chapter 24 musculoskeletal

temporomandibular joint’s articulation and motion

Articulation between the temporal bone and mandible. Motion: Opens and closes mouth, Projects and retracts jaw, Moves jaw from side to side

elbow joints articulation and motion

Articulation between the ulna and radius of the lower arm and the humerus of the upper arm; contains a synovial membrane and several bursae.

Motion: Flexion and extension of the forearm, Supination and pronation of the forearm

sternoclavicular joint’s junction and motion

Junction between the manubrium of the sternum and the clavicle; has no obvious movements.

shoulder joint’s articulation and motion

Articulation of the head of the humerus in the glenoid cavity of the scapula. The acromioclavicular joint includes the clavicle and acromion process of the scapula. It contains the subacromial and subscapular bursae.

Motion: Flexion and extension, Abduction and adduction, Circumduction, Rotation (internal and external)

wrist, fingers and thumb joint’s articulation and motion

Articulation between the distal radius, ulnar bone, carpals, and metacarpals. Contains ligaments and is lined with a synovial membrane.

Motion: Wrists: Flexion, extension, hyperextension, adduction, radial and ulnar deviation

Fingers: Flexion, extension, hyperextension, abduction, and circumduction

Thumb: Flexion, extension, and opposition

vertebral joint’s articulation and movement

Thirty three bones: 7 concave-shaped cervical (C); 12 convex-shaped thoracic (T); 5 concave-shaped lumbar (L); 5 sacral (S); and 3–4 coccygeal, connected in a vertical column. Bones are cushioned by elastic fibrocartilaginous plates (intervertebral discs) that provide flexibility and posture to the spine. Paravertebral muscles are positioned on both sides of vertebrae.

Motion: Flexion, Hyperextension, Lateral bending, Rotation

hip joint’s articulation and motion

Articulation between the head of the femur and the acetabulum. Contains a fibrous capsule.

Motion: Flexion with knee flexed and with knee extended, Extension and hyperextension, Circumduction, Rotation (internal and external), Abduction, Adduction

knee joint’s articulation and motion

Articulation of the femur, tibia, and patella; contains fibrocartilaginous disks (medial and lateral menisci) and many bursae.

Motion: Flexion, Extension

ankle and foot joint’s articulation and motion

Articulation between the talus (large posterior foot tarsal), tibia, and fibula. The talus also articulates with the navicular bones. The heel (calcaneus bone) is connected to the tibia and fibula by ligaments.

Motion: Ankle: Plantar flexion and dorsiflexion

Foot: Inversion and eversion

Toes: Flexion, extension, abduction, adduction

subjective data questions

Any recent weight gain, difficulty performing ADLS

difficulty chewing and is it associated with tenderness or pain

any joint muscle or bone pain, limiting of movement

past injuries with the joints, muscles and bones

last tetanus and polio immunizations

ever been diagnosed with diabetes mellitus, SLE, osteoporosis or sickle cell anemia,

meds

family history of osteoporosis, gout, rheumatoid arthritis

do they smoke or drink alcohol, and how often

ask about diet

do they need assistive devices

any falls and did that add trauma to your bones? how did you fall?

have they started menopause

physical examination of the joints

Inspection: size, shape, color (redness), symmetry

Palpate: edema, heat, tenderness, pain, nodules, or crepitus, and compare bilaterally

Test each joint’s ROM. Demonstrate how to move each joint through each ROM of motion. Ask the client to actively move through the same motion. Compare bilaterally.

how do we test for muscle strength?

by asking a client to move an extremity through its full ROM against resistance.

If the client can’t move against resistance, what do you do? If it isn’t possible, then what?

then attempt to move the part passively through its full ROM. If this is not possible, then inspect and feel for a palpable contraction of the muscle while the client attempts to move it. Compare bilateral joint findings.

ratings of ROM/muscle strength

5- active motion against full resistance : normal

4 - active motion against some resistance: slight weakness

3: active motion against gravity: average weakness

2: passive ROM: poor ROM

1: slight Flicker of contraction: severe weakness

0: no Muscular contraction: paralysis

what else is being assessed for the musculoskeletal system during physical examination

Posture and gait

Inspect for symmetry, color and mobility 

TMJ

Sternoclavicular joint

Cervical, thoracic, lumbar spine 

skeletal movements

Circumduction: circular motion

Inversion: moving inward

Eversion: moving outward

Extension: straightening the extremity at the joint and increasing the angle of the joint

Hyperextension: joint bends greater than 180 degrees

Flexion: bending the extremity at the joint and decreasing the angle of the joint

Dorsiflexion: toes draw upward to ankle

Plantar flexion: toes point away arm the ankle

Pronation: turning or facing downward

Supination: turning or facing toward

Protraction: moving forward 

Retraction: moving backward

Rotation: turning of a bone on its own axis

Internal rotation turning of a bone toward the center of the body 

External rotation : turning of a bone away from the center of the body 

scoliosis

S curvature of the spine, A lateral curvature of the spine with an increase in convexity on the side that is curved is seen in..

kyphosis

seen in older people, people more prone to osteoporosis, A rounded thoracic convexity

Lordosis

exaggerated inward curvature of the spine, often seen in the lower back (lumbar) or neck (cervical) regions. It's characterized by a swayback appearance and can cause pain, discomfort, and limited mobility.

Rheumatoid arthritis

Tender, painful, swollen, and stiff joints are seen in

Osteoarthritis

Osteoarthritis (DJD) nodules on the dorsolateral aspects of the distal interphalangeal joints (Heberden nodes) are due to the bony overgrowth of osteoarthritis. Usually hard and painless, they may affect middle-aged or older adults and often, although not always, are associated with arthritic changes in other joints. Flexion and deviation deformities may develop. Similar nodules on the proximal interphalangeal joints (Bouchard nodes) are less common. The metacarpophalangeal joints are spared.

characteristic of Acute gouty arthritis (also called rich man’s disease)

the metatarsophalangeal joint of the great toe is tender, painful, reddened, hot, and swollen.

normal findings of ausculating bowel sounds

A series of intermittent, soft clicks and gurgles are heard at a rate of 5–30/minute. Hyperactive bowel sounds referred to as “borborygmus” may also be heard.