3016: CHAPTER 21 (Exam #3)

CHAPTER 21

Flexion = ?

Decreases angle (bend) btwn bones

Flexion 2 types?

Dorsiflexion (toward head) + Plantar flexion (away from head)

Bending elbow/pulling knee towards chest?

Flexion

Extension = ?

Straightens (increases) joint

Straightening the elbow after it has been bent?

Extension

Abduction = ?

Away from midline

Lifting your arm straight out to the side away from your torso?

Abduction

Adduction = ?

Toward midline

Bringing your arm back down to your side?

Adduction

Internal vs External rotation?

• Internal = toward body

• External = away

Turning the sole of the foot inward?

Inversion

Pronation vs Supination?

• Pronation = palm down

• Supination = palm up

Turning the forearm so the Palm is facing down?

Pronation

Circumduction

Circular movement

Protraction vs Retraction?

Moving body part forward vs backwards

Functions of bones?

• Support body

• Protect organs

• Store calcium + phosphate

• Make blood cells (hematopoiesis)

Functions of muscles?

• Movement

• Heat production

Function of joints?

Mobility

Key Connective Tissues: (Function of musculoskeletal system & its components)

• Cartilage

• Tendons

• Ligaments

• Bursae

• Meniscus

• Fascia

Cartilage function? (components of musculoskeletal system)

Reduces friction + absorbs shock (articular cartilage)

Tendons connects? (components of musculoskeletal system)

Connect muscle to bone (Biceps brachii)

Ligaments connects? (components of musculoskeletal system)

Connect bone to bone; stabilize joints + limit movement (ACL)

Bursae (components of musculoskeletal system)

Fluid-filled sacs that cushion areas of friction (subacromial bursa)

Meniscus are?

Cartilage disks that cushion joints (in the knee)

Fascia protects?

Protects muscle fibers, muscle to bone, structure (nerves, vessels, lymph)

Joint Types

Synovial (Diarthrotic)

Synovial (Diarthrotic)

Freely movable (ball-and-socket, hinge, etc.)

Hip and shoulder?

Ball and socket joint

Elbow and knee joint?

Hinge joint

Atlas and axis joint?

Pivot joint

Wrist joint?

Condyloid joint

Saddle joint?

Thumb

Gliding joint?

Intervertebral

Assessment of Major Joints

• TMJ

• Shoulder

• Elbow

• Knee

• Spine

TMJ how to assess? (Assessment of Major Joints)

• Palpated anterior to the tragus

• Permits jaw movement for chewing + speaking

TMJ normal findings? (Assessment of Major Joints)

Normal finding: smooth, painless movement

Abnormal: Clicking, popping, or crepitus

Shoulder (Assessment of Major Joints)

Ball-and-socket; Check the Rotator cuff (four muscles) for stability

How to assess shoulder? (Assessment of Major Joints)

Drop Arm Test (rotator cuff tears)

• Ask patient to abduct arm

Normal ROM for Shoulder? (Assessment of Major Joints)

Full, smooth, no pain

Can’t abduct arm? (Assessment of Major Joints)

Rotator cuff injury

Elbow? (Assessment of Major Joints)

A hinge joint. The ulnar nerve ("funny bone") runs near the medial epicondyle.

Knee (Assessment of Major Joints)

Largest joint. Stabilized by cruciate ligaments (ACL/PCL).

How to assess Wrist & Hand (Assessment of Major Joints)

Radiocarpal + interphalangeal joints. Check for Carpal Tunnel Syndrome (Phalen or Tinel tests)

How to assess Hip (Assessment of Major Joints)

A ball-and-socket joint. Stability is provided by deep insertion of the femur head into the acetabulum

How to assess knee? (Assessment of Major Joints)

Bulge Test or Ballottement for fluid (effusion)

Normal knee? (Assessment of Major Joints)

Symmetrical, no swelling

Swelling + warmth in knee? (Assessment of Major Joints)

Arthritis or injury

Spine (Assessment of Major Joints)

cervical (concave), thoracic (convex), lumbar (concave), and sacrococcygeal (convex

What is common in older adults (Changes in musculoskeletal system of aging adults)

Kyphosis (forward thoracic curve) is common

Bone changes for older adults? (Changes in musculoskeletal system of aging adults)

Bone resorption occurs faster than deposition (osteoporosis) (↓ density) IN POST MENOPAUSE!!!!

Interventions for decreased bone density in older adults?

• Weight bearing exercise

• Educate hazards (prevent falls)

Muscle changes for older adults? (Changes in musculoskeletal system of aging adults)

Atrophy after 60 (↓ strength + fall risk)

Interventions for muscle atrophy in older adults?

Isometric exercises (maintain strength)

Height loss in older adults due to? (Changes in musculoskeletal system of aging adults)

Loss of water in intervertebral disks (ages 40-60) + vertebral compression from osteoporosis (after age 60)

Subcutaneous fat changes in older adults?

• After 40 years → gain weight (abdomen + hips)

• After 80 years → fat decreases (bony prominences MORE obvious)

Joint changes for older adults?

• Stiffness

• ↓ ROM

Result for aging changes?

↑ fall risk

Why higher fall risk for older adults?

• ↓ strength + balance

• ↓ cognition → poor safety awareness

Morse scale assesses for what?

Assesses history of falls, secondary diagnoses, ambulatory aids, IV access, gait, and mental status

Who is a high fall risk?

a patient who "forgets limitations" (e.g., trying to walk without an aid despite being told not to) is at high risk

What to do if fatigued patient?

Divide the assessment into portions if the patient appears tired

Who has higher osteoporosis risk? (Ethnicity differences)

White women (developing problems from bone density loss)

Who has lower fracture risk? (Ethnicity differences)

Asian Americans than white people

African Americans typically have what?

straighter femurs

Who has a anteriorly curved femurs + higher risk for RA? (Ethnicity differences)

Native Americans (like Mrs. Begay) often have anteriorly curved femurs and the highest risk for RA

Vitamin D issue in darker skin? (Ethnicity differences)

↓ absorption from sunlight in African Americans

Best prevention for bone loss?

• Weight-bearing exercise (walking) at least 30 minutes, 3 times/week

• Calcium + Vitamin D

• Avoid smoking/alcohol intefere w/ calcium absoprtion

What worsens bone loss?

• Smoking

• Alcohol

• Inactivity

Post-Op Hip Care (Mrs. Begay)

Avoid hip flexion >90 degrees and do not adduct the joint past the midline
in anyone with a hip replacement to avoid DISLOCATION!!!!!

Occupational Therapist vs Physical Therapist

Occupational Therapists (OT) → fine motor skills and ADLs (bathing, dressing)

Physical Therapists (PT) → large motor groups/mobility

Key nursing goal after surgery?

Early mobilization

Hip replacement precaution?

Early mobilization

ADLs

Use of adaptive devices (Velcro shoes, elastic waists) → independence

Signs of fracture (fx)?

• Pain/Swelling/Bruising

• Deformity

• Malalignment

• Loss of function

Affected leg in fractured/femur hip looks like?

External rotation and may appear shorter

First priority action for fractures?

• Immobilize

• Check neurovascular status (CMS) → pulse, color, temp, cap refill, distal to the injury

NOT to do for fractures (fx)

Do not attempt to correct malalignment → avoid damage to nerves + blood vessels

Normal: 5/5? (Muscle Strength Scale)

Normal (Movement against gravity + full resistance)

Good: 4/5? (Muscle Strength Scale)

Movement against gravity + moderate resistance

Fair: 3/5? (Muscle Strength Scale)

Movement against gravity but no resistance

Poor: 2/5? (Muscle Strength Scale)

Movement without gravity (joint supported)

Trace: 1/5 (Muscle Strength Scale)

Muscle contraction felt, but no joint movement

1/5?

Flicker only

0/5? (Muscle Strength Scale)

No movement

Limb Measurement

A discrepancy in leg length >1 cm → gait difficulties + back pain

Abnormal Findings & Diseases

Rheumatoid Arthritis (RA):

Chronic, systemic inflammatory disease. (Bilateral/symmetrical)

Rheumatoid Arthiritis (RA) Key symptoms?

• Morning stiffness worsens

• heat/redness/swelling

• EDEMA

• Ulnar deviation

Risk factors for Rheumatoid Arthiritis (RA)?

Pain location for Rheumatoid Arthiritis (RA)?

Onset for Rheumatoid Arthiritis (RA)?

Generalized complaints for Rheumatoid Arthiritis (RA)?

• Physical + Emotional Stress

• Upper extremities

• Young adulthood

• Weakness, fatigue, low fever

Diagnostic tests for Rheumatoid Arthiritis (RA)?

Elevated serum proteins in blood +synovial fluid—rheumatoid factor

Osteoarthritis (OA)

Localized, progressive, noninflammatory

What is common in Osteoarthritis (OA)?

Painful joints in fingers

Osteoarthritis Pattern?

Wear & tear

Osteoarthritis (OA) Key symptoms?

• Stiffness worse at the end of the day

• Heberden nodes (distal joints)

• Bouchard nodes (proximal joints)

Risk factors for Osteoarthritis (OA)?

Pain location for Osteoarthritis (OA)?

Onset for Osteoarthritis (OA)?

Generalized complaints for Osteoarthritis (OA)

• Obesity + Aging

• Lower extremities

• 50-60s

• NO COMPLAINTS!

Diagnostic tests for Osteoarthritis (OA)?

X-ray, CT, MRI

Gout Classic Sign?

Swollen, hot, red joint (often the big toe). Elevated uric acid

Balance Dysfunction Test

Romberg

Positive = ? for Balance Dysfunction

Loss of balance (neuro issue)