307 (Exam 2) Nurs 307 ch 23: Musculoskeletal System

what are the functions of the musculoskeletal system?

1. support

2. movement

3. protect

4. produce: rbc, abc, platlets in bone marrow

5 reservoir for essental minerals

fibrous bands from one bone to another that strengthen the joint and prevent unwanted movement

ligament

enclosed fluid filled sac that serves as a cushion

Bursa

Skeletal

Voluntary control

Connected by TENDON to bone

muscle

ROM of the TMJ?

protraction

retraction

open

close

side to side

additionally assess this area for popping and clicking

TMJ

ROM of neck?

flexion, extension, hyper extension, lateral flexion, rotation, shoulder shrug=elevation & depression

ROM of shoulder

flexion, extension, hyperextension, internal rotation, external rotation, abduction, adduction, CIRCUMDUCTION

ROM of elbows

flexion, extension

ROM of the wrists

flexion, extension, hyperextension, radial deviation, ulnar deviation, rotation

ROM of fingers

flexion, extension, abduction, adduction

ROM of the hips

flexion, extension, (hyperextension), abduction, internal rotation, external rotation

ROM of the knees

flexion, extension

ROM of the ankles

plantar flexion, dorsiflexion, inversion, eversion, rotation

ROM of the toes

flexion, extension

ROM of the spine

flexion, extension, hyperextension, lateral flexion, rotation

What Joint has

Bones united by interjacent fibrous tissue or cartilage and do not move. (sutures in skull)?

Fibrous joints

This joint is separated by fibrous cartilage and are SLIGHTLY movable (VERTEBRAE)

Cartilaginous joints

Freely moveable joint separated by one another and enclosed in a cavity lined with synovial membrane that secrets fluid

synovial joints

- articulation of mandible and temporal bone

- can feel it depression anterior to trigs of ear

- permits jaw function of speaking and chewing

TMJ

Hip is an articulation between __________ and _______

acetabulum, head of femur

it permits wide range of motion on many axes

ball and socket

this structure gives more stability for weight bearing function

hip

knee joint is an articulation of which three bones?

femur, tibia, and patella

hinge joint, largest joint in body, permitting flexion and extension of lower leg on a single plane

knee

which synovial membrane is the largest in the body

knee

Two wedge-shape cartilages that cushion tibia and femur

medial and lateral menisci

lateral view shows vertebral column having found curves, a double-S shape

spine

Factors that allow spine to absorb shock

balance or compensatory nature of curves, together with intervertebral disks

Each disk center is composed of soft, semifluid, mucoid material

Nucleus pulposus

- Accounts for 40-50% of body weight

-are under voluntary conscious control

-attached to bone with a tendon

muscles

Flexion?

bending limb at joint

Extension?

straightening limb at a joint

Abduction?

moving limb away from joint

Adduction

moving limb toward joint

pronation

turning forearm so palm is down

Supination?

turning forearm so palm is up

Circumduction

moving arm in circle around shoulder

inversion?

moving sole of foot inward at the ankle

Eversion?

moving sole of foot outward at the ankle

Rotation

moving head around a central axis

protraction?

moving (jaw) forward and parallel to the ground

Retraction?

moving jaw back and parallel to the ground

elevation

raising body part

depression

lowering body part

With history questions of the MUSCLES: ask about location of _____ or ______

pain, cramping

With muscle characteristics: Ask whether the person has any _____ in his or her muscles

weakness

with aging adults, you want to ask about this during subjective HISTORY qustions

new onset weakness

Recommendation for DEXA screening for ______ages ______ and older

females, 65

Ask specific functional assessment of these ADLs

bathing, toileting, dressing, grooming, eating, mobility, communicating

Purpose of of a musculoskeletal examination is to assess function for ______ and _______

ADLs and screen for abnormalities

when prepping for physical examination, Take an orderly approach by:

head to toe, proximal to distal, midline outward

note _____ and ___ of EVERY JOINT

size and contour

inspect skin and tissues over joints for _____,______, and any_______, or ______

color, swelling, masses or deformities

palpate each joint including

-

-

-

-

skin temp

muscles

bony articulation

area of joint capsules

While palpating, notice any:

-

-

-

-

*which signals inflammation

heat

tenderness

swelling

mases

joint fluid is usually????

not palpable

Ask for _____ voluntary ROM, while stabilizing the body area _____ to that being moved

active and proximal

If you see a limitation, gently use ______ rom

passive

Audible and palpable crunching or grating that accompanies movement b/c the articular surfaces in the joints are roughened

Crepitation

true or false: crack, which is heard as a tendon or ligament slipping over the bone during motion as you do a knee bend is the same as crepitation?

false

5/5 muscle strength is

normal

3/5 muscle strength is

movement against gravity ONLY

When asking person to move jaw forward and laterally against your resistance and to open mouth against your resistance, tests which cranial nerve

Cranial never V (trigeminal nerve)

Inspect _____ of head and neck( (c-spine)

alignment

If person can maintain (cervical) flexion against full resistance, this tests for CRANIAL NERVE?

CN XI (SPINAL NERVE)

What movement also test CN XI, SPINAL ACCESSORY NERVE

shoulder shrug

Inspect size and contour of elbow in which two positions?

flexed and extended

palpate elbow flexed about ___ degrees and relaxed

70

acute flexion of wrists for 1 minute produces numbness and burning if positive

Phalen test

What is the most common motion dysfunction found in hip disease?

limitation of abduction of hip while supine

note symmetric levels of

-

-

-

in the hips

iliac crests

gluteal folds

equally sized buttocks

Smooth even gait reflects

-

-

equal leg lengths

functional hip motion

while inspecting the knee check lower leg for:

-

-

-

alignment

knee shape

contour

If swellings observed in the knee, test for ________ and ______ to distinguish soft tissue swelling or increased fluid injoint

Bulge sign

Ballottement of patella

perform ______ to assess for any limitation or prescreens of pain in the knee

ROM

Examining well-worn shoes help asses areas of

wear and accommodation

when assessing muscle strength in ankle/foot, ask the client to maintain ________ and ______ against your resistence

plantar and dorsiflexion

This spinal condition has ENHANCED THORACIC CURVE, usually seen in aging people

Kyphosis

This spinal curve has a PRONOUNCED LUMAR CURVE, normally seen in obese and pregnant people

lordosis

scoliosis

lateral curvature of the spine

kyphosis

curvature of the thoracic spine

lordosis

anterior curvature in the lumbar spine

back(spine) should have ______ curve

single convex C-shaped

While stabilizing pelvis with your hands, check ROM

lateral. bending of ______ degrees

Hyperextension of _____ degrees

Twisting shoulders one side and the other: rotation of _____ degrees

35, 30, 30

Higher Bone mineral density (BMD) =

denser bone

Low BMD indicates

predictor of hip and vertebral fractures

Earlier peak and rapid decline of BMD assoiciated with increase fx affects _______

Caucasian women

pay attention to _______ in adolescences and adults

spinal posture

Which condition of the spine will affect pregnant women leading to increased back strain

lordosis

after age _____, resorption (breakdown,osteoclasts) occurs more rapidly than desposition (new bone formed, osteoblasts)

40

Systemic inflammatory disease of joints surrounding CT

Rheumatoid arthritis

non inflammatory, localized disorder, normally caused by OVERUSE

osteoarthritis

rate of resorption(breakdown) is greater than deposition(bone formation)

osteoporosis

loss of muscle mass

atrophy

Anterior dislocation (95% is exhibited as a hollow where it would normally look rounded

Dislocated shoulder

swelling from excess fluid in the joint capsule

Joint effusion

"hunched" position and limit of abductin of arm

torn rotator cuff

redness, heat, soft, boggy, or FLUCTUANT FULLNESS to palpation and limited ROM

gouty arthritis

curvature of the spine

scoliosis