NURS 210: Module 11 PowerPoint Notes

Where can you feel the TMJ?

Where can you feel the TMJ?

in depression anterior to tragus of ear

The TMJ permits what function?

jaw function of speaking and chewing

What is the TMJ? (temporomandibular joint)

The articulation of mandible and temporal bone

The TMJ allows what 3 motions?

Hinge action to open and close jaws

Gliding action for protrusion and retraction

Gliding for side-to-side movement of lower jaw

Flexion:

bending limb at joint

Extension:

straightening limb at joint

Abduction:

moving limb away from midline of body

Adduction:

moving limb toward midline of body

Pronation:

turning forearm so that palm is down

Supination:

turning forearm so that palm is up

Circumduction:

moving arm in circle around shoulder

Inversion:

moving sole of foot inward at ankle

Eversion: moving sole of foot outward at ankle

moving sole of foot outward at ankle

Rotation:

moving head around central axis

Protraction:

moving body part forward, parallel to ground

Retraction:

moving body part backward, parallel to ground

Elevation:

raising a body part

Depression:

lowering a body part

What are the 33 connecting bones?

7 cervical, 12 thoracic, 5 lumbar, 5 sacral, 3 to 4 coccygeal

Spinous processes of C7 and T1 prominent at?

the base of neck

Inferior angle of scapula is normally at?

the level of interspace between T7 and T8

The imaginary line connecting the highest point on each iliac crest crosses at?

L4

The imaginary line joining two symmetric dimples that overlie posterior superior iliac spines crosses where?

the sacrum

Cervical and lumbar curves are?

concave (inward or anterior)

Thoracic and sacrococcygeal curves are?

convex

Balanced or compensatory nature of curves, together with intervertebral disks, allows the spine to?

absorb shock

Intervertebral disks are?

elastic fibrocartilaginous plates that constitute one fourth the length of column

Nucleus pulposus:

disk center composed of soft, semifluid, mucoid material

(allow for compensatory expansion on each side)

Motions of the vertebral column:

flexion, extension, abduction, and rotation

The shoulder girdle includes?

the humerus, scapula, clavicle, joints and muscle

Rotator cuff:

group of four SITS muscles (supraspinatus, infraspinatus, teres minor, subscapularis) and tendons support and stabilize the shoulder

The ________ and ________ form the shoulder girdle

scapula, clavicle

where can you feel the bump of the scapula’s acromion process?

at the very top of shoulder

Elbow joint contains what three bony articulations?

humerus, radius, and ulna of the forearm.

What are the palpable landmarks of the elbow?

the medial and lateral epicondyles of the humerus and the large olecranon process of the ulna between them

Where do the radius and ulna articulate with each other?

at two radioulnar joints, one at elbow and one at wrist.

The wrist (or radiocarpal joint) has articulation of?

radius on thumb side and row of carpal bones

Condyloid action permits what movement in two planes at right angles?

flexion and extension, and side-to-side deviation

Midcarpal joint:

articulation allows flexion, extension, and some rotation

Hip:

articulation between acetabulum and head of the femur

more stability for weight-bearing function

muscles enhance stability and bursae facilitate movement.

what action of the hip permits wide range of motion on many axes?

ball-and-socket

what bony landmarks in the hip will guide examination when palpating?

Iliac crest—anterior superior spine to posterior

Ischial tuberosity

Greater trochanter of the femur

The knee joint has articulation of what three bones?

femur, tibia, and patella

What is the largest joint in the body and what does it do?

hinge joint

it permits flexion and extension of the lower leg on a single plane

what is the largest membrane in the body?

synovial membrane

two wedge-shaped cartilages, called ______ and ______ menisci, cushion tibia and femur

medial, lateral

The knee is stabilized by what two sets of ligaments?

Cruciate (give anterior and posterior stability and help control rotation)

Collateral (give medial and lateral stability and prevent dislocation)

Landmarks of knee joint:

Quadriceps muscle (felt on anterior and lateral thigh)

Tibial tuberosity (felt as bony prominence in the midline)

Lateral and medial condyles of tibia.

Medial and lateral epicondyles of femur (are on either side of patella)

The ankle (or tibiotalar) joint has articulation of what three bones?

tibia, fibula, and talus

Hinge joint movement:

limited to flexion (dorsiflexion) and extension (plantar flexion) in one plane

Medial malleolus and the lateral malleolus:

~help stability of ankle

~may be torn in eversion or inversion sprains of ankle

Subtalar joint permits what movement of the foot?

inversion and eversion

How does the longitudinal arch of the foot distribute weight?

between the parts that touch the ground

-the heads of metatarsals and calcaneus (heel)

Fibrous joints (sutures in skull):

bones united by interjacent fibrous tissue or cartilage (does not move)

Cartilaginous joints (vertebrae) are separated by what?

fibrous cartilage (are slightly moveable)

What are all the synovial joints?

shoulder, hip, elbow, knee, ankle/plantar, hinge, condyloid, saddle, ball & socket

Synovial joints key points:

~freely moveable joints separated by one another and enclosed in a cavity lined with synovial membrane that secretes fluid

~contains a layer of avascular cartilage

~surrounded by ligaments

~bursae located in areas of potential friction to facilitate movement of muscles and tendons

common concern questions to ask:

Any problem with your joints? Which joints?

Any stiffness, swelling, heat, redness, limitation of movement?

Any cramps?

Do you have issues walking, or any other position?

Do any activities give you problems?

when inspecting gait and posture, you should see?

a stable gait and an erect posture

Should there be any involuntary movements present?

no

(if present, note: location, frequency, rate, and amplitude; and note if movements can be controlled at will)

What should the tone be when inspecting?

normal tension in relaxed muscles

(persuade the person to relax completely and move each extremity smoothly through a full range of motion; normally note mild, even resistance to movement)

Diabetic neuropathy screening:

monofilament test (standardized measurement tool to detect peripheral neuropathy)

how many grades are there on the strength grading scale?

six (0-5)

An audible and palpable snap or click of the TMJ occurs in?

many healthy people as the mouth opens

What does the testing the TMJ test the integrity of?

cranial nerve V (trigeminal nerve)

How to assess the TMJ:

~palpate contracted temporalis and masseter muscles as person clenches teeth

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

~ask the person to move their jaw forward and laterally against your resistance, and to open their mouth against your resistance

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

cervical spine movement:

extension, flexion, lateral bending, rotation

when inspecting the alignment of the head and neck, the spine should be?

straight and head erect

when palpating the spinous processes and sternomastoid, trapezius, and paravertebral muscles, they should feel?

firm, with no muscle spasm or tenderness

a person normally can maintain flexion against ___ resistance.

full

~this tests integrity of cranial nerve XI (spinal nerve).

when a patient is moving their head and neck, you should observe for?

limitation of motion and/or reported pain

shoulder movement:

flexion, hyperflexion, internal rotation, external rotation, abduction, adduction

You should inspect and compare both shoulders posteriorly and anteriorly, but do not attempt if?

you suspect neck trauma

If person reports shoulder pain, you should ask the,?

to point to spot with hand of unaffected side.

shoulder pain may be from local causes or may be referred pain, which could be?

potentially serious

Shoulder pain from a local cause is reproducible during the examination by?

palpation or motion

While standing in front of the person and palpating both shoulders, you should note?

any muscular spasm or atrophy, swelling, heat, or tenderness

elbow movement:

flexion, extension, pronation, supination

You should inspect the size and contour of each elbow in both _________ and ___________ positions.

flexed, extended

What is normally present of either side of the olecranon process?

hollows

(note any abnormal swelling)

You should palpate the elbow flexed at about?

70 degrees and relaxed

Wrist and hand movement:

wrist extension and flexion, finger hyperextension and flexion, abduction, make a fist

When inspecting hands and wrists on dorsal and palmar sides, you should note?

position, contour, and shape

(normally no swelling or redness, deformity, or nodules are present)

What is ulnar deviation caused by?

rheumatoid arthritis

Carpal Tunnel Syndrome tests:

Phalen test: acute flexion of wrist produces numbness and burning (if positive)

Tinel sign test: percussion of median nerve produces burning and tingling (if positive)

Hip movements:

extension, flexion, internal rotation, external rotation, abduction, adduction

When inspecting the hip joint together with the spine as the person stands, you should note?

symmetric levels of iliac crests, gluteal folds, and equally sized buttocks

Smooth, even gait reflects?

equal leg lengths and functional hip motion

When palpating the hip joints when the person is in the supine position, the joints should feel?

stable and symmetric, with no tenderness or crepitation

Limitation of abduction of hip while supine is?

the most common motion dysfunction found in hip disease

Knee movements:

flexion and extension

Ballottement test:

~reliable when larger amounts of fluid are present

~use your left hand to compress the suprapatellar pouch to move any 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)

Bulge sign:

~confirms the 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 and then tap the lateral aspect

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

(normally none is present)

McMurray’s test is done if a?

meniscal tear is suspected

(audible click on examination is positive for presence of tear)

Ankle and Foot movement:

plantar flexion, dorsiflexion, inversion, eversion

Ankle and Foot inspection:

~compare both feet, noting contour of joints; foot should align with long axis of lower leg.

~weight-bearing should fall on middle of foot; most feet have a longitudinal arch, but this can vary normally from “flat feet” to high instep.

~toes point straight forward and lie flat (note locations of calluses or bursal reactions as they reveal areas of abnormal friction)

~examining well-worn shoes helps assess areas of wear and accommodation

Ankle and Foot palpation:

~palpate metatarsophalangeal joints between your thumb on dorsum and fingers on plantar surface

~perform ROM to assess for any limitation or presence of pain.

~assess muscle strength by asking person to maintain dorsiflexion and plantar flexion against your resistance

Spine movement:

extension, flexion, lateral bending, rotation

Stabilize pelvis with your hands and check ROM by asking patient to:

Bend sideways: lateral bending of 35 degrees

Bend backward: hyperextension of 30 degrees

Twist shoulders to one side, then the other: rotation of 30 degrees, bilaterally.

(these maneuvers reveal gross restrictions only…movement is still possible even if some spinal fusion has occurred)

~lastly: ask the person to walk on his or her toes for a few steps, then return walking on heels

The presence of herniated nucleus pulposus is tested by?

straight leg raising while keeping the knee extended

raise the affected leg just short of the point where it produces pain; then dorsiflex the foot

(the test is positive if it reproduces sciatic pain)