MSK reproductive health assess

What are the functions of the MSK system

Structure, support, protection, ability of human body to move in many directions

How many bones in the human body

206

What is the structure of the skeleton

Bones, vertebrae, muscles, joints, tendons, ligaments

What are the types of vertebrae

Cervical, thoracic, lumbar, sacral

What is a joint

Two or more bones coming together

What are the three types of muscles?

Cardiac, skeletal, smooth

Is smooth muscle voluntary or involuntary

involuntary

Is skeletal muscle voluntary or involuntary

Voluntary

What does a tendon connect

Muscle to bone

What does a ligament connect

Bone to bone

What does cartilage do

Reduces friction between bones

What does synovial fluid do

Lubricates and reduces friction between cartilage of joints during movement

What is a bursae

Liquid filled sacs that help with joint movement

What joint has the biggest ROM

Ball and socket

What health history should be collected for MSK

Family - genetic/familial, muscular dystrophy

Surgical history - injury, repair, overuse

PMH - chronic disease, arthritis, myopathy, osteoarthritis, rheumatoid arthritis, osteoporosis

Nutrition - weight loss/gain

Pain assessment

Risk factors (gender, age, activity)

Cultural considerations (white and asian women more likely to have bone loss)

Common/concerning symptoms (muscle pain/cramps, weakness, neck pain)

What does myalgia mean

Muscle pain

What is the name for numbness/tingling

Parasthesia

What is arthralgia

Joint pain

Why would bowel and bladder dysfunction be concerning with low back pain

Indicates spinal cord compression

What should be collected in the aging adults health history

• ADLs

• Weakness In past months/years

• Increase of falls or stumbling

• Mobility aids

Why do some old adults not disclose falls

Fear of losing independence

Is a morse fall scale of higher or lower number concerning

High

What is the MSK sequence of assessment

• Inspection

• Palpationg

• Assess ROM

• Assess muscle strength

What is crepitus

Feeling of bones grinding on one another

What is compartment syndrome

Pressure build up within muscles

Why is compartment syndrome common in casts

Swelling occurs and there is no where for swelling to go, so it compresses arteries causing circulation loss

What is the treatment for compartment syndrome

Fasciotomy

What is a fasciotomy

Slicing open muscle allowing it to swell out and not against arteries

What is the purpose of inspecting and palpating UE

Determine if any abnormalities are present

What is being inspected for in the UE

• Skin changes

• Symmetry (always look at R vs L)

• Anterior/posterior aspect

• Edema

• Erythema

What are fasciculations

Tremors

What is being inspected/palpated when looking at muscle bulk

Size, definition, atrophy, hypertrophy, fasciculations

What is muscle tone

Tension of muscle at rest

hypotonia

Low tone

Flaccidity

FLoppy

Spasticity

Muscle tightness

Paresis

Weakness

How to palpate upper extremities

Two or three finger pads

What are unexpected findings of inspection and palpation of the UE

• Pain

• Deformties

• Limited RM

• No symmetry

• Forward rounding of shoulder

• Upper arms not straight

• No bend or excessive elbow bend

• Wrists not aligned

What is the purpose of assessing ROM

Assess strength and limitation in ROM in neck and upper extremities

Should ROM or strength be assessed first

ROM

What is eversion

Feet out

What is inversion

Feet in

How to assess neck hyper flexion

Chin to chest

How to assess neck hyperextension

Look at ceiling

How to assess neck rotation

Look over shoulder

How to assess neck lateral bending

Ear to shoulder

What CN is assessed when shrugging shoulders

CN XI

What is flexion

Bending limb at joint

What is extension

Straightening limb at joint

What is paresis

Muscle weakness

What are things to remember when assessing muscle strength

• Look at variables (Age, gender, muscular training)

• Dominant side is slightly stronger

• Active resistance testing

What is a muscle strength of 0

No muscle movement

What is a muscle strength of 5

Full ROM

How to assess elevation in the LE

Raise body part

How to assess depression in the LE

Lowering body part

What is kyphosis

Hunchback

What is lordosis

Lower spine extension (normal in pregnancy)

How to assess spinal ROM

Hyperflexion, hyperextension, lateral bending, rotation

What is the purpose of inspecting gait

Assess ability of patient to ambulate

What are the safety considerations before assessing gait

• May have assistive device

• May need support to steady themselves

• May not be able to ambulate due to injury

• May be a fall risk

What should be done before asking PT to ambulate

LE FMM (heel to shin)

What are unexpected findings of inspecting gait

• Unequal leg/arm swing

• Arm swing not contralateral

• Pattern not even/smooth

• Assistive device use

• Unable to maintain balance

• Limping

• Limited/increased alterations

• Ataxia

• Scissors

• Shuffling

• Foot drop

What is the purpose of inspecting posture

Assess alignment of muscle and joints

What should be done if posture inspection cannot safely be done standing

Have them sit

What are unexpected findings when inspecting posture

• Numbness/tingling

• Head not centered on axial skeleton

• Limitations in ROM

• Shoulders not level

• Motion of trunk not symmetric

What is a concerning symptoms when assessing breasts

• Lumps/mass

• Pain/discomfort

• Change in shape

• Nipple discharge (when not breastfeeding)

• Edema

• Rashes

• Scaling

• Dimpling

• Retraction

• Gynecomastia

What PMH should be collected in a breast exam

• Medications

• Pregnancy

• Menstrual history

• Breast/reproductive cancer history

• Breast biopsy

• Breast self exams

• Clinical breast exams

• Mammogram/MRI

What are breast concerns

• Lumps

• Pain in one or both breasts

• Tenderness

• Nipple discharge

• Skin changes

• Axillary changes

What is mastalgia

Breast pain (usually correlated to period)

How should patient be instructed to sit during a breast inspection

Sitting upright

Arms at side

What is being inspected during a breast inspection

• Skin appearance

• Size/symmetry of breasts

• Contour of breasts

• Retractions (may indicate breast cancer)

• Nipple characteristics

What positions and why are they used to assess for abnormalities

Arms over head, hands pressed against hips, arms out to side and bend over

Looking for symmetric rise and ensuring breasts are moving as they should

What are unexpected findings of inspecting breasts

• Asymmetry

• Erythema or inflammation

• Mastitis

• Tissue retraction, lumps, or dimpling

• Unilateral venous pattern

• Skin looks like an orange

How to palpate breasts

• Patient lies supine

• Look for tissue density

• Look for lumps, masses or increased density

How to document breast nodules

By quadrant, face of clock, or centimeters from nipple

If nipple discharge present, note…

Amount

Odor

Color

Consistency

What are unexpected findings when palpating the breast

Tenderness/pain

Lumps or masses

Nipple discahrge

Pagets disease

What is gynecomastia

Breast buds in males

What does a dimpling breast look like

Like dimples or retractions

What is a nipple retraction

Nipple retracts inwards

What is a large piece of breast education for women

Breast self exams and understanding what their normal tissue feels like

When is the best time to perform a BSE (breast self exam)

7-9 days after period

What is key education when educating on breast self exams

Do same pattern each time

What should be documented during a breast exam

• Contour

• Color

• Masses

• Dimpling

• Discharge

• Skin

• Prior surgery

Subjective female health history questions

• Frequency of period

• Duration of period

• Dysmenorrhea

• PMS

• Amenorrhea

• Abnormal bleeding

What is dysmenorrhea

Severe painful periods

What is menorrhagia

Prolonged bleeding

Menses

Monthly Flow of blood

What is menarche

Age of period onset

What is menopause

12 consecutive months of no period

What is perimenopause

Transition of menopause, hot flashes, flushing, sweating, variable cycle length

Postmenopausal bleeding

Abnormal!!

What is expected after menopause

• Vaginal dryness

• Dyspareunia (painful intercourse)

• Mild hirsutism (facial hair)

• Hair loss

What are some tips for obtaining sexual history

• Ensure conversation is confidential

• Explain need for sexual history

• Encourage patient to be honest

• Relate that this info is gathered with all patients

What is a concerning symptoms in a male health history

Penile discharge/lesions

Scrotal pain, selling, lesions

Urinating issue

Cryptorchidism

Testes dont descend

Mumps orchitis

testicular swelling/infklamamtion

Hydrocele in childhood

Fluid filled sac around testicle