Objective & Abnormal Flashcards
Make the person comfortable as your general approach, compare _____ to affected side, and proceed in a cephalocaudal order (proximal to distal -from the midline outward), look at ______ appearance, ________, and gait and mobility patterns….what do these include? 3 things
unaffected, overall, posture, weight-bearing status, gait patterns, and transfer ability
Abnormal Gait patterns:
- ) limited weight bearing: _________
- ) Foot dragged across floor in semicircle: ________
- ) Staggering (cerebellar) : ________
- ) Foot flaps floor (polio) : ________
- ) Difficulty starting; shuffling (alzheimer’s) : _____________
antalgic, scissors , ataxia ,steppage, apraxic
A general assessment includes:
- Height and weight are __________.
- Full ROM
- Ambulate independently.
- No structural _______.
- Shoulders & hips are level.
- Head & torso are upright
- ________ gait.
proportionate, defects, stable
Inspection includes:
- muscle size and shape: _________, atrophy, __________ muscle mvmt’s, limb circumference.
- Joint ______ and periarticular tissue
Hypertrophy, involuntary, contour
Normal findings of Inspection:
- ________ muscle contour.
- No involuntary muscle movements.
- Bilateral limb circumference is within __-__ cm of each other
- Joints are _____ when extended, and smooth/round during ______.
- No joint enlargement or deformity.
symmetrical, 1-3, flat, flexion
Palpation includes:
- Measure muscles and use _______ or gravity against to assess.
- Look for heat, _____, tenderness, limitation, masses on joints.
- Assess muscle strength, Scale (5/5)= WNL
- The ______ membrane normally is not palpable, when thickened with fluid, it feels “spongy”, can visibly see the fluid shift from side to side
resistance, edema, synovial
What are some special techniques for assessing joints?
- temporomandibular
- cervical spine
- shoulders
- elbows
- wrist & hands
- knees
- ankles & feet
- spine
On the patellar ballotement assess for large ______, No palpable click.
effusions
Normal findings of Joints & muscles:
- _______ muscle tone
- No ______ or masses
- Joints without _____, tenderness, or edema.
- Full ROM
- Muscle strength 5/5, and equal bilaterally
- No lordosis, _______, or scoliosis.
bilateral, crepitus, pain, kyphosis
Gerontological variations:
- bone density decreases
- weaker bones increases risk of ________
- Muscle ______.
- decreased muscle strength
- deterioration of articulating cartilage.
- vertebral ________
- thoracic _________
osteoporosis, atrophy, inflexibility, kyphosis
On inspection, ______ may be due to excess joint fluid, thickening of the _____ lining, inflammation of surrounding soft tissue ( _____, tendons), or bony _________.
swelling, synovial, bursae, enlargement
Deformities include:
- complete loss of contact btw the two bones in a joint: _______
- Two bones in a joint stay in contact, but their alignment is off : ________
- Shortening of a muscle leading to limited ROM of joint: _________
- Stiffness or fixation of a joint: _________
dislocation, subluxation, contracture, ankylosis
Limitation in ____ ____ _______ is the most sensitive sign of joint disease.
- Disease inside the joint capsule (e.g. Arthritis): ________, produces swelling and tenderness around the whole joint, and it limits all planes of ROM in both ____ and passive motion.
- Injury to a specific tendon, ligament, nerve : ________, produces swelling and tenderness to that ___ spot in the joint and affects only certain planes of ROM, especially during ______ (voluntary) motion
Range of motion, Articular, active, Extra-articular disease, one, active
An audible and palpable crunching or grating that accompanies movement: _______, It occurs when the articular surfaces in the joints are roughened, as with ______ arthritis.
Crepitation, Rheumatoid
Degenerative conditions:
- Noninflammatory, localized, progressive disorder involving deterioration of articular cartilages and subchrondral bone and formation of new bone (osteophytes) at joints surfaces: __________.
- A decrease in skeletal bone mass occuring when rate of bone resorption is greater than that of bone formation. the weakened bone increases risk for stress fractures esp at wrist, hip and vertebrae: _________
Osteoarthritis (degenerative joint disease), Osteoporosis
Inflammatory conditions:
- A chronic, systemic inflam. disease of joints and surrounding connective tissue. inflam of synovial membrane leads to thickening; then to fibrosis, which limits motion, and finally to bony ankylosis. Head, redness, swelling, and painful motion of affected joints: ________ ______
- A chronic, progress, inflam of spine, sacroilliac, and larger joints of the extremities, leading to bony ankylosis and deformity, a form of RA : _____ spondylitis
Rheumatoid arthritis, ankylosing
*Crepitus and pain occur with _________ joint dysfunction.
*______ motion may be lost earlier and more significantly than vertical.
temporomandibular, lateral
When assessing muscle strength, the nurse observes that a patient has complete range of motion against gravity with full resistance. What Grade should the nurse record using a 0 to 5 point scale?
A) 2
B) 3
C) 4
D) 5
5
Pages: 578-579. Complete range of motion against gravity is normal muscle strength and is recorded as Grade 5 muscle strength.
The nurse is assessing the joints of a woman who has stated, “I have a long family history of arthritis, and my joints hurt.” The nurse suspects that she has osteoarthritis. Which of these are symptoms of osteoarthritis? Select all that apply.
A) Symmetric joint involvement
B) Asymmetric joint involvement
C) Pain with motion of affected joints
D) Affected joints are swollen with hard, bony protuberances
E) Affected joints may have heat, redness, and swelling
B) Asymmetric joint involvement
C) Pain with motion of affected joints
D) Affected joints are swollen with hard, bony protuberances
Page: 608. In osteoarthritis, asymmetric joint involvement commonly affects hands, knees, hips, and lumbar and cervical segments of the spine. Affected joints have stiffness, swelling with hard bony protuberances, pain with motion, and limitation of motion. The other options reflect signs of rheumatoid arthritis.
What are some abnormalities of the shoulder?
Atrophy, dislocated shoulder, joint effusion, tear/rotator cuff, frozen shoulder (adhesive capsulitis), and subacromial bursitis
Loss of muscle mass is exhibited as a lack of fullness surrounding the deltoid muscle from a shoulder abnormality (picture representation is axillary nerve palsy). Also occurs from disuse, muscle tissue damage, or motor nerve damage.
atrophy
Anterior ________ of the shoulder is exhibited when hunching the shoulder forward and the tip of the clavicle dislocates. it occurs with trauma involving abduction, _______, and rotation (ex. falling on an outstretched arm or diving into a pool)
dislocation, extension
Swelling from excess fluid in the joint capsule,(picture from rheumatoid arthritis), best observed anteriorly. fluctuant to palpation. considerable fluid must be present to cause a visible distention b/c the capsule is normally is so loose.
joint effusion
Characteristic “hunched” position and limited abduction of arm. Occurs from traumatic adduction while arm is held in abduction, or from fall on shoulder, throwing, or heavy lifting.
*Positive drop arm test: if the arm is passively abducted at the shoulder, the person is unable to sustain the position and the arm falls to the side
Tear or rotator cuff
Fibrous tissues form in the joint capsule, causing stiffness, progressive limitation of motion, and pain. motion limited in abduction and external rotation; unable to reach overhead. associated with prolonged bed rest or shoulder immobility, may resolve spontaneously
Frozen shoulder-adhesive capsulitis
Inflammation and swelling of subacromial bursa over the shoulder cause limited ROM and pain with motion. Caused by direct trauma, strain during sports, local/systemic inflam process or repetitive motion with injury
subacromial bursitis
Large, soft knob, or “goose” egg and redness on elbow from inflammation of olecranon bursa. localized and easy to see b/c bursa lies just under skin.
Olecranon bursitis
Joint effusion or synovial thickening of elbow, seen first as a bulge or fullness in grooves on either side of olecranon process. redness & heat can extend beyond area of synovial membrane. soft, boggy to palpation. limited extension of elbow
gouty arthritis
Raised, firm, nontender nodules on the elbow that occur with rheumatoid arthritis. common sites are in the olecranon bursa and along extensor surface of arm. the skin slides freely over the nodules
Subcutaneous nodules
Chronic disabling pain at lateral epicondyle of humerus, radiates down extensor surface of forearm. Pain can be located with one finger. Resisting extension of the hand will increase the pain
*occurs with activities combining excessive pronation and supination of forearm with an extended wrist (racquet sports or using a screwdriver)
Epicondylitis-tennis elbow
*Medial epicondylitis is rarer and is due to activity of forced palmer flexion of wrist against resistance
Round, cystic, nontender nodule overlying a tendon sheath or joint capsule, usually on dorsum of wrist.
- Flexion makes it more prominent.
- A common benign tumor; it does not become malignant
Ganglion Cyst
Atrophy occurs from interference with motor function from compression of the median nerve inside the carpal tunnel. Caused by chronic repetitive motion
- Occurs between 30-60 years of age, 5 times more common in women than men
- symptoms include pain, burning, numbness, positive findings on phalen test, tinel sign, and often atrophy of thenar muscles
Carpal tunnel syndrome with atrophy of thenar eminence
Wrist in extreme flexion, due to severe rheumatoid arthritis.
*This is a functionally useless hand because when the wrist is palmar flexed, a good deal of power is lost from the fingers and the thumb cannot oppose the fingers
Ankylosis
Nonarticular fracture of distal radius, with or without fracture of ulna at styloid process. *usually from a fall on an outstretched hand and most common in old ladies
*characteristic hump when viewed from side
colles fracture
Chronic hyperplasia of the palmar fascia causes flexion contractures of the digits, first in the 4th, than the 5th, and than 3rd.
- more common in men > 40 yrs, usually bilateral
- occurs with diabetes, epilepsy, and alcoholic liver disease and as an inherited trait
- the contracture is painless but impairs hand function
Dupuytren contracture
Flexion contracture resembles curve of a ____ _____. Note flexion contracture of metacarpophalangeal joint, then hyperextension of the proximal interphalangeal joint, and flexion of the distal interphalangeal joint.
*occurs with chronic rheumatoid arthritis and is often accompanied by ulnar drift of the fingers
swan neck
In _______ deformity, the knuckle looks as if it is being pushed through a button hole.
Boutonniere
Fingers drift to the ulnar side b/c of stretching of the articular capsule and muscle imbalance.
*Also note subluxation and swelling in the joints and muscle atrophy on the dorsa of the hands. this is caused by chronic rheumatoid arthritis
ulnar deviation and drift
________ is chracterized by hard, nontender nodules, 2-3mm or more. These osteophytes (bony overgrowths) of the distal interphalangeal joints are called Heberden nodes, and those of the proximal interphalgeal joints are called _______ nodes.
Osteoarthritis, bouchard
Painful swelling and stiffness of joints, with fusiform or spindle-shaped swelling of the soft tissue of proximal interphalangeal joints. Fusiform swelling is usually symmetric. the hands are warm, and the veins are engorged. the inflamed joints have a limited range of motion.
Acute rheumatoid arthritis
extra digits are a congenital deformity, usually occurring at the fifth finger or the thumb
polydactyly
Webbed fingers are a congenital deformity, usually requiring surgical separation
syndactyly
Localized soft swelling in knee from cyst in lateral meniscus shows at the midpoint of the anterlateral joint line. semiflexion of knee makes swelling more prominant
swelling of menisci
Loss of normal hallows on either side of the patella, which are replaced by mild distention.
*occurs with synovial thickening or effusion. also note mild distention of the suprapatellar pouch
mild synovitis
Localized swelling on anterior knee between patella and skin. a tender, fluctuant mass indicated swelling, in some cases, infection spreads to surrounding tissue. the condition is limited to the bursa, and the knee joint itself is not involved.
*overlying skin may be red, shiny, atrophic, or coarse and thickened
prepatellar bursitis
Painful swelling of the tibial tubercle just below the knee, probably from repeated stress on the patellar tendon.
- occurs most in puberty during rapid growth and most often in males.
- pain increases with kicking, running, biking, etc.
- self limiting, symptoms resolve with rest
Osgood-schlatter disease
Thousands of polio survivors have right leg and foot muscle _______
atrophy
inflammation of tendon sheath near the ankle produces a superficial linear swelling and a localized tenderness along the route of the sheath.
*pain and movement of the involved tendon usually causes pain
achilles tenosynovitis
Hard, painful nodule (_____) over metatarsophalangeal joint of the first toe. tophi are a collection of sodium urate crystals due to chronic ____ in and around the joint that cause extreme swelling and joint deformity.
*sometimes burst with chalky discharge
Tophi, gout
Usually involves the metatarsophalangeal joint first, clinical findings consist of redness, swelling, heat and extreme tenderness. Gout is a metabolic disorder of disturbed purine metabolism, associated with elevated serum uric acid.
*primarily in men > 40
Acute Gout
____ _______is a common deformity from rheumatoid arthritis. it is a lateral or outward deviation of the great toe with medial prominence of the head of the first metatarsal
Hallux valgus
hypertrophy of the epithelium develops because of prolonged pressure, not painful
Callus
Inflamed bursa that forms at the pressure point
bunion
_____ (thickening of soft tissue) develop on the dorsum over the bony prominence from prolonged pressure from shoes.
Corns
The nail does not grow in, but the soft tissue grows over the nail and obliterates the groove. occurs almost always on the great toe. do to trimming nail to short or toe crowding in tight shoes.
*The area becomes infected when the nail grows and its corner penetrates the soft tissue
ingrown toenail
Vascular papillomatous growth that is probably due to a virus and occurs on the sole of the feet, commonly on the ball. extremely painful
plantar wart
_______: Lateral curvature of thoracic and lumbar segments of the spine, usually with some rotation involved vertebral bodies.
- ______: flexible, apparent with standing, disappears with forward bending
- _______: fixed, curvature shows both on standing and on bending forward, unequal shoulder elevation, scapulae, and hip level.
scoliosis, functional, structural
The nucleus pulposus (at the center of the intervertebral disk) ruptures into the spinal canal and puts pressure on the local spinal nerve root
- usually occurs from stress, such as lifting, twisting, continuous flexion with lifting, or fall on butt.
- lumbar hernias occur mainly in interspaces L4 and L5 and L5 to S1
- note sciatic pain, numbness, and paresthesia of involved dermatone.
herniated nucleus pulposus
head of the femur is displaced out of the cup shaped acetabulum
congenital dislocated hip
Congenital, rigid, and fixed malposition of food, including
- ) inversion
- ) forefoot adduction
- ) foot pointing downward (equinus)
*common birth defect
talipes equinovarus (clubfoot)
incomplete closure of posterior part of vertebrae results in a neural tube defect
spina bifida
chronic disorder of unknown cause characterized by widespread muscluoskeletal pain lasting 3 months or longer, associated with fatigue, insomnia, and psychosocial distress. most patients (90%) are women
- two major diagnostic criteria
1. ) pain bilateral, above and below waist, and axial skeletal pain (Cervical, thoracic, lumbar spine or anterior chest)
2. ) point tenderness on digital palpation in 11 of 18 specified sites showin in picture.
Fibromyalgia syndrome
