Lec 13: Musculoskeletal system

Superior vs Inferior

• Superior = closer to head

• Inferior = closer to feet

Medial vs Lateral

• Medial = closer to midline

• Lateral = farther away from midline

Proximal vs distal

• Proximal = closer to center

• Distal = farther from center

Anatomy review: Bones

• Support + protect soft tissue and organs

• Produce blood cells + platelets

  • Hematopoiesis

Anatomy review: Skeletal muscles

• Attached to bones

• Help facilitate movement

• Voluntarily controlled

Anatomy review: Ligaments

Connect bone to bone

Anatomy review: Tendons

Connect muscle to bone

Anatomy review: Joints

Where 2 or more bones come together

Anatomy review: Synovial joints

• Most common joint type

• Ends of bones covered with cartilage + enclosed in a joint cavity containing synovial fluid

• Freely moveable

• Ex) Knees, Elbows, Shoulders

Anatomy review: Non-Synovial joints

• “Solid joints”

• Bones united by fibrous tissue / cartilage

• No synovial cavity

• Little to no movement

• Ex) Skill, Vertebrae

Musculoskeletal pain: Bone

• Dull

• Gnawing

• Achy

Musculoskeletal pain: Muscle

• Cramping

• Sore

Musculoskeletal pain: Radiculopathy

• Pain

• Numbness

• Tingling

• Caused by a pinched nerve in spine

Musculoskeletal pain: Acute

• Constant

• Intense

Unexpected findings posture: Kyphosis

Pronounced outward curvature of thoracic spine

• Hump back

Unexpected findings posture: Lordosis

Exaggerated inward curvature of the lower back

• Crazy arch

Ataxic gait =

• Uncoordinated

• Swaying body

• Poor balance

• Neurological disorder / Alcohol use

Parkisonian gait

• Leaning foward

• Shuffling

• Small steps

Genu Varum =

• Exaggerated bending outward of the legs from the knees down

• “Bowlegs”

• Exception = Infants

Genu Valgum =

• Knees tilt inward while the ankles remain spaced apart

• “Knock knees”

Heberden + Bouchard nodes

• Sign of OA

Ulnar deviation + Swan neck deformity

• Sign of RA

Muscle strength assessment: Grade 1 (trace)

Visible / Palpable contraction with no motion

Muscle strength assessment: Grade 2 (poor)

Full ROM with gravity eliminated

Muscle strength assessment: Grade 3 (fair)

Full ROM against gravity

Muscle strength assessment: Grade (good)

• Full ROM against gravity

• Some resistance

Muscle strength assessment: Grade 5 (normal)

• Full ROM against gravity

• Full resistance

Testing for hip dysplasia: Barlow test

• Adduction

• Posterior pressure

Testing for hip dysplasia: Ortolani test

• Abduction

• Anterior pressure

Strain =

Stretched / Torn muscle or tendon

Sprain =

Stretched / Town ligament

RICE should be done in which phase

Acute phase only

Subluxation

Partial dislocation

Osteoporosis

• Bone disease resulting from low bone density

• Risk factors

  • 50+ YO female

  • Caucasian + Asian

  • Small boned / Thin

  • Family Hx

  • Smoking / Drinking

  • Estrogen deficiency

• Pt. Education

  • Diet rich in Ca + Vitamin D

  • Weight baring exercise

Osteoarthritis

• Most common type

• Degenerative joint disease

• Associated with wear and tear

• Loss of cartilage in 1+ joints

• Often unilateral

• Affects weight baring joints

• Morning pain + stiffness that lasts <30 min = better with movement

Rheumatoid arthritis

• Autoimmune disease

• Commonly affects middle aged women

• Inflammation + Degeneration of joints systemically

• Bilateral joint involvement common

• Morning pain + stiffness lasts >30 min = worse with movement