Health Exam 4 - Musuloskeletal

Musculoskeletal system consists of?

bones, joints, and muscles

What are ligaments?

Bands connecting one bone to another

What is a bursa?

Enclosed fluid filled sac (viscous synovial fluid) that serves as a cushion

Ex: subacromial bursa of the shoulder

What is a fibrous joint?

Bones united by interjacent fibrous tissue or cartilage and do NOT move!

Where would fibrous joints be located?

In the skull

What is a cartilaginous joint?

Separated by fibrocartilginous discs and are slightly moveable

What would be an example of cartilaginous joints?

Vertebrae

What are synovial joints?

Freely moveable joints separated by one another and enclosed in a synovial membrane that secretes fluid

Are synovial joints vascular or avascular?

Avascular

What is protraction?

Moving body part forward, parallel to ground

What is retraction?

Moving body part backwards, parallel to ground

What is the function of TMJ?

Jaw function of speaking and chewing

What 3 motions are allowed from TMJ?

Open/close mouth

Gliding action for protrusion and retraction

Side to side jaw movement

How many vertebrae are there?

33

Where would you feel for the spinous processes?

Down midline of back

How many cervial vertebrae?

7

How many thoracic vertebrae are there?

12

How many lumbar vertebrae are there?

5

How many sacral vertebrae?

5

How many coccygeal vertebrae are there?

3-4

What final landmarks are located at the base of the neck?

C7 and T1

Where are T7 and T8 located?

Inferior angle of scapula

What is the curvature of cervical and lumbar?

Concave (inwards or anterior)

What is the function of the curvatures and intervertebral discs?

Allows spine to absorb shock

What is the Nucleus pulposus?

Disk center composed of soft, semifluid mucoid material

What are the motions for the vertebral column?

Flexion/ Extension

Abduction and rotation

What does the shoulder girdle consist of?

Humerus

Scapula

Clavicle

Joints and muscle

What is the glenohumeral joint?

articulation of humerus with glenoid fossa of scapula

Describe a ball and socket joint?

Allows for mobility

What kind of joint is the glenohumeral joint?

ball and socket

What does the subacromial bursa assist with ?

Abduction of the arm

What are the palpable landmarks to guide your shoulder examination?

scapula

Clavical

What are the 3 bony articulations of the elbow joint?

Humerus

Radius

Ulna of forearm

What are the palpable landmarks of the elbow joint?

Medial and lateral epicondyles of humerus and large olecranon process of ulna

What does condyloid action permit?

movement in two planes at right angles: flexion and extension, and side-to-side deviation

What is the function of the mid carpal joint?

Flexion

Extension

Some rotation

Where is the hip articulation located?

Between acetabulum and head of femur

What are the landmarks for a hip examination?

Illiac crest

Ischia tuberosity

Greater trochanter of femur

What are the 3 articulations of the knee joint?

Femur

Tibia

Patella

What is the largest joint in the body?

Knee joint (hinge joint)

What are the 2 ligaments that stabilize the knee?

Cruciate

Collateral

What is the function of the cruciate ligament?

Give anterior and posterior stability to help control rotation

What is the function of the collateral ligament?

Allows for medial and lateral stability and prevents dislocation

What are the lankmarks of the knee joint?

Quadriceps - anterior and lateral thigh

Tibial tuberosity - bony prominence in midline

Lateral and medial condyles of tibia

Medial and lateral epicondyle of femoral- on sides of patella

What are the articulations of the ankle joint ?

Tibia

Fibula

Talus

What is the function of the hinge joint?

flexion and extension

What are the landmarks for the ankle?

The medial malleolus and the later malleolus

What does the subtler joint permit?

Permits inversion and eversion of the foot

What is the name of the heel of the foot?

Calcaneus

Describe Kyphosis

Slight flexion of hips and knees too compensate for hump of the back

What are some normal changes in an older adult ?

Bone remodeling

Postural/ decreased height changes are most noticeable

Kyphosis

Fat loss

Muscle atrophy

What does a high Denser bone, bone mineral density (BMD), indicate?

a person's bones are stronger and less likely to fracture.

What are the elderly at risk for?

Osteoporosis

What should be done to reduce the risk of osteoporosis?

All adults should engage in regular physical activity, including strength training, balance training, and fast walking

What are the signs of postural changes and decreased height?

Decreased height of 3 to 5 cm occurs w/ shortening of vertebral column

Loss of water & thinning of intervertebral discs

Loss of bone matrix

Kyphosis

What is recommended for females of the age 65 and older postmenopausal women?

DEXA screening

Women younger than age 65 who are at increased risk for osteoporosis w/ a low-dose x-ray called?

DXA

Tinetti test

Assessing gait score/balance score indicates risk for falls

The tinetti test should be performed on what kind of pts?

>65 yo

sarcopenia

frailty syndrome

dementia

hearing/vision impairments

PD/MS

traumatic brain injury

stroke

urinary incontinence

diabetes

CV pathologies

peripheral vascular disorders

anxiety

sleep disorders

pt receiving hemodialysis

previously identified risk factors for fall

Tinetti test - Performance-oriented mobility assessment (POMA)

Indicates low risk of falls

• >24 out of 28 is considered low risk of falls

• <19 indicate high risk

What is the orderly approach for a musculoskeletal examination?

Head to toe

Proximal to distal

From midline to outward

What do you inspect for in a musculoskeletal examination?

Size and contour of joint

Swelling/ Masses/ deformities

What do you palpate for a musculoskeletal examination?

Each joint/Skin for temp

Muscles/bony articulations/area of joint capsule

Notice any heat, tenderness, swelling, or masses which signal inflammation

Range of motion for a musculoskeletal examination:

Ask for active voluntary ROM while stabilizing body area proximal to that being moved

If limitation is noticed, gently use passive ROM

What is the grading scale used for muscle testing?

0 - 5 range

What should the pt do when performing a muscle test?

Flex and hold as you apply pressure

How do you palpate the TMJ?

Ask pt to move jaw forward and laterally against your resistance, and open against resistance

What occurs w/ TMJ dysfunction during movement or chewing?

crepitus and pain

What should you palpate for the cervical spine?

Spinous process

Sternomastoid

Trapezius

Paravertebral muscles

What cranial nerve is being testing when performing a cervical spine test?

CN XI (11) - Spinal nerve

What should be noted during palpation of both shoulders?

muscular spasm or atrophy, swelling, heat, or tenderness

What tests integrity of cranial nerve XI, spinal accessory nerve?

shoulder shrug

How do you palpate the elbow?

Flex the elbow to 70 degrees and relaxed

Check olecranon bursa for abnormal swelling

Lateral epicondylitis

Also known as tennis elbow

Tendons that extend the wrist becoming swollen and inflamed

What do you test for when examining the wrist/hands?

Presence of Carpal Tunnel syndrome

Carpal tunnel syndrome

Caused by pressure bc of compression on the median nerve in the carpal tunnel of the wrist

• Numbness/tingling/weakness in thumb and fingers

• Pain/swelling at base of thumb

What test do you use to find Carpal Tunnel syndrome ?

Phalen test

Tinel sign

Phalen test

Hold both hands back to back while flexing wrists 90 degrees

Acute flexion of wrist, produces numbness and burning if positive

Tinel sign

Percussion of median nerve produces burning and tingling is a positive Tinel sign

Heberden & Bouchard nodules

Hard, nontender

Characterize osteoarthritis

Heberden nodes

Bony outgrowths of distal interphalangeal joints

Bouchard nodes

Bony outgrowths of proximal interphalangeal joints

Joint pain of osteoarthritis worsens w/ what?

movement

What should you note in a hip exam?

Symmetry of iliac crests, gluteal folds, and equally sized buttocks

What does limitation of abduction of hip indicate?

Most commonly motion dysfunction found in hip disease

What are you testing for when performing a knee exam?

Bulge sign and Ballottement (fluid) of the patella to distinguish swelling or increased fluid in the joint

Bulge sign

Small amounts of effusion, 4 to 8 mL and identifies pts at high risk for knee pain and progressive osteoarthritis of knee

Ballottement of Patella

If fluid has collected, your tap on the patella moves it through the fluid, will hear a tap as patella bumps up on femoral condyles

What test is used if a meniscal tear is suspected and how do you know its positive?

McMurrays test

Should hear clicking or pain during examination for a positive test

When do you inspect the ankle/foot?

When sitting, when standing and when walking

What joint do you palpate for the ankle/ foot?

Metatarsalphalangeal joint between thumb on dorsal and fingers on plantar surface

What is Lordosis?

Pronounced lumbar curve seen in obese people

What degree should flexion be for a spine exam?

75-90 degrees (touching toes)

What should you do to perform a Spinal exam?

Mark dots on back when pt is bending down, they should form a straight line when standing straight

What should disappear w/ touching toes motion?

Concave lumbar curve; back should have single convex C-shaped curve

How should a pt be bent for a spinal exam?

Bent sideways - lateral at 35 degrees

Bend backwards - hyperextension at 30 degrees

Straight leg raising (Lasegue’s Test) while keeping the knee extended normally produces what?

no pain

During a straight leg raising test, what does pain indicate?

Presence of herniated nucleus pulpous

Where do you measure for a leg length discrepancy test?

From anterior iliac spine to medial malleolus, crossing medial side of knee

Abnormalities affecting multiple joints:

• Inflammatory conditions:

  • rheumatoid arthritis

  • ankylosing spondylitis

• Degenerative conditions:

  • osteoarthritis (degen joint disease)

  • osteoporosis