objective 11 Flashcards
206 ____ in the body; they are hard, rigid, and very dense; cells in the ____ are continuously remodeling and turning over
bones
where two or more bones come together
joints
immoveable or only slightly moveable, fibrous tissue or cartilage unite the bones
nonsynovial joints
freely moveable, bones are separate from each other and enclosed in a joint cavity that is filled with synovial fluid
synovial joints
covers the surface of opposing bones, cushions the bones, and creates a smooth surface that facilitates movement
cartilage
fibrous bands connecting one bone to another; strengthen the joint, stabilize movement
ligaments
enclosed sac that contains synovial fluid; located in areas of potential friction; help muscles and tendons slide smoothly over bone
bursa
produce movement when they contract
muscles
what are the 3 types of muscles?
skeletal, smooth, cardiac
what is the musculoskeletal system needed for?
support
movements
protection
hematopoiesis
reservoir for storage of essential minerals
Articulation of the mandible and temporal bone
* Palpable in the depression anterior to the tragus
* Enables jaw function for speaking and chewing
temporomandibular joint
what does the temporomandibular joint allow for?
Opening and closing of the jaws (hinge action)
* Protrusion and retraction (gliding action)
* Moving the lower jaw from side to side (gliding action)
what are the connecting bones in the vertical column?
7 cervical
* 12 thoracic
* 5 lumbar
* 5 sacral
* 3-4 coccygeal vertebrae
what are the surface landmarks?
C7 and T1; T7 and T8; L4; sacrum
what does the spines unique structure allow for?
upright posture
flexion, extension, abduction, rotation
what are the 4 curves of the vertebral column?
cervical and lumbar- concave
thoracic and sacrococcygeal- convex
cushion the spine and help it move
intervertebral discs
articulation of the humerus with the glenoid fossa of the scapula; ball and socket allows for greater mobility
glenhumeral joint
consists of muscles and tendons that support and stabilize the glenohumeral joint
rotator cuff
during abduction of the arm it helps the greater tubercle of the humerus moves easily
subacrimial bursa
what are the palpable landmarks of the shoulder joint?
acromian process
greater tubercle
coracoid process
contains 3 bony articulations of the humerus, radius and forearm
flexion and extension
elbow joint
what are the palpable landmarks for the elbow joint?
Medial and lateral epicondyles of the humerus
* Olecranon process of the ulna in between the
epicondyles
articulation of the radius and a row of carpal bones
allows for flexion and extension; side to side deviation
radiocarpal joint
articulation between the two parallel rows of carpal bones
allows for flexion extension, some rotation
midcarpal joint
allow for flexion and extension of the fingers
metacarpophalangeal and interphalangeal joints
articulation between the acetabulum and the head of the femur
hip joint
allows a wide range of motion on many axes
ball and socket
what are the landmarks for the hip joint?
anterior superior iliac spine; ischial tuberosity; greater trochanter
articulation of three bones in one common articular cavity- femur, tibia, patella
largest joint in the body, synovial membrane largest in the body
knee joint
allows for flexion and extension of the lower leg on one plane
hinge joint
2 wedge-shaped cartilages that cushion the tibia and femur
medial and lateral menisci
what is the knee joint stabilized?
cruciate ligaments
collateral ligments
articulation of the tibia, fibula, and talus
ankle joint
allows flexion and extension
hinge joint
what are the landmarks for the ankle joint?
medial malleolus and lateral malleolus
what are the developmental considerations for infants and children?
Bone growth – from in utero through to adolescence when a rapid growth
spurt occurs
* Long bones grow in 2 dimensions: width (diameter) and length
* Skeletal contour changes noted at the vertebral column
* Development of dysplasia of the hip (DDH) - congenital abnormalities of the
hip joint
* Infants should be examined periodically until they are walking
independently
* Several risk factors. Examples: having a first=degree relative with DDH,
breech delivery etc.
* Growing Pains - Noninflammatory pain syndrome affecting children between
ages 3-12
what are the developmental considerations for pregnancy?
Increased joint mobility occurs
due to increased levels of
circulating hormones such as
estrogen, relaxing etc.
* Change in posture - lordosis which
compensates for the growing
fetus
Reabsorption of bone occurs more rapidly then deposition
after the age of 40 years
osteoporosis
Caused by shortening of the vertebral column - due to loss of
water content, thinning of the vertebral discs
decreased height
how do we inspect the musculoskeletal system?
Assess size and contour of the joint
* Inspect the skin and tissues over the joint (colour, swelling,
masses, deformity)
* Presence of swelling is significant – indicates joint irritation
* Swelling can be caused by:
* Excess joint fluid (effusion)
* Thickening of the synovial lining
* Inflammation of surrounding soft tissue
* Bony enlargements
* Deformities include: Dislocation, subluxation, contracture ,
ankylosis
how do we palpate the musculoskeletal system?
Palpate skin (temperature), muscles, bony articulations, area of the
joint capsule
* Note heat, tenderness, swelling, masses
what are the normal findings for palpation of the musculoskeletal system?
Joints not tender to palpation, synovial membrane is not
palpable
* Note: a small amount of fluid is present in the normal joint but it is
not palpable
what are the abnormal findings for palpation of the musculoskeletal system?
Warmth, tenderness, palpable fluid, tenderness, thickened
synovial membrane
* If tenderness is noted– try to localize it to specific anatomical
structures (i.e. muscles, tendons, joint capsule etc.)
* When the synovial membrane is thickened, it feels doughy or boggy
what are the normal findings for testing ROM?
no tenderness, pain, or crepitation with joint motion
* Active and passion ROM (normal ranges) should be the same
what are the abnormal findings for testing ROM?
enderness, pain, crepitation
* Crepitation - crunching or grating, that is audible and palpable, that occurs
with movement
* Articular disease and extra-articular disease
what is the grading system for ROM?
5 - Full ROM against gravity, full resistance
* 4 - Full ROM against gravity, some resistance
* 3 - Full ROM with gravity
* 2 - Full ROM with gravity eliminated (passive motion)
* 1 - Slight contraction
* 0 - No contraction
how do we inspect the temporomandibular joint?
Inspect the area just anterior to the ear.
* Assess for a bulge over the joint - this indicates swelling
* To be visible, at least a moderate amount of swelling has to
be present
how do we palpate the temporomandibular joint?
The examiner places the tips of their first two fingers in front
of each ear
* Ask client to open the mouth
* The examiner then drops their fingers into the depressed
area over the joint
what are the normal and abnormal findings for palpation of the temporomandibular joint?
Normal: Smooth motion of the mandible
* Consideration: An audible or palpable snap/click occurs when the
client opens their mouth
* Abnormal: Swelling over the joint, crepitus, and pain
how do we test muscle strength in the temporomandibular joint?
Ask the client to:
* Clench their teeth
* Examiner palpates the contracted temporalis and masseter
muscles
* Compare bilaterally for size, firmness, and strength
* Move their jaw forward and laterally against resistance
* Open their mouth against resistance
* See Figure 24., p. 654
* Note: Muscle strength testing is also testing the integrity of the
trigeminal nerve
how do we inspect the cervicalm spine?
inspect alignment of the head and neck
how do we palpate the cervical spine?
Palpate the: spinous process, sternomastoid muscle, trapezius
muscle, and the paravertebral muscles
what are the normal and abnormal findings when palpating the cervical spine?
Normal: Firm with no muscle spasm or tenderness
* Abnormal: Asymmetry of the muscles, tenderness, and hard
muscles with muscle spasm
how do we test muscle strength of the cervical spine?
Ask the client to repeat the ROM while the examiner applies
opposing force
what are the normal and abnormal findings when testing muscle strength of the cervical spine?
Normal: The client can maintain flexion against full
resistance
* Abnormal: The client cannot maintain flexion
how do we inspect the shoulders?
Compare both shoulders posteriorly and anteriorly.
* Check the size and contour of the joint, & the equality of bony landmarks
* Check the anterior aspect of the joint capsule and subacromial bursa for
swelling
what are the normal and abnormal findings when inspecting the shoulders?
Normal: No redness, muscular atrophy, deformity, or swelling
* Abnormal: Redness, inequality of bony landmarks, atrophy, dislocated
shoulder, swelling from excess fluid (this is best seen anteriorly), swelling
of subacromial bursa (localized under the deltoid), pain
how do we palpate the upper extremities?
Stand in front of the client
* Palpate both shoulders, starting at the clavicle (note: muscular spasm,
atrophy, swelling, heat, or tenderness)
* Explore the following: Acromioclavicular joint, scapula, greater tubercle
of the humerus, area of the subacromial bursa, biceps groove, and
anterior aspect of the glenohumeral joint, axilla
what are the normal and abnormal findings when palpating the upper extremities?
Normal: No swelling, tenderness, muscle spasm, adenopathy or masses
* Abnormal: Swelling, tenderness, hard muscles with muscle spasm,
presence of adenopathy or masses
how do we test muscle strength of the shoulders?
Ask client to shrug their shoulders against resistance:
* Shoulder shrug is also a test of the integrity of the spinal
nerve
* Ask the client to flex their shoulders forward and up and abduct
them against resistance
how do we inspect the elbow?
Size and contour
* This should be done in both the flexed and extended positions
* Deformity, redness, or swelling
* Check the olecranon bursa - there are normally hollows on
either side and no swelling should be present
how do we palpate the elbow?
When palpating:
* The elbow should be flexed about 70 degrees and relaxed
* The examiner uses their left hand to support the client’s left forearm
* Palpate the extensor surface of the elbow with right thumb and fingers
* Palpate the olecranon process by placing the thumb in the lateral groove and
index and middle fingers in the medial groove
* Use varying pressure when palpating
what are the normal and abnormal findings when palpating the elbow?
Normal:
* Tissues and fat pads feel fairly solid, no synovial thickening, swelling,
nodules, or tenderness
* No swelling, tenderness, consistency, nodules noted in the area of the
olecranon bursa
* Abnormal: soft or boggy when palpated, local heat or redness, subcutaneous
nodules
how do we test muscle strength of the elbow?
When testing muscle strength:
* Stabilize the client’s arm with one hand
* Apply resistance proximal to the wrist
* Instruct client to both flex and extend the elbow against
resistance
how do we inspect the wrist and hands?
During inspection of the hands and wrists, assess the following:
* Dorsal and palmer sides
* Observe: position, contour, shape
* Normal functional position of the hand: Wrist is slightly extended;
fingers in same axis as the forearm
* Skin
* Muscles - should be full; note the thenar eminence
what are the normal and abnormal findings when inspecting the hands and wrists?
Normal: Skin is smooth with knuckle wrinkles present; no swelling
or lesions, redness, deformity, or nodules
* Abnormal: Subluxation of the wrist, ulnar deviation, ankylosis,
Dupuytren’s contracture, generalized swelling, tenderness etc.
how do we palpate the hands and wrists?
Palpate each joint:
* Examiner faces the client
* Examiner supports the client’s hand with their fingers under it, palpate
wrist firmly with both thumbs on its dorsum
* Client’s wrist should be relaxed and in straight alignment
* Move palpating thumbs side to side – note depressed areas that overlie
joint space
what are the normal and abnormal findings when palpating the wrists and hands?
Normal: Joint surfaces smooth, no swelling, bogginess, nodules, or
tenderness
* Abnormal: Absence of the thenar eminence, swelling, tenderness
etc.
* Using their thumbs, the examiner palpates the metacarpophalangeal
joints
* Palpate distal to and on either side of the knuckle
* Using their thumb and index finger in a pinching motion, the
examiner palpates the sides of the interphalangeal joints
* Findings:
* Normal: No synovial thickening, redness, warmth, or nodules noted
how do we test muscle strength of the wrists and hands?
To test muscle strength:
* Place client’s forearm in supinated position on a table
* Stabilize client’s arm - examiner places their hand at the mid-
forearm
* Apply resistance at the client’s palm
* Instruct client to flex their wrist against the examiner’s resistance
how do we inspect the hip?
Inspection of the hip joint is completed with assessment of the
spine
* The client will be in the standing position
* Inspect for:
* Symmetrical levels of iliac crests and gluteal folds;
* Equal size buttocks
* Smooth, even gait
how do we palpate the hip?
For palpation of the hips:
* Position the client supine
what are the normal and abnormal findings when palpating the hip?
Normal: Joints feel stable and symmetrical, no tenderness or
crepitation
* Abnormal: pain with palpation, crepitation
how do we inspect the knee?
Client should be in the supine position with legs extended
* Inspect the skin
what are the normal and abnormal findings when inspecting the skin of the knee?
Normal: Skin smooth, even colouring, no lesions
* Abnormal: Shiny, atrophic skin, swelling, inflammation, lesions
what are the normal and abnormal findings when inspecting the lower leg alignment?
Normal: Leg extends in same axis as the thigh
* Abnormal: Genu varum, Genu valgum, flexion contractures
how do we inspect the shape and contour of the knee?
Normal: Distinct concavities present on either side of the
patella - no sign of fullness or swelling
* Abnormal: Concavities disappear, bulging noted
how do we inspect the quads for atrophy?
Normal: No atrophy
* Abnormal: Atrophy (occurring with disuse or chronic disorders)
how do we palpate the lower extremities?
Palpate each joint:
* Client should be in the supine position with complete relaxation
of quadriceps muscle
* Start 10 cm above patella and proceed down to the knee
* Palpate using left thumb and fingers in a grasping manner
what are the normal and abnormal findings when palpating the lower extremities?
Normal: Muscles and soft tissue feel solid, joint smooth with
no warmth, tenderness, thickness, or nodules
* Abnormal: Boggy texture, warmth, tenderness, thickness, or
nodules
how do u test muscle strength in the lower extremities?
Client maintains knee flexion while the examiner opposes by
trying to pull the leg forward
how do we test muscle extension in the lower extremities?
Client rises from a seated position (low chair or from a squat)
without using the hands for support
how do we inspect the ankle and foot?
When client is sitting, standing, and walking
* Compare both feet
* Positioning of feet and toes, contour of joints, skin, foot alignment with
axis of lower leg, weight bearing, pointing of toes, longitudinal arch,
ankles
what are the normal and abnormal findings when inspecting the ankle and foot?
Normal: Smooth skin, even colouring, no lesions, no issues noted with
above
* Abnormal: Hallux valgus, hammertoes, claw toes, swelling,
inflammation, calluses, ulcers
how do you palpate the ankle and foot?
Examiner supports the ankle by grasping the heel while palpating
with fingers and thumbs
Examiner palpates the metatarsophalangeal joints between the
thumb (on the dorsum) and fingers (on plantar surface)
* Examiner uses a pinching motion to palpate the interphalangeal joints
on the medial and lateral sides of the toes
what are the normal and abnormal findings when palpating the ankle and foot?
Normal: Joint spaces should feel smooth and depressed, with no
fullness, swelling, or tenderness
* Abnormal: Tenderness, swelling, inflammation
how do you assess the spine?
The client should
be standing
* The hospital gown
should be open in
the back
how do we examine the spine?
The examiner should be positioned so that the client’s entire back can be
seen.
* For inspection:
* Assess the spine for straightness`
what are the normal and abnormal findings when inspecting the spine?
Normal:
* Imaginary straight line from the client’s head, down the spinous
processes, and down the gluteal cleft
* Equal horizontal positioning of: the shoulders, scapulae, iliac
crests, and gluteal folds
* Equal spaces between the arm and lateral thorax on both sides
* Knees and feet are aligned with truck and pointing forward
* Abnormal:
* Difference in shoulder elevation, level of scapulae, and level of
the iliac crests
what are the normal and abnormal findings when palpating the spinuous processes?
Normal: Straight and non-tender
* Abnormal: Spinal curvature
what are the normal and abnormal findings when palpating the paravertebral muscles?
Normal: Feel firm with no tenderness or spasm
* Abnormal: Tenderness, spasm
what are the normal and abnormal findings when testing rom of the spine?
Normal: Expected range, no pain with movement
* Abnormal: Limited ROM, pain with movement
* Note: Movements will only reveal gross restriction.
* Once the ROM assessment is completed, ask the client to:
* Walk on their toes for a few steps
* Walk on their heels
