Quiz #4 Musculoskeletal Flashcards
By what gestation has fetus formed cartilage scale model of the skeleton?
3 months
When is bone growth most rapid?
infancy and adolescence
epiphyses
growth plates. Transverse disks at the ends of the long bones where lengthening of the long bones occurs.
curve of the spine at birth
single C shape
change in the spine at 3-4 months
raising the baby’s head from prone develops the anterior curve in the cervical neck region
change in the spine from 1 year-18 months
standing erect develops the anterior curve in the lumbar region
Diets rich in what and low in what in prevent obesity and promote bone mass accrual in children?
Dark green and deep yellow vegetables (greens, carrots, sweet potatoes)
Low in fried foods
What causes increased mobility in the joints of the pregnant woman?
Estrogen, relaxin, corticosteroids
Spine in the pregnant woman
lordosis increased, which compensates for enlarging fetus to shift weight back to lower extremities.
What postural changes in the pregnant woman compensate for lordosis?
Anterior flexion of the neck and slumping of the shoulder girdle. May put pressure on nerves and cause aching, numbness, and weakness in upper extremities.
bone remodeling
cyclic process of bone resorption and deposition.
Remodeling favors deposition until
skeletal maturity at 25-35 years- peak bone mass
After what age does loss of bone matrix occur more rapidly than new bone formation?
Age 40
Why do women have more osteoporosis than men?
For 5 years after menopause, women lack estrogen, leading to accelerated bone loss.
What causes decreased height with age?
- Shortening of the vertebral column due to loss of water content and thinning of the intervertebral disks
- Decrease in the height of individual vertebrae due to osteoporosis.
When does decrease in height begin/become signficant?
Begins in the 40s, becomes significant at age 60. Increaes in the 70s and 80s due osteoporitic collapse of the vertebrae
Postural changes with aging
kyphosis
backward head tilt to compensate for kyphosis
slight flexion of the hips and knees
In the 40s and 50s, weight….
begins to increase. Fat lost in the face and deposited in the abdomen and hips
In the 80s and 90s, fat
decreases in the periphery—especially apparent in the forearms.
Best preventative exercise for osteoporosis
Fast walking- faster decreases chance of a bone fracture.
Benefits of physical activity in the older adult
- Improves muscle strength
- Prevents falls
- Increases balance and posture control
- Decreases back pain
- Improves quality of life
Older adults with a physical activity training program with resistance, balance, and functional training showed
significant increases in strength, flexibility, HR after exercise, and balance.
BMD values in Af Am women
Much higher- lower risk of hip fracture
BMD in white women
In femoral neck at the hip joint, BMD peaks earlier in whites than other race groups. Weight bearing exercise is imperative.
Subjective data for musculoskeletal system
- Joint pain or problems
- Knee joint
- Muscles
- Bones
- Functional ADL
- Patient-centered care
Pain in bilateral joints may indicate
Rheumatoid arthritis
rheumatoid arthritis S+S
Bilateral joint pain, very tender
Worse in the morning and after rest
Joint pain that is worse later in the day
osteoarhritis
Joint pain that improves during the day
Tendonitis
Joint pain 10-14 days after untreated strep throat suggests…
rheumatic fever
Decreased ROM may be caused by
Joint injury to cartilage or capsule or muscle contracture
Myalgia felt as
cramping or aching, viral illness when associated with fever/chills
Fracture pain
sharp, increases with movement
Categories for functional ADL in subjective interview
- Bathing
- Toileting
- Dressing
- Grooming
- Eating
- Mobility
- Communicating
Cigarettes and alcohol affect on bones
Cigarettes cause increased bone loss and risk of fracture in older women
Moderate-heavy drinking increases falls risk
Patient centered care for musculoskeletal system
Occupational hazards Exercise program— type, frequency, warm up Pain during exercise Weight gain, diet Medications- NSAIDS, muscle relaxant, pain relievers, hormones Calcium, vitamin D, dairy Effect of chronic disability or illness Cigarettes & Alcohol
Objective data for musculoskeletal system
- Inspection
- Palpation
- ROM
- Hip
- Spine
Swelling in the joints may be caused by
- Excessive joint fluid (effusion)
- Thickening of the synovial lining
- Inflammation of the surrounding soft tissue (bursae/tendons)
- Bony enlargement
Dislocation
Complete loss of contact between two bones in a joint
Subluxation
Two bones in a joint still in contact, but misaligned
Contracture
Shortening of a muscle causing decreased ROM in a joint
Ankylosis
Stiffening or fixation of a joint
Is the synovial membrane normally palpable?
No
When thickened, synovial membrane feels
Doughy or boggy. If pushed, fluid will move and bulge out on another side.
When is a musculoskeletal exam appropriate?
Problems with ADLs
Musculoskeletal symptoms
If you see a limitation in active ROM
gently attempt passive motion with the person’s muscles relaxed while you move the body part.
What is the most sensitive sign of joint disease?
Limitation in ROM
Articular disease
Inside the joint capsule. Produces all around swelling and tenderness around the whole joint, limits all planes of ROM in both active and passive motion.
Extra-articular disease
Injury to a tendon, ligament, or nerve. Produces only partial limitations to ROM, especially during active movement.
Crepitation
Audible and palpable crunching when joints move. Caused by roughening of the articular surfaces of the joints, eg RA
Hip inspection
Look for symmetric iliac crests, gluteal folds, and buttocks. Check for smooth and even gait
Positive thomas test
Flexion reveals a flexion deformity in the opposite hip
Limited internal rotation of hip
early and reliable sign of hip disease
Most common motion dysfunction in hip disease
Limitation of abduction of the hip while supine
A difference in shoulder elevation and level of scapulae and iliac crests, gluteal folds indicates
scoliosis
Kyphosis
pronounced curve
Lateral tilting and forward bending occur with
herniated nucleus pulposus
Chronic axial skeletal pain occurs with
fibromyalgia
Lasegue test
Straight leg raise while supine. If sciatic pain produced, confirms the presence of herniated nucleus puplosus
True leg lengths equal but apparent leg lengths unequal occurs with
Pelvic obliquity or adduction or flexion deformity in the hip
Kyphosis is common in adolescents due to
chronic poor posture
Screen for scoliosis with
Foward bend test- stand with feet shoulder widith apart and bend forward and touch toes. Spine should be straight and vertical. Posterior ribs should be symmetric, equal elevation of shoulders, scapulae, and iliac crests
Scoliosis most apparent when?
During the adolescent growth spurt
Lengthening of the arm trunk axis in the aging adult refers to
Shortening of the trunk with comparatively long extremities
Get up and Go test
Identifies older adults at increased risk of falling. Health adult can rise, walk 10 feet, turn, walk back, and sit down in under 10 seconds.
>10 seconds and hx of falls and mobility problems indicates increased risk of future falls
Perform a functional assessment for ADLs in
Those with advanced aging changes, arthritic changes, or musculoskeletal disability
IADL assesssment tests (6)
- Walk with shoes on
- Climb up stairs
- Walk down stairs
- Pick up an object from the floor
- Rise from sitting in a chair
- Rise up from lying on the bed.
What bones are most commonly affected by osteoporosis?
Wrist, hip, and spine
Among what group is osteoporosis highest?
Mexican Americans, white women
How much calcium do women need?
1000mg age <50
1200mg age 51+
Spinal change common in obese people
pronounced lumbar curve
Prevent osteoporosis through
- Well-balanced Diet
- Exercise
- Avoid Smoking
- Limit alcohol intake
- Enough vitamin D and calcium
