Common Musculoskeletal Concerns and Conditions

Joint pain and loss of function.

Common musculoskeletal concerns

Symmetric joint involvement.

Characteristic joint involvement in rheumatoid arthritis (RA)

Isolated or unilateral joints.

Joint involvement in most other musculoskeletal illnesses (not RA)

Potential cause of the musculoskeletal issue.

Insight from joint tenderness with acute inflammation

In the morning when arising.

When is RA pain typically worse?

Later in the day.

When is osteoarthritis pain typically worse?

In the morning, improves during the day.

When is tendinitis pain typically worse?

Increases pain.

Effect of movement on most joint pain

Decreases pain.

Effect of movement on RA pain

Rheumatic fever.

Condition suggested by joint pain 10 to 14 days after untreated strep throat

Trauma or repetitive motion.

Possible causes of joint injury

In the morning and after rest periods.

When does RA stiffness commonly occur?

Acute inflammation.

What does stiffness suggest in musculoskeletal evaluation?

Risk of Lyme disease.

What should be assessed in relevant musculoskeletal cases?

Joint injury to cartilage or capsule, or muscle contracture.

Causes of decreased range of motion (ROM)

Inside knee injury.

Type of knee injury that can strain or rupture the medial ligament

Outside knee injury.

Type of knee injury that can strain or rupture the lateral ligament

Anterior cruciate ligament.

What can an abrupt twisting injury to the knee damage?

Tear in ligament or fracture.

What might a 'pop' in the knee indicate?

Inability to flex knee to 90 degrees, inability to bear weight for 4 steps, pain at fibula head or patella, or age over 55 years.

Criteria for obtaining a knee x-ray after direct trauma (Ottawa knee rules)

Musculoskeletal or neurologic systems.

Systems involved when a patient reports weakness

Atrophy.

Physical sign that might indicate muscle wasting or disuse

Sharp pain that increases with movement.

Type of pain a fracture typically causes

Dull and deep, and unrelated to movement.

How does other bone pain usually feel?

Degenerative discs, osteoporosis, lumbar stenosis, or nonspecific causes.

Common causes of low back pain

Increased anxiety symptoms.

Psychological contribution of chronic pain

Safety of independent living, need for home health services, and quality of life.

What does a functional assessment help determine in musculoskeletal evaluation?

Any self-care deficit.

What should be assessed when evaluating a patient's ability to care for themselves?

Impaired physical mobility.

Nursing diagnosis related to difficulty with body movement

Impaired verbal communication.

Nursing diagnosis related to difficulty speaking or expressing needs

Risk for back pain or carpal tunnel syndrome.

What should be assessed to prevent workplace or repetitive strain injuries?

Increases bone strength and reduces fracture risk.

Benefits of a regular exercise program for bones

Schedule and screening for adverse effects such as GI pain and bleeding.

What should be reviewed in patients taking daily aspirin or NSAIDs?

Bisphosphonates.

First-line therapy for osteoporosis

Due to associated risk factors.

Why is hormone therapy not recommended for osteoporosis?

Dietary calcium.

Better absorbed form of calcium

Serum levels can be checked and supplements recommended.

What can be done if there is concern about vitamin D levels?

Self-esteem disturbance, loss of independence, body image disturbance, role performance disturbance, and social isolation.

Psychological and social issues to assess in musculoskeletal patients

(Definition not provided in the notes.)

Effect of smoking on bone health in older women

Increases bone loss and risk of fracture.

Smoking effect on bone health in older women

Increases the risk of falls.

Moderate-to-heavy alcohol use effect on fall risk

Exercise.

Encouraged activity within a patient's ability and safety

Increased risk of future falls.

History of falls indication

There is insufficient evidence to recommend routine screening; it should be based on clinical evaluation of risk factors.

Current recommendation on routine osteoporosis screening in men

No, it has not been identified.

Optimal screening interval for osteoporosis

Excess joint fluid (effusion), thickening of the synovial lining, inflammation of surrounding soft tissue (bursae, tendons), or bony enlargement.

Swelling around a joint indication

Fracture, dislocation, subluxation, contracture, or ankylosis.

Common types of deformities affecting joints

Inflammation.

Warmth and tenderness in a joint indication

Abnormal.

Palpable joint fluid

The fluid shifts and causes visible bulging on the other side.

Pushing on one side of a sac containing joint fluid effect

Limitation in range of motion (ROM).

Most sensitive sign of joint disease

Helps determine the cause of the joint disease.

Amount of ROM limitation determination

Produces swelling and tenderness around the whole joint; limits all planes of ROM in both active and passive motion.

Articular disease effect on ROM and joint appearance

Causes localized swelling and tenderness, affects only certain planes of ROM, especially during active motion.

Extra-articular disease effect on ROM and joint appearance

Audible and palpable crunching or grating that occurs when joint surfaces are roughened.

Crepitation

In conditions like rheumatoid arthritis.

When crepitation might be felt during movement

A round bulge over the joint, visible when swelling is moderate or marked.

Visible joint swelling appearance

Crepitus and pain.

TMJ dysfunction symptoms during movement or chewing

Malocclusion of teeth.

Dental issue causing palpable crepitus or audible click in TMJ

Decreased range of motion.

ROM effect with TMJ inflammation and arthritis

Lateral motion.

Motion lost earlier and more significantly in TMJ dysfunction

Tenderness.

Palpation reveal in TMJ dysfunction

Muscle asymmetry or spasm.

Head tilted to one side indication

Muscle spasm or abnormal posture.

Asymmetry of neck muscles suggestion

Muscle spasm.

Tenderness and hard muscles in the neck indication

15% of the population reports neck pain; 80-90% have cervical disc degeneration.

Neck pain prevalence and common cause

Arthritis.

Limited neck ROM suggestion

Arthritis or muscle overuse.

Pain with neck movement cause

Muscle weakness or neurological issue.

Indication when a person cannot hold neck flexion

Inflammation.

Redness around a joint indication

Scoliosis.

Inequality of bony landmarks along the spine suggestion

Possible rotator cuff problem or disuse.

Atrophy in the shoulder area indication

Loss of normal rounded shape, appears flattened laterally.

Dislocated shoulder appearance

Anteriorly.

Best observation location for swelling from excess fluid in the shoulder

A considerable amount, due to the capsule's natural looseness.

Fluid amount needed to visibly distend the shoulder joint capsule

Localized under the deltoid muscle.

Location of swelling of the subacromial bursa

When the person tries to abduct the arm.

Noticeability of subacromial bursa swelling

Swelling and hard muscles.

Signs of muscle spasm

Symptoms associated with muscle issues or inflammation.

Swelling and hard muscles

Symptoms associated with muscle issues or inflammation.

Tenderness or pain

Condition characterized by limited range of motion, asymmetry, pain with motion, and crepitus during movement.

Rotator cuff lesion

Elbow condition showing the forearm dislocated posteriorly.

Elbow subluxation

Condition causing visible swelling and redness over a superficial bursa near the elbow.

Olecranon bursitis

Condition appearing as a bulge or fullness near the olecranon process and associated with gouty arthritis or bursitis.

Effusion or synovial thickening

Condition where the epicondyles, head of radius, and tendons are common sites of inflammation and tenderness.

Tennis elbow (lateral epicondylitis)

Indicated by soft, boggy, or fluctuant swelling in both grooves near the elbow.

Synovial thickening or effusion

Condition indicated when local heat or redness extends beyond the synovial membrane.

Inflammation

Raised, firm, nontender growths found over the olecranon bursa or along the ulna that occur with rheumatoid arthritis.

Subcutaneous nodules

Finding that typically rules out an elbow fracture after a fall or trauma.

Full extension of the elbow

Wrist condition involving a partial dislocation that may follow trauma or strain.

Subluxation of the wrist

Finger abnormality causing the fingers to angle toward the ulnar side.

Ulnar deviation

Condition presenting as the wrist being stuck in extreme flexion, often impairing function.

Ankylosis

Hand condition resulting in the permanent flexion of one or more fingers.

Dupuytren contracture

Finger deformities characterized by abnormal bending at the joints, often seen in rheumatoid arthritis.

Swan-neck or boutonnière deformities

Physical sign of carpal tunnel syndrome including wasting of muscle at the base of the thumb.

Atrophy of the thenar eminence

Localized, non-tender swelling commonly found on the wrist, often benign and filled with fluid.

Ganglion cyst

What synovial swelling on the back of the hand might suggest.

Synovial swelling on dorsum

Condition suggested by widespread swelling in the wrist or hand, possibly due to inflammation or infection.

Generalized swelling with arthritis or infection

What should be checked if there is tenderness in the wrist or hand after a fall.

Possible fracture

Systemic condition typically presenting with bilateral hand swelling and tenderness.

Rheumatoid arthritis (RA)