objective data and case studies Flashcards
what should you note about every joint?
size, contour
look for color, swelling, masses and deformity
*swelling can indicate effusion, bursitis, or bony enlargement
deformities of the joint
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)
what are clues for abnormals of the joints
warmth and tenderness signal inflammation
palpable fluid is abnormal
crepitation
audible and palpable crunching or grating that accompanies movement. it occurs when the articular surfaces in the joints are roughened.
where does articular (eg arthritis) produce swelling
does the swelling have any effect on ROM?
the whole joint
limits all planes or ROM–active and passive
how to grade ROM?
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
temporomandibular joint: how to assess
expected motion
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)
temporomandibular joint: assessment continued
decreased ROM occurs with TMJ dysfunction and arthritis.
should hear and audible and palpable snap when the person moves their jaw back into place.
cervical spine assessment
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
cervical spine-clues for abNOrmals
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
shoulder inspection
compare both shoulders posteriorly and anteriorly
check the size and contour for equality of bony landmarks
shoulder inspection clues for abnormalities
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.
tests to determine shoulder function
hyperextension,
internal rotation
adduction and abduction
external rotation
abnormal are limited ROM, asymmetry, and pain or crepitus with motion
elbow inspection
and clues for abnormals
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.
elbow ROM testing
flexion/extension
pronation and supination
if they can extend after a fall or trauma, they don’t have a fracture.
what are subcUtaneous nodules?
raised, firm, and nontender and overlying skin moves freely. occur with rheUmatoid arthritis.
wrist and hand inspection and clues for abnormalities
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.
what are Heberden and Bouchard nodules and what do they occur with?
hard and nontender nodules found in the wrist that occur with osteoarthritis.
how to test ROM of the wrist
hyperextension palmar flexion flexion ulnar deviation abduction (spread apart) touch thumb to each finger
responses should be eqaul bilat as the person performs.
Phalen test
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.
Tinnel sign
what is it and what does a positive tinnel sign mean
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.
