Comprehensive Review of Musculoskeletal System for Health Assessment Final Exam

structure and function of musculoskeletal system

consists of bones, joints and muscles

bursa

enclosed fluid filled sac (viscous synovial fluid) that serves as a cushion (i.e. subacromial bursa of the shoulder)

temporomandibular joint (TMJ)

- articulation of mandible and temporal bone

- can feel it in depression anterior to tragus of ear

- TMJ permits jaw function of speaking and chewing

temporomandibular joint (TMJ) allows for three (3) motions

- hinge action to open and close jaws

- gliding action for protrusion and retraction

- gliding for side-to-side movement of lower jaw

developmental competence: aging adult

- high risk for osteoporosis

- loss of mineralized bone mass leads to porous bone and greater fracture risk

- estrogen drop in menopause accelerates osteoarthritis process

- aging women are at HIGHER risk than men

reducing risk of osteoporosis

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

developmental competence: aging adult

postural changes and decreased height are most noticeable

additional questions

recommendation for DEXA screening for females:

- women ages 65 and older postmenopausal women younger than 65 years who are at increased risk for osteoporosis with a low-dose x-ray called DXA

order of examination: inspection (1)

note size and contour of joint; inspect skin and tissues over joints for color, swelling, and any masses or deformity

order of examination: palpation (2)

- palpate each joint, including skin for temperature, muscles, bony articulations, and area of joint capsule; notice any head, tenderness, swelling or masses which signal inflammation

- joints normally NOT tender to palpation

- if tenderness occurs, localize to specific anatomic structures

order of examination: range of motion (3)

- ask for active voluntary ROM while stabilizing the body area proximal to that being moved

- if you see a limitation, gently use passive ROM

temporomandibular joint (TMJ)

- inspection and palpation:

- audible and palpable snap or click occurs in many healthy people as mouth opens

- palpate contracted temporals and master muscles as person clenches teeth

- compare right and left sides for size, firmness, and strength

- ask person to move jaw forward and laterally against your resistance, and to open mouth against your resistance (tests for integrity of trigeminal nerve)

- observe for swelling, limitation of motion and/or reported pain

TMJ dysfunction

crepitus and pain occur with TMJ dysfunction during movement of chewing

shoulder

- while standing in front of person, palpate both shoulders, noticing any muscular spasm or atrophy, swelling, heat, or tenderness

- shoulder shrug also tests integrity of cranial nerve XI (spinal accessory nerve)

tennis elbow

the tendons that extend the wrist become swollen and inflamed

lateral epicondylitis

commonly known as tennis elbow

carpal tunnel syndrome

- caused by pressure because of compression on the median nerve in the carpal tunnel of wrist

- carpal tunnel is a narrow passageway surrounded by bones and ligaments on the palm side of the hand

- numbness, tingling, and weakness in the thumb and fingers

- pain and swelling at the base of the thumb

test to confirm carpal tunnel syndrome (1)

phalen test:

- ask the person to hold both hands back to back while flexing the wrists 90 degrees

- acute flexion of the wrist for 60 seconds produces no symptoms in the normal hand

- this test reproduces numbness and burning in a person with carpal tunnel syndrome

test to confirm carpal tunnel syndrome (2)

tinel sign test:

- direct percussion of the location of the median nerve at the wrist produces no symptoms in the normal person

- in carpal tunnel syndrome, percussion of the median nerve produces burning and tingling along its distribution, which is a POSITIVE tinel sign

heberden & bouchard nodules

- hard, nontender Heberden and Bouchard nodules characterize osteoarthritis

- bony outgrowths of distal interphalangeal joints are called Heberden nodes

- bony outgrowths of proximal interphalangeal joints are called Bouchard nodes

- pain with tendinitis worsens in the morning and decreases during the day

- pain rheumatoid arthritis (autoimmune) worsens in the morning and decreases with movement

joint pain of osteoarthritis

joint pain worsens with movement, which explains why pain increases later in the day

knee

- if swelling observed, TEST for bulge sign and ballottement of patella to distinguish soft-tissue swelling or increased fluid in joints or synovitis

- perform McMurray's TEST if meniscal tear is suspected

knee: bulge sign

- to confirm fluid collection suprapatellar pouch of knee joint

- presence of small amounts of fluid as you try to move the fluid from one side of the joint to the other; firmly stroke up on the medial aspect of the knee 2 or 3 times to displace any fluid

- watch the medial side in the hollow for a distinct bulge from a fluid wave

- NORMALLY, NONE is present

bulge sign

small amounts of effusion, 4 to 8 mL and identifies patients at high risk for knee pain and progressive osteoarthritis of the knee

ballottement of the patella

- aid to confirm fluid collection in the knee joint- reliable when larger amounts of fluid are present

- use your left hand to compress the suprapatellar pouch to move fluid into the knee joint. With your right hand, push the patella sharply against the femur

- if NO FLUID is present, the patella is already snug against the femur

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

knee -- McMurray's test

- helps diagnose a torn meniscus in the knee

- position the person supine as you stand on the affected side. hold the heel and flex the knee and hip

- place your other hand on the knee with fingers on the medial side; rotate the leg in and out to loosen the joint

-palpate medial joint line and lateral joint line tenderness based on tear

- perform TEST and audible click on examination/pain is + for presence of torn meniscus/tear

McMurray's test

- the patient lies down with their knee bent

- the examiner twists the lower leg while straightening the knee

- a painful click or pop during this motion may indicate a tear in the meniscus

kyphosis

enhanced thoracic curve typically seen in aging people

lordosis

pronounced lumbar curve seen in obese people

spine

- concave lumbar curve should disappear with this motion; back should have single convex c-shaped curve

- if you suspect spinal curvature during inspection, this may be more clearly seen when person touches toes

- while is bending over, mark a dot on each spinous process; when person resumes standing, dots should form a straight vertical line

straight leg raising or lasègue's test

straight leg raising while keeping the knee extended normally produces no pain

straight leg raising test

- this stretches the nerve route over the disc protrusion and gives a painful response of muscle contraction

- raise unaffected leg leaving other leg flat; inquire about involved side to check for a crossed straight leg raise test

health promotion and patient teaching

osteoporosis screening

abnormalities affecting multiple joints -- inflammatory conditions

- inflammatory conditions:

- rheumatoid arthritis

- ankylosing spondylitis

abnormalities affecting multiple joints -- degenerative conditions

- osteoarthritis (degenerative joint disease)

- osteoporosis

abnormalities of the elbow

- arthritis

- epicondylitis (tennis elbow)

wrist and hand abnormalities

carpal tunnel syndrome

ankle and foot abnormalities

- tophi with chronic gout/acute gout (collections of sodium grate crystals in and around the joint)

- plantar fasciitis

- plantar wart