objective data and case studies

Question 1

what should you note about every joint?

Answer 1

size, contour
look for color, swelling, masses and deformity

*swelling can indicate effusion, bursitis, or bony enlargement

Question 2

deformities of the joint

Answer 2

fracture (break in the bone completely)
dislocation (moved out of place)
subluxation (two bones in a joint stay in contact but their alignment is off-partial dislocation of a joint)
contracture (shortening of a joint leading to limited ROM)
ankylosis (stiffness or fixation of a joint)

Question 3

what are clues for abnormals of the joints

Answer 3

warmth and tenderness signal inflammation

palpable fluid is abnormal

Question 4

crepitation

Answer 4

audible and palpable crunching or grating that accompanies movement. it occurs when the articular surfaces in the joints are roughened.

Question 5

where does articular (eg arthritis) produce swelling

does the swelling have any effect on ROM?

Answer 5

the whole joint

limits all planes or ROM–active and passive

Question 6

how to grade ROM?

Answer 6

0–no contraction
1–slight contraction
2–Full ROM with gravity eliminated (passive motion)
3–Full ROM with gravity
4–Full ROM against gravity and some resistance
5–full ROM against gravity and full resistance

Question 7

temporomandibular joint: how to assess

expected motion

Answer 7

instruct patient to open mouth maximally (vertical motion, 3 to 6 cm)
partially open mouth, protrude lower jaw and move lower jaw from side to side
(lateral motion, 1 to 2 cm)
stick out lower jaw
(protrude w/o deviation)

Question 8

temporomandibular joint: assessment continued

Answer 8

decreased ROM occurs with TMJ dysfunction and arthritis.

should hear and audible and palpable snap when the person moves their jaw back into place.

Question 9

cervical spine assessment

Answer 9

inspect alignment of the head and neck

have person touch chin to chest, lift chin towards ceiling (45 degrees), touch each ear to respective shoulder (55 degrees), and turn the chin to each shoulder (40 degrees)

repeat the motions while applying force.
can the person maintain flexion against resistance?

also testing CN XI-spinal accessory

Question 10

cervical spine-clues for abNOrmals

Answer 10

limited ROM occurs with arthritis
pain with movement occurs with arthritis or muscle overuse
the person NOT being able to hold flexion indicates and abnormality

inspection: head tilted to one side, asymmetry of the muscles, tenderness and hard muscles with muscle spasm. tenderness with arthritis of postural disorders with desk or office work

Question 11

shoulder inspection

Answer 11

compare both shoulders posteriorly and anteriorly

check the size and contour for equality of bony landmarks

Question 12

shoulder inspection clues for abnormalities

Answer 12

redness
inequality of bony landmarks occurs with scoliosis
atrophy can signs rotator cuff problem or disuse.

dislocated shoulder loses normal rounded shape and looks flattened laterally.

Question 13

tests to determine shoulder function

Answer 13

hyperextension,
internal rotation
adduction and abduction
external rotation

abnormal are limited ROM, asymmetry, and pain or crepitus with motion

Question 14

elbow inspection

and clues for abnormals

Answer 14

size and contour
subluxation of the elbow shows the forearm dislocated posteriorly.

swelling and redness of the olecranon bursa are localized and easy to observe
effusion or synovial thickening shows as a bulge or groove in either side of the olecranon process–occurs with bursitis and gouty arthritis.

Question 15

elbow ROM testing

Answer 15

flexion/extension
pronation and supination

if they can extend after a fall or trauma, they don’t have a fracture.

Question 16

what are subcUtaneous nodules?

Answer 16

raised, firm, and nontender and overlying skin moves freely. occur with rheUmatoid arthritis.

Question 17

wrist and hand inspection and clues for abnormalities

Answer 17

position, contour and shape.

should be no swelling or redness, deformity, or nodules present.
skin should look and feel smooth, no swelling, bogginess, nodules, or tenderness.

Question 18

what are Heberden and Bouchard nodules and what do they occur with?

Answer 18

hard and nontender nodules found in the wrist that occur with osteoarthritis.

Question 19

how to test ROM of the wrist

Answer 19

hyperextension
palmar flexion
flexion
ulnar deviation
abduction (spread apart) 
touch thumb to each finger 

responses should be eqaul bilat as the person performs.

Question 20

Phalen test

Answer 20

have person hold both hands back while flexing the wrists 90 degree. Acute flexion for 60 seconds produces no symptoms in the normal hand.

Phalen test will reproduce numbness and burning in a person with carpal tunnel.

Question 21

Tinnel sign

what is it and what does a positive tinnel sign mean

Answer 21

a test that involves direct percussion of the location of the median nerve.

no symptoms are produced in the normal hand

in carpal tunnel, percussion of the median nerve produces burning and tingling along it’s distribution–>positive tinnel sign.