of the thumb (most sensitive)
tinel’s sign
phalen’s sign
Tinel’s Sign
tingling with tapping over medial nerve as it enters the carpal tunnel
Phalen’s Sign
numbness of tingling with pressing backs of hands together in acute flexion
Hip Inspection
symmetry of iliac crests, gluteal folds and equally sized buttocks
smooth, even gait reflects equal leg lengths
assess base
rhythm smooth and continuous
Hip Palpation
inguinal ligament
trochanteric bursa
ischiogluteal bursa
Hip ROM
flexion/extension
abduction/adduction
internal/external rotation
Knee Inspection
contours and alignment for swelling
quadriceps for atrophy
knee action during swing and stance phases of gait
Knee Palpation
left thumb and fingers grasping fashion down toward knee
patellar pouch
Knee ROM
flexion/extension
Ankle & Foot Inspection
compare feet noting position of feet and toes, contours of joints
foot should align with long axis of lower leg
ankles are smooth bony prominences
Ankle & Foot Palpation
achilles tendon for nodules and tenderness
metatarsophalangeal joints
Ankle & Foot ROM
flexion/extension (toes)
inversion/eversion
plantarflexion/dorsiflexion
Spine Vertebrae
7 cervical
12 thoracic
5 lumbar
Spine Inspection
spine is straight
knees and feet aligned with trunk and point forward
convex thoracic curve and concave lumbar curve
Spine Palpation
spinous processes
paravertebral muscles
Spine ROM
flexion/extension
rotation
lateral bending
AROM
patient actively doing exercise on own
PROM
exercise carried out by therapist
AAROM
therapist manually helping patient move a body part while patient exerts a small amount of effort
Hazards of Immobility
muscle atrophy contractures increased cardiac workload orthostatic hypotension thrombus formation decreased lung expansion
Common therapeutic positions
semi-fowlers (45 degrees) fowlers (90 degrees) supine (back) dorsal recumbent (legs up exam) sims/semi-prone (flexed between pillows laying on side) lateral/side-lying prone (stomach)
