Assessment of the Musculoskeletal and Neurological Systems

Bones

-Support and protect soft tissues and organs
-Produce blood cells and platelets

Skeletal Muscles

-Help facilitate movement
-Attached to bones
-Voluntarily controlled

Ligaments

Bone to bone

Tendons

Muscle to bone

Joints

Where two or more bones come together

Bursa

Small fluid-filled sacs that reduce friction between moving joints
-Filled with synovial fluid

Synovial Joints

-Most common
-Bones separated
-In joint cavity
-Lubricated and ends covered with cartilage
-Freely movable
Ex. knees, elbows

Non-synovial Joints

-Solid joints
-Bones united by fibrous tissue or cartilage
-No synovial cavity
-Little/no movement
-Provide structural integrity only
Ex. skull, vertebrae, pubic symphysis

Distal interphalangeal joints (DIP)

Between distal and middle phalanges

Proximal interphalangeal joints (PIP)

Between middle and proximal phalanges

Metacarpophalangeal joint (MCP)

Between proximal phalanges and metacarpal bones

Tylenol max dose

4000mg/day

Ibuprofen max dose

3200mg/day

Bone pain

Dull, gnawing, achy

Muscle pain

Cramping, dull, sore

Acute injury

Constant, intense pain

Headaches

Previously discussed types OR tumor, ischemia, increased intracranial pressure

Seizures

-Known triggers?
-Warning signs?
-LOC?

Loss of consciousness

-Neuro
-Cardiovascular
-Drug use

Change in movement/weakness/coordination

-Stroke
-MS
-Brain tumor
-Parkinson's disease

Change in sensations

-CNS vs. Dm
-B-12 deficiency

Aphasia

Loss of ability to understand or express speech

Receptive aphasia

Inability to comprehend speech of others

Expressive aphasia

Inability to speak or speak meaningfully

Dysphasia

Difficulty with understanding or expressing speech

Hypotonia

Decrease in muscle tone
-Flaccidity

Hypertonia

Increased muscle tone
-Rigidity
-Spasticity

Crepitus

Grating sound/sensation produced by friction between bones and cartilage or fractured parts of bone

Effusion

Fluid in a joint

Paresthesia

Numbness/tingling sensation

Paralysis

Unable to move the affected body part in any capacity

Paresis

Condition of muscular weakness; still some motor function

What does redness of a joint indicate?

Infection or inflammation

Dislocation

Abnormal separation of bones within a joint
-Complete loss of contact between bones

Subluxation

Partial dislocation
-Bones in contact but misaligned

Open fracture

Skin is broken

Closed fracture

Skin remains intact

Contracture

Permanent tightening of muscles, tendons, skin, and nearby tissues that cause joints to shorten and become very still
-Often caused by inactivity or injury/scarring

Internal (medial) rotation

Movement of a joint towards the center of the body

External (lateral) rotation

Movement of a joint away from the body
-creates a "4"

Active ROM

Moving a body part using your own muscles

Passive ROM

Movement of a body part by someone or something else other than the patient

Kyphosis

Pronounced posterior curvature of the thoracic spine

Lordosis

Exaggerated inward curvature of the lower back

Scoliosis

Lateral curvature of the spine

Forward bend test

-Test for scoliosis
-Done in adolescence
-Hands are put together and bend forward towards toes
-Positive test: visible hump, asymmetric shoulder blades

Straight leg raise/LaSegue's Sign

Tests: for nerve root compression, lumbar disc herniation
-Pt. lying supine, Rn raises one leg
Positive test= reproduces gluteal or leg pain
-Tight hamstring is NOT positive test

Shoulders Flexion

Arms beside ears

Shoulders Extension

Arms at side

Shoulders Hyperextension

Extend arms backward

Shoulders Internal Rotation

Hands behind back w/palms facing out

Shoulders External Rotation

Hands behind head with elbows out; palms touching head

Heberden nodes

Osteoarthritis în DIP joints

Bouchard nodes

Osteoarthritis în PIP joints

Swan neck and Boutonniere Deformities

Rheumatoid arthritis
-Can cause permanent contracture of finger joints

Ulnar Deviation

-Rheumatoid arthritis
-Fingers drift to the ulnar side due to loss of wrist stability

Ganglion cyst

-Firm, round nodule commonly found on dorsum of wrist
-Benign
-Grows out of joint or lining of a tendon

Phalen's test

-Carpel tunnel
-Press back of hands together at 90-degree angle x 1 minute
-Positive test= numbness and paresthesia

Tinel's Sign

-Percuss/tap inner wrist over median nerve
-Positive test= numbness/tingling sensation

Hip flexion with knee

Pull knee up to chest

Hip flexion with leg extended

Raise leg w/o bending knee

FABER (Patrick's) Test

-Flexion, Abduction, External Rotation
-Pt. supine and in figure 4 position
-RN stabilizes hip and pushed down on leg
-Positive test= Recurrence of hip, sacroiliac joint or lumbar pain

Ballottement Test

-Tests for joint effusion
-Patellar tap test
-Compress suprapatellar pouch w/ one hand and vertically push down/tap patella with the other hands
-Positive test= patella floats/bounces back (knee effusion)

Bulge sign

-Tests for joint effusion
-Sweep hand on medial knee to displace fluid
-Sweep hand on lateral knee and watch for bulge of fluid on medial side of patella
-Positive test= bulge present (knee effusion)

Genu Varum

Exaggerated bending outward of the legs from the knees down
-Bowlegs

Genu Valium

Knees tilt inward while the ankles remain spaced apart
-Knock knees

Foot Drop

Muscular weakness/paralysis caused by nerve injury
-unable to dorsiflex

Thompson's Test

-Test for Achilles tendon rupture
-Pt. lying prone, squeeze calf
-Positive test= No plantarflexion noted when calf is squeezed

Hallux Valgus (bunion)

-Most common foot deformity
-Painful, bony bump forms on the joint at the base of the great toe

Hammer toe

-Commonly affects 2nd toe
-Causes: shoes are too tight, trauma, arthritis, DM

Muscle Strength: Grade 0

No visible or palpation muscle contraction
-NONE

Muscle Strength: Grade 1

Visible or palpable contraction with no motion
-TRACE

Muscle Strength: Grade 2

Full ROM with gravity eliminated
-POOR

Muscle Strength: Grade 3

Full ROM against gravity
-FAIR

Muscle Strength: Grade 4

Full ROM against gravity, some resistance
-GOOD

Muscle Strength: Grade 5

Full ROM against gravity, full resistance
-NORMAL

Infants Developmental Considerations

-Hip dysplasia
-Talipes equinovarus: clubfoot

Barlow and Ortolani Tests

B: Adduction, posterior pressure
O: Abduction, anterior pressure
-Positive test: palpable or audible cluck during either test = probable hip dislocation/dysplasia

Injury to a growth plate can cause...

Extremity deformity or shortening
-Future hip and knee problems

Circulating hormones cause an ____ ____ __ ____ during pregnancy

increased mobility of joints

Developmental Considerations of Older Adults

-Loss of bone mass
-Decreased height die to shortening of vertebral column
-Decreased balance and muscle strength
-Test for functional ADLs

Osteopenia

Bone density is lower than usual for age

Osteoporosis

More severe bone loss

Risk factors for osteoporosis

-Older than 50
-Women
-Caucasian and Asian
-Small-boned, thin
-Family Hx
-Smoking, drinking alcohol, inadequate Calcium/Vit. D, inadequate weight-bearing exercise
-Prolonged steroid use, some seizure meds
-Estrogen deficiency

Rheumatoid Arthritis (RA)

-Autoimmune disease
-Systemically (Inflammation and degeneration)
-Bilateral
-Affects fingers, wrists, ankles, feet, and knees
-More than 30 minutes of morning pain

Osteoarthritis (OA)

-More common
-Degenerative joint disease
-Progressive breakdown and loss of cartilage in 1+ joints
-Often unilateral
-Affects weight-bearing joints
-Less than 30 minutes of morning pain

Gout

-Inflammatory arthritis
-Build up of uric acid crystals
-Severe pain, redness, swelling
-Most commonly great toe
-Affects knees, ankles, wrists
-Tophi: visible deposits of sodium rate crystals in soft tissues
-Mostly men
-Increased alcohol consumption, high purine foods

Cerebrum

-Largest part of the brain
-Coordinates movement, regulates temperature
-Speech, judgement, thinking and reasoning, problem-solving, emotions, learning

Brainstem

-Connect cerebrum to spinal cord
-Breathing, consciousness, blood pressure, heart rate, sleep

Cerebellum

Posture, balance, coordination

Ascending tract of Spinal Cord

-Carry sensory information from he body to brain
-Pressure, pain, temperature, touch, and vibration

Descending tract of Spinal Cord

Carry impulses from frontal lobe down to muscles for voluntary movement

What is the sign if impaired cerebral function?

A change in LOC

AVPU scale

Awake, Verbal, Pain, Unconsciousness

Glasgow Coma Scale

Standardized scale for assessing LOC
-Often used in traumas or after a head injury
-Eye-opening
-Verbal response
-Motor response

Should you talk freely around an unconscious patient?

No, always assume that they an hear you

LOC: Painful Stimuli

-15-30 seconds
-Sternal rub
-Pressure to nailed w/ pen/pencil
-Pressure to ear lobe

Spastic paralysis

Increased muscle tone
-CVA, Spinal cord injury

Flaccid paralysis

Lack of muscle tone and deep tendon reflexes

Tests to assess for balance and symmetry

-Heel to toe walk
-Alternating hopping on 1 foot
-Tip toe and heel walk
Romberg tes