Topic 13 Flashcards
Nonsynovial joints
Joints that do not have a joint cavity, connective tissue, or cartilage.
synovial joints
created where two bones articulate to permit a variety of motions; freely movable joint
muscle
tissue composed of fibers that can contract, causing movement of an organ or part of the body
flexion
bending limb at joint
extension
straightening limb at joint
abduction
moving limb away from midline of body
adduction
moving limb toward midline of body
pronation
turning forearm so that palm is down
supination
turning forearm so that palm is up
circumduction
moving arm in circle around shoulder
inversion
moving sole of foot inward at ankle
eversion
moving sole of foot outward at ankle
rotation
moving head around central axis
protraction
moving body part forward, parallel to ground
retraction
moving body part backward, parallel to ground
elevation
raising a body part
depression
lowering a body part
wht spinous processes are prominent at the base of the neck
C7 and T1
Inferior angle of scapula normally at level of interspace between
T7 and T8
Imaginary line connecting highest point on each iliac crest crosses
L4
fetus bone and muscle development
skeleton of cartilage by 3 months
adolescents bone and muscle development
rapid growth
adulthood bone and muscle development
Longitudinal growth continues until about 20
After 40, bone resorption _____ and deposition _____
increases
decreases
aging adult: postural changes
-Decreased height
-Kyphosis
aging adult: subQ fat
Different distribution
-Decreases in forearms
-More apparent in abdomen/hips
In eighties and nineties, fat further decreases in…
periphery, especially noticeable in forearms and apparent over abdomen and hips
aging adult: bony prominences
Loss of subcutaneous fat leaves bony prominences more marked
aging adult: muscle mass
o Absolute loss in muscle mass occurs; some decrease in size, and some atrophy, producing weakness
o Lifestyle affects musculoskeletal changes (activity level affects M/S)
functional assessment of ADLs
Bathing, toileting, dressing, grooming, eating, mobility, communicating
self care behaviors: muscles/joints
Occupational hazards, exercise program, recent weight gain, medications, chronic disability or crippling illness
purpose of M/S exam
o Assess function for ADLs
o Screen for abnormalities
what is the orderly approach for a physical exam
head to toe, proximal to distal, and from midline outward
Compare corresponding paired joints:
Expect symmetry of structure and function and normal parameters for each joint
order of examination for M/S
inspection
palpation
range of motion
muscle testing
Active voluntary ROM
pt moves joint area while you are stabilizing the body area proximal to that being moved
what do you do if a patient has ROM limitations
gently attempt passive motion;
anchor joint with one hand while other hand slowly moves it to its limit; normal ranges of active and passive motion should be same
Joint motion normally causes…
no tenderness, pain, or crepitation
SCALE for MUSCLE TESTING-against gravity and resistance
0-5 grading=0-100%
5 Full ROM and resistance-normal
4 full ROM and some resistance
3 full ROM with gravity
2 full ROM with no gravity(eliminated)
1 slight contraction
0 NO contraction
assessment: TMJ
Place tips of first two fingers in front of each ear and ask person to open and close mouth
what is normal during TMJ assessment
Audible and palpable snap or click occurs in many healthy people as mouth opens
what tests the integrity of CN V (trigeminal)
Ask person to move jaw forward and laterally against your resistance, and to open mouth against your resistance
kyphosis
humpback; enhanced thoracic curve
lorodosis
Swayback; pronounced lumbar curve
what is normal finding for palpation of the spine
normally straight and not tender
what is normal finding for palpation of paravertebral muscles
should feel firm with no tenderness or spasm
what are normal findings of the shoulder
Normally no redness, muscular atrophy, deformity, or swelling is present
If shoulder pain, point to spot with hand of…
unaffected side
local causes of shoulder pain
may be referred pain from a hiatal hernia or cardiac or pleural condition, which could be potentially serious
-pain from a local cause is reproducible during the examination by palpation or motion
when palpating pyramid-shaped axilla…
no adenopathy or masses should be present
what tests the integrity of CN XI (spinal accessory)
shoulder shrug
measure leg length discrepancy
-Perform this measurement if you need to determine whether one leg is shorter than other
-For true leg length, measure between fixed points, from anterior iliac spine to medial malleolus, crossing medial side of knee
what test id used to screen fine and gross motor skills for childs age
Denver II
M/S changes in the aging adult
-Postural changes include decrease in height (more apparent in eighth and ninth decades)
-Kyphosis
-Contour changes include a decrease of fat in body periphery; fat deposition over abdomen and hips
-bony prominences become more marked
-ROM and muscle strength are much like younger adult, provided no musculoskeletal illnesses or arthritic changes are present
get up an go test: normal
< 10 seconds is normal >60 yrs old
Rheumatoid arthritis
a chronic inflammatory pain condition that is possibly started by an autoimmune response, inflammatory event, or infection
Ankylosing spondylitis
chronic inflamed vertebrae (spondylitis) that in extreme form leads to bony fusion of vertebral joints (ankyloses).
- inflammatory arthritis affecting spine and large joints
Osteoarthritis (degenerative joint disease)
Noninflammatory, localized, progressive disorder involving deterioration of articular cartilages (cushion between the ends of bones) and subchondral bone remodeling, synovial inflammation, and formation of new bone (osteophytes) at joint surfaces.
Osteoporosis
Decrease in skeletal bone mass leading to low bone mineral density (BMD) and impaired bone density.
atrophy
Loss of muscle mass -Atrophy also occurs from disuse, muscle tissue damage, or motor nerve damage.
Dislocated shoulder
anterior dislocation (95%)is exhibited when hunching the shoulder forward and the tip of the clavicle dislocates; occurs with trauma involving abduction, extension, and rotation
what is the most frequent type of joint dislocation.
Glenohumeral dislocation
joint effusion
swelling from excess fluid in the joint capsule, here from rheumatoid arthritis
tear of rotator cuff
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
used for rotator cuff tear; if the arm is passively abducted at the shoulder, the person is unable to sustain the position and shrugs or hitches the shoulder forward to compensate with remaining intact muscles.
Frozen shoulder, adhesive capsulitis
fibrous tissues form in the joint capsule, causing stiffness, progressive limitation of motion, and pain.
Subacromial bursitis
Inflammation and swelling of subacromial bursa over the shoulder cause limited ROM and pain with motion.
Olecranon bursitis
Large, soft knob, or “goose egg,” and redness from swelling and inflammation of olecranon bursa. Localized and easy to see because bursa lies just under skin.
Gouty arthritis
Joint effusion or synovial thickening, seen first as bulge or fullness in grooves on either side of olecranon process. Redness and heat can extend beyond area of synovial membrane.
Subcutaneous nodules
These raised firm nodules are granulomatous lesions that grow along small blood vessels in people with RA. Can be tender or nontender, movable or fixed; skin slides freely over nodules. Develop over pressure points such as extensor surface of arm (ulna) and olecranon.
Epicondylitis, tennis elbow
Chronic disabling pain at lateral epicondyle (LE) of humerus; radiates down extensor surface of forearm. Pain can be located with one finger. Resisting extension of the hand increases the pain. Inflammation along flexor and extensor tendons of elbow joint with overuse.
Ganglion cyst
Round, cystic, nontender nodule overlying a tendon sheath or joint capsule, usually on dorsum of wrist
Colles’ fracture
Nonarticular fracture of distal radius, with or without fracture of ulna at styloid process. Usually from a fall on an outstretched hand; occurs more often in older women. Wrist looks puffy with “silver fork” deformity, a characteristic hump when viewed from the side.
Carpal tunnel syndrome
Pain along thumb and index and middle fingers and atrophy occur from interference with motor function from compression of the median nerve inside the carpal tunnel.
Ankylosis
Wrist in extreme flexion with ruptures of wrist and finger extensors, caused by severe rheumatoid arthritis (RA).
Dupuytren’s contracture
Chronic hyperplasia of the palmar fascia causes flexion contractures of the digits, first in the 4th digit, then the 5th digit, and then the 3rd digit. Note the bands that extend from the midpalm to the digits and the puckering of palmar skin.
Conditions caused by chronic rheumatoid arthritis
o Swan-neck and boutonniere deformities
o Ulnar deviation or drift
o Degenerative joint disease or osteoarthritis
o Syndactyly
o Polydactyly
Swan neck deformity
hyperextension of PIP joint and flexion of DIP joint
Boutonniere deformity
the knuckle looks as if being pushed through a buttonhole
Ulnar deviation or drift
Fingers drift to the ulnar side because 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.
Degenerative joint disease or osteoarthritis
characterized by hard, nontender, noninflammatory nodules, 2 to 3 mm or more.
osteophytes (bony overgrowths) of the DIP joints are called
Heberden nodes
osteophytes (bony overgrowths) of the PIP joints are called
Bouchard nodes
Syndactyly
Webbed fingers are a congenital deformity requiring surgical separation
Polydactyly
Extra digits are a congenital deformity, usually occurring at the 5th finger or the thumb
Mild synovitis
Loss of normal hollows on either side of the patella, which are replaced by mild distention. Occurs with synovial thickening or effusion (excess fluid) as in RA.
prepatellar bursitis
Localized swelling on anterior knee between patella and skin. A tender, fluctuant mass indicates swelling; infection may spread to surrounding soft 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.
Post polio
Right leg and foot muscle atrophy as a result of childhood polio.
Osgood-Schlatter disease
Painful swelling of the tibial tubercle just below the knee, from overuse injury that places traction and microtrauma on the bone
Chondromalacia patellae
abnormal softening of the patella because of thinning and uneven wear
Achilles tenosynovitis
Inflammation of a tendon sheath near the ankle (here the Achilles tendon) produces a superficial linear swelling and a localized tenderness along the route of the sheath.
Chronic gout
Hard nodules (tophi) most often in the metatarsophalangeal joint of first toe. Tophi are collections of sodium urate crystals caused by chronic gout in and around the joint. Crystals are stong inflammation triggers that cause extreme painful swelling and joint deformity. They may erode through skin with a chalky discharge.
Acute gout
Gout is a painful inflammatory arthritis characterized by excess uric acid in the blood and deposits of urate crystals in the joint space. Acute episodes are triggered by surgery, trauma, diuretics, alcohol intake.
Hallux vagus
a common deformity from RA, is a lateral or outward deviation of the great toe with medial prominence of the head of the 1st metatarsal
bunion
is the inflamed bursa that forms at the pressure point. The great toe loses power to push off while walking; this stresses the 2nd and 3rd metatarsal heads, and they develop calluses and pain.
Hammer toes
o deformities in the 2nd, 3rd, 4th, and 5th toes that include hyperextension of the metatarsophalangeal joint and flexion of the proximal interphalangeal joint
Callus/Corns
(thickening of soft tissue) develop on the dorsum over the bony prominence from prolonged pressure from shoes.
Plantar wart
Vascular papillomatous growth is caused by human papillomavirus and occurs on the sole of the foot, commonly at the ball and has small dark spots.
Ingrown toenail
A misnomer; the nail does not grow in, but the soft tissue grows over the nail and obliterates the groove. It occurs almost always on the great toe on the medial or lateral side.
Scoliosis
Lateral curvature of thoracic and lumbar segments of the spine, usually with some rotation of involved vertebral bodies.
Functional scoliosis
is flexible; appears with standing and disappears with forward bending. It may compensate for other abnormalities (leg length discrepancy).
Structural scoliosis
is fixed; the curvature shows both on standing and on bending forward. Note rib hump with forward flexion. When the person is standing, note unequal shoulder elevation, unequal scapulae, obvious curvature, and unequal hip level.
Idiopathic scoliosis
hows at 10 years of age through adolescence during the peak of the growth spurt; usually not progressive and more common in girls.
Herniated nucleus pulposus
The nucleus pulposus (the center of the disc) ruptures into the spinal canal and puts pressure on the local spinal nerve root, causing pain and inflammation. Usually occurs from strenuous activities (lifting, twisting, continuous flexion with lifting, fall on buttocks)
Fibromyalgia Trigger Points
lower clavicle
second rib
lateral epicondyle
knee
occiput
trapezius
supraspinatus
gluteal
greater trochanter
