WEEK 10- MUSULOSKELETAL Flashcards
Conduct an independent review of anatomy & physiology (know landmarks & bony prominences).
indications for measuring bone mineral density to assess for osteoporosis
Up to 90% of peak
bone mass is deposited by age 18 years in girls and age 20 years in
boys; thus, maximizing bone mineral density early in life reduces
effects of bone loss during aging.
After age 40, resorption occurs
more rapidly than deposition. The net effect is a loss of bone density
(osteoporosis).
Osteoporosis Canada recommends that all women and men
older than age 50 be assessed for risk factors for osteoporosis and
fracture. Bone mineral density (BMD) testing is used to diagnose
osteoporosis and predict fracture risk.
‡ BMD testing is
recommended for all women aged 65 and older and for those with
clinical risk factors for fracture such as fragility fracture after age
40, prolonged use of glucocorticoids, or parental hip fracture (see
Table 24.1, p. 645).
Identify equipment needed for physical examination & safe infection prevention & control practices
Describe abnormal findings: measure leg length discrepancies; assess for lordosis, kyphosis, scoliosis, contractures, & atrophy,
scoliosis- s curve- spinal curvature is not straight and instead curved left or right
lordosis- abdomen is pushed forward, spinal curvature is pushed forwards
kyphosis- slumping motion,
atrophy- muscles get smaller when they are not used.
A 75 year old client has come to the clinical for a health examination – which is a common age related change in curvature of the spinal column?
kyphosis
During an assessment of the spine the client should be asked to :
flex, extend, rotate
The nurse knows that when assessing gait the client should:
walk straight with arms swinging back and forth
Assessment of a synovial joint includes: Select all that apply
Crepitation
Temperature
Hypertrophy
effusion
range of motion of the knee includes
flexion and extension
The nurse knows that for assessment of the musculoskeletal system ROM consists of
active ROM
The nurse understands that osteoporosis can be: ( Select all that Apply)
- found in women mainly
- can cause compression fractures
A client has ankylosis of the wrist- The nurse knows that the client:
cant move the wrist any longer
An infant that presents with 2 folds of skin on the thigh on one leg and 3 folds on the other thigh should have what type of assessment?
Ortolani test
Examiner is going to measure a client’s legs for length discrepancy. Normal finding would be:
within 1.0 cm difference between the two legs.
musculoskeletal system consists of
Bones
Muscles
Joints
functions of the MSK system
Support & protection
Movement
Hematopoiesis
Storage of minerals
Be prepared to know & name every bony prominence/landmark related to the skull, neck/spine, shoulder, elbow, wrist, hand, ankle, feet, knee, hip
2 types of joints
non synovial
synovial-
Joint is where bones meet
- Non synovial joints
Immovable or slightly movable - Synovial joints
Freely movable
Synovial fluid
Bones are separated from each other
Cartilage
Ligaments
types of muscles
Smooth
Cardiac
Skeletal
Conscious control
Attached to skeleton by tendons
subjective data
joints: pain, stiffness, swelling, heat, redness
muscles: pain, weakness
bones: pain, deformity, trauma
self care behaviors: occupational hazards, exercise, weight gain, medications
health history questions- infants and adolescence
For infants and children
Birth trauma
Anoxia
Milestones
Bone injuries
Bone deformities
For adolescents
Athletics
Sports equipment
Warming up
Injury
Time management
health history questions: older adults
For older adults
Weakness
Injury
Mobility
objective data
drape, bilateral, proximal to distal, asses joint above and below affected joint
Inspection:
- skin and tissues over joint
- size and contour of joint
palpation:
skin temperature,
muscles, bony articulations, area of joint capsule,
ROM
muscle strength
ROM
note findings:
pain/tenderness
crepitation
ROM (full or limited)
muscle testing (apply opposing force, grading muscle strength)
testing muscle strength
0-5
0- no ROM
1- slight contraction
2- FULL ROM, passive motion
3- FULL ROM, slight resistance
4- FULL ROM, some resistance
5- FULL ROM, full resistance
temporomandibular joint- TMJ
inspection
- size and contour
- colour
- swelling
- masses/deformites
palpation:
- temperature, tenderness, swelling, masses
- two fingers over TMJ and ask client to open and close jaw
ROM
- vertical motion
- lateral motion
- protrusion
- retraction
Muscle strength
- repeat ROM and apply resistance
- test CNV- trigeminal, clench teeth
wrist and hand- IPRM
radiocarpal joint- articulation of radius, ulna, carpal bones
inspect: symmetry, contour, shape, deformities, masses, atrophy, swelling, colour
palpate:Palpate
Temperature, swelling/edema, muscle spasm/atrophy, masses/deformities, pain
Wrist
Flexion, extension, hyperextension, ulnar & radial deviation
Fingers
Flexion, hyperextension, abduction (fist & spread)
Muscle testing of wrist (flex & extend)
inspection- hands
Size & contour
Colour, swelling, masses
Deformities
Dislocation
Subluxation
Contracture
Ankylosis
palpation- hands
bony articulations, joint muscle, and capsule
-Temperature
Tenderness
Swelling, atrophy, masses, edema/palpable fluid, muscle spasm
assessment of hands
ROM
Without resistance and with resistance to assess muscle strength
the elbow- hinge joint
Palpable landmarks
Olecranon process of ulna & medial & lateral epicondyles of humerus
Inspect
Symmetry/size/contour, deformities/masses/atrophy, swelling, & colour
Palpate
Temperature, swelling/edema, muscle spasm/atrophy, masses, pain
ROM
Flexion, extension, pronation, supination
Muscle strength testing (flex and extend)
The shoulder
Glenohumeral joint (ball & socket)
Inspect
Symmetry/size/contour, colour, swelling, deformity/masses/atrophy
Palpate
Spasm/atrophy, swelling/edema, temperature, masses/deformities, pain
ROM
Flexion, hyperextension, internal & external rotation, abduction, adduction
Muscle strength testing
Shrug, flex, extend, adduct, & abduct (also, tests CNXI – spinal nerve)
the shoulder ROM
Flexion, hyperextension, internal & external rotation, abduction, adduction
knee joint
Articulation of 3 bones
Inspection
Symmetry/size/contour/ deformities, colour, swelling, masses
Palpation
Temperature, swelling/edema, muscle spasm/atrophy, masses/nodules, pain, fluid
ROM - Flexion & extension
Muscle testing
All ROM can also ambulate for strength and flexion while standing
hip joint (ball and socket joint)
Inspect
Symmetry/size, colour, swelling, deformities/masses/atrophy
Palpate
Temperature, swelling/edema, masses, pain, muscle spasm/atrophy
Range of motion
Flexion (knee straight & bent), abduction, adduction, internal & external rotation, hyperextension while standing)
Muscle strength testing
Flex, extend, abduct, & adduct
ankle and foot
Ankle joint & foot
Ankle: hinge joint & articulation tibia, fibula & talus
Medial & lateral malleoli
Inspection
Symmetry/size/contour, deformities/masses/atrophy, colour, swelling
Palpation
Temperature, swelling/edema, muscle spasm, atrophy, masses, pain
ROM
Dorsiflexion, plantar flexion, inversion & eversion, & flex & extend toes
Muscle testing – dorsiflexion & plantar flexion
spine conditions
- degenerative disk
- bulging disk
- thinning disk
- herniated disk
- disk degeneration with osteophyte formation
cervical spine and spine
Four curves “double S”
33 vertebrae
Cervical spine (7)
Thoracic spine (12)
Lumbar spine (5)
Sacral spine (5)
Coccyx (4)
spinal curvatures
Scoliosis
Lordosis
Kyphosis
the cervical spine- inspection
size and contour, color, swelling, masses/deformities, alignment of head and neck.
the cervical spine- palpation
spinous process and sternomastoid, trapezius, and paravertebral muscle for symmetry
- temp, pain, swelling/masses, spasm, deformities
the cervical spine- ROM
- flexion
- hyperextension
- lateral bend
- rotation
the cervical spine- muscle strength testing
all rom movements
- CNXI- Accessory
ROM- skeletal muscles
Flexion
Extension
Pronation
Supination
Circumduction
Elevation
Lateral bend
Rotation
Protraction
Retraction
Abduction
Adduction
Inversion
Eversion
Dorsiflexion
Plantarflexion
Ulnar & radial deviation
developmental considerations- infants
- ossification of cartilage
- spinal curvature
- developmental dysphagia of hip
- growing pains
developmental considerations- pregnancy
lordosis- spinal curvature
- increased joint mobility
developmental considerations- older adults
osteoporosis- predom in women
decreased height( Long bones do not shorten with age; decrease
in height results from shortening of the vertebral column caused by
loss of water content and thinning of the intervertebral discs, which
occurs more in middle age.)
influence of exercise on skeletal mass
social considerations
Arthritis is a leading cause of pain, disability, and health care utilization in Canada
Increased prevalence in women and with age
Higher among those with lower education and income level
Osteoarthritis risk factors
Hip fractures and falls
Injuries: sprains, strains, and fractures
why are women more likely to get osteoporosis?
Although some degree of osteoporosis is nearly
universal, women are more affected than men because lack of
estrogen after menopause causes bone loss to accelerate.
kyphosis
- usually older adults
- after 60+
Other postural changes are
kyphosis, a backward head tilt to compensate for the kyphosis, and a
slight flexion of hips and knees
health promotion- fight against osteoporosis
Physical exercise
increases skeletal mass, helping prevent or delay osteoporosis in
postmenopausal women and older men.
why does osteoporosis happen?
bones can become “spongy,”
weak, and more likely to break with even the slightest of twists or
bumps. This condition is called osteoporosis. The bones of the
wrist, hip, and spine are most often affected.
arthritis
Arthritis is one of the most prevalent chronic health conditions and
a leading cause of pain, physical disability, and health care system
use in Canada.
lordosis
- pregnant women
- infant
during full term pregnancy shows a protruding
abdomen such that the spial vertebrae is curved inward.
health promotion
Posture & body mechanics
Exercise
Calcium & vitamin D
Caffeine & alcohol
Smoking
Talk with health care professionals
phalen test- hands
A close up view of the hands of a patient for Phalen test. The elbows
of the patient are flexed such that dorsal side of both the hands and
fingers are together with the wrists positioned at the center of the
chest.
Positive Phalen test:
numbness and
burning sensation
occurs with carpal
tunnel syndrome
complete musculoskeletal exam
A complete musculo-skeletal examination, as described in
this chapter, is appropriate for patients with articular disease, a
history of musculo-skeletal symptoms, or any problems with ADL
screening- musculoskeletal exam
Inspection and palpation of joints, integrated with inspection
of each body region
* Observation of ROM as patient proceeds through motions
described earlier
* Age-specific screening measures, such as the Ortolani
manoeuvre for infants or scoliosis screening for adolescents
subjective data
Joints:
Pain
Stiffness
Swelling, heat, redness
Limitation of movement
2. Knee joint (if injured)
3. Muscles:
Pain (cramps)
Weakness
4. Bones:
Pain
Deformity
Trauma (fractures, sprains, dislocations)
5. Functional assessment (ADLs)
6. Self-care behaviours
