Week 4: Musculoskeletal Assessment

Question 1

Subjective Data Collection

Answer 1

Assessment of Risk Factors
-demographic data
-past medical history
-family history
-nutrition and medication
-psychological history
-occupational, lifestyle, and behaviors
-functional assessment

Question 2

Special Circumstances: Pregnancy

Answer 2

-increased levels of circulating hormones may increase mobility of joints (relaxin)
-changes in maternal posture - lordosis
-compensate for enlarging fetus - centre of gravity shifts
-strain or lower back muscles and pain in late pregnancy
-sciatic nerve pain from pressure
-anterior flexion of neck, slumping of shoulders to compensate

Question 3

Special Circumstances: Scoliosis, Polio (the lasting effects), Basilar Skull Fracture

Answer 3

Scoliosis: sideways curvature of the spine

Polio: illness caused by virus that affects nerves in the spinal cord or brain stem

Basilar Skull Fracture: facture from around the check bones area in the skull

Question 4

Lifestyle Considerations: Newborns, Infants, Children, and Older Adults

Answer 4

Legs
- ‘Bowlegged’ (genu varus) until ~ 18 months
- Transition to ‘knock-knee’ (genu valgus)
- Legs usually straighten by 6-7 years
- Teens - hips - slipped capital femoral epiphysis (SCFE)
- Growth plates, long bones, risk for infection

Fontanels
- Anterior closed by 18-24 months
- Posterior closed by 2 months

Back
- C-shaped curve in infancy
- Spinal curvature with growth & weight-bearing
- Check for scoliosis (especially ages 10-16)

Older Adults
-mainly focuses on preventing falls

Question 5

Objective Data Collection: Inspection

Answer 5

Inspection:
~Posture - static or dynamic
~Gait - locomotion/movement
~Balance - cerebellum, neuro component
~Coordination - organization of movement, neuro component

Joints, Muscles, & Extremities
-size of joint/muscle/bone
-symmetry
-contour
-colour
-edema/deformity
-facial expression with use
-curvature of spine

Question 6

Objective Data Collection: Palpation

Answer 6

Joints, Muscles, & Extremities
-muscle tone
-temperature variations
-tremor/fasciculation
-edema
-crepitus
-bony articulations
-tenderness

Question 7

Objective Data Collection: Physical Assessment

Answer 7

Range of Motion (ROM)
-do not move to point of pain
-move all joints

Active vs Passive
-prevention of joint stiffness, muscle shortening, Contractures

Question 8

ROM of Joints

Answer 8

-Flexion/Extension
-Abduction/Adduction
-Pronation/Supination
-Circumduction
-Inversion/Eversion
-Protraction/Retraction
-Elevation/Depression

Question 9

Assessing Muscle Strength

Answer 9

-usually integrated with exam of associated joint for ROM
-compare bilaterally
-full muscle strength requires complete active ROM
-grade strength on scale of 1-5

Question 10

Atony

Answer 10

lack of residual tension

Question 11

Hypotonicity

Answer 11

diminished tone of skeletal muscles

Question 12

Spasticity

Answer 12

hypertonic, so the muscles are stiff and movements awkward

Question 13

Spasm

Answer 13

sudden violent involuntary contraction of a muscle

Question 14

Fasciculation

Answer 14

involuntary twitching of muscle fibers