Musculoskeletal JAMES

What does grade 2 mean? (muscle strength)

Full ROM with gravity eliminated (passive motion) 25

What does grade 1 mean? (muscle strength)

Slight contraction 10

What does grade 0 mean? (muscle strength)

No contraction, 0

What should the alignment be for the head and neck?

Spine should be straight and head erect

What muscles are we palpating regarding the cervical spine?

Spinous processes, sternomastoid, trapezius, paravertebral muscles

What ROM movements should the cervical spine be able to do?

Flexion, Hyperextension, Lateral flexion, Chin toward each shoulder (rotation)

What does CN XI test for the cervical spine?

Muscle strength, Neck and shoulders

What are Fibrous joints?

Immovable joints

What are cartilaginous joints?

Slightly movable joints

What are synovial joints?

Freely movable joints

What are some findings in the aging adult?

Decrease in height, Kyphosis is common, Fat deposits over abdomen and hips, Loss of subq fat over bony prominences, Loss of muscle

What age does bone resorption happen more than deposition?

40

What are some subjective findings about the musculoskeletal system?

Joint pain, stiffness, limited movement, swelling, redness, myalgia, muscle weakness, bone pain, injury history, ADLs

What is the order of examination?

Inspection, Palpation, ROM, Muscle Testing

What does grade 5 mean? (muscle strength)

Full ROM against gravity, Full resistance 100

What does grade 4 mean? (muscle strength)

Full ROM against gravity, Some resistance 75

What does grade 3 mean? (muscle strength)

Full ROM with gravity 50

How do we palpate the shoulder?

Clavicle → AC joint, scapula, humerus, anterior glenohumeral joint

What ROM movements should the shoulder be able to do?

Abduction, Adduction, Forward flexion, Hyperextension, Internal/External rotation

Where would the patient’s hands be for internal rotation of shoulder?

Lower back

Where would the patient’s hands be for external rotation of shoulder?

Back of neck

What are we palpating on the elbow?

Olecranon process, medial/lateral epicondyles of humerus

What ROM movements should the elbow be able to do?

Flexion/Extension, Supination, Pronation

How do you palpate the hands?

Pinch the sides of the fingers and move upwards to palpate both sides

What ROM movements should the hand be able to do?

Flexion, Extension, Hyperextension, Radial and Ulnar deviation

What is the thenar eminence?

Muscle at bottom of thumb

What are the two carpal tunnel tests?

Phalen test and Tinel sign

How do you do the Phalen test?

Put backs of palms together and push

How do you elicit Tinel’s sign?

Tap on anterior wrist (median nerve) – evaluates carpal tunnel syndrome

What ROM movements should the hip be able to do?

Hyperextension, Flexion with knee flexed/extended, External/Internal rotation, Abduction, Adduction

What ROM movements should the knee be able to do?

Flexion and Extension

What ROM movements should the ankle and foot be able to do?

Dorsiflexion, Plantar flexion, Inversion, Eversion

What ROM movements should the spine be able to do?

Forward flexion, Lateral flexion, Hyperextension, Rotation

What are we inspecting to see if spine is straight?

Shoulders, scapulae, iliac crests, thoracic and lumbar curvatures

What are we inspecting regarding the forward bend test?

Shoulder elevation, scapular prominence, uneven waistline curve

How do we measure leg length discrepancies?

Anterior iliac spine → medial malleolus (crossing medial knee)

What would be bad regarding leg length discrepancies?

Difference greater than 1 cm

How to perform straight leg raise test?

Flex at hip and dorsiflex the foot

What are some abnormalities that affect multiple joints? (inflammatory)

Rheumatoid arthritis and Ankylosing spondylitis

What is rheumatoid arthritis?

Swan neck and boutonniere deformities, ulnar deviation or drift, inflammatory condition worse in morning

What is ankylosing spondylitis?

Chronic inflammation of vertebrae and larger joints

What are some abnormalities that affect multiple joints? (degenerative)

Osteoarthritis and Osteoporosis

What is Osteoarthritis?

Degenerative joint disease; forms osteophytes on DIPs and PIPs

What is Osteoporosis?

Decrease in skeletal bone mass leading to low bone mineral density

What are some abnormalities of the shoulder?

Dislocated shoulder, Rotator cuff tear, Joint effusion

What is joint effusion?

Swelling from excess fluid in the joint capsule

What are some abnormalities of the elbow?

Olecranon bursitis and Epicondylitis

What is Epicondylitis known as?

Tennis elbow

What are some abnormalities of the wrist and hand?

Ganglion cysts and Carpal tunnel syndrome

What are some abnormalities of the ankle and foot?

Chronic/Acute gout, Hallux valgus, Plantar warts, Ingrown nail

What does genu mean?

Knee

What does Hallux mean?

Toes

What does varum mean?

Open or spread

What does valgus mean?

Close together

What would genu varum mean?

Bow-legged

What would genu valgus mean?

Knock-kneed

What are some abnormalities of the spine?

Scoliosis, Disk problems

Which gender is more likely to have scoliosis?

Women

Where is most back pain?

L4/L5 region, common in men

What disk problems are naturally occurring?

Degenerated disk, thinning disk, osteophyte formations