Ch18 - MSK

History of Present Illness

recent weight gain

difficulty chewing

joint, muscle, bone throbbing

Past medical history

past problems or injuries to joints, muscles, bones

past treatments: surgeries, meds, PT, exercise, rest

Tetanus and polio immunizations

DM, lupus, sickle cell anemia

age of menarche, menopause, estrogen replacement therapy

Family history

RA

Gout

Osteoporosis

Psoriasis

TB

Lifestyle and health practices

activities to promote MSK health

home remedies to relieve problem

assistive devices to promote mobility

smoking

alcohol or caffeine

diet, milk intake, calcium supplements

difficulty with ADLs

body image

stress

common/concerning s/s

joint pain

joint pain with systemic symptoms

low back pain

bone pain

muscle pain/cramp

muscle weakness

Exam Order

IPASS:

Inspection, Palpation, Active ROM, Stength, Special tests

Joints to assess

TMJ

Sternoclavicular joint

cervical, thoracic, and lumbar spine

Shoulders

Elbows

Wrists

Hands and fingers

Hips

Knees

Ankles and feet

Hips ROM

Flexion

extension

abduction

adduction

Internal rotation

External rotation

Knee ROM

flexion, extension

Ankle ROM

plantar flexion

dorsiflexion

inversion

eversion

Toes ROM

flexion

extension

Fingers ROM

flexion

extension

abduction

adduction

Wrist ROM

Flexion

extension

elbow ROM

flexion

extension

supination

pronation

Shoulder ROM

Flexion

extension

abduction

adduction

circumduction

Internal rotation

external rotation

Neck ROM

flexion

extension

rotation to right/left

right/left lateral bending

Spine ROM

flexion

extension

rotation to right/left

right/left lateral bending

Special test: Carpel Tunnel Syndrome

phalen test

tinel test

thumb weakness

Muscle strength scale

0 - no visible contraction

1 - trace, muscle contraction detectable, but no joint mov’t

2 - poor, complete ROM with joint supported, cannot perform ROM against gravity

3 - fair, complete ROM against gravity

4 - good, complete ROM against gravity and moderate resistance

5 - normal, complete ROM against gravity and full resistance

Muscle bulk

assess size and contours

atrophy

muscle tone

resistence to passive stretch

Floppiness - hypotonia or flaucidity

jerkiness - spasticity or rigidity

Wrist/finger abnormalities

acute RA

chronic RA

ganglion

osteoarthritis

chronic tophaceous gout

trigger finger

scaphoid fracture

Feet/toe abnormalities

acute gouty arthritis

flat feet

callus

hallux valgus

corn

hammer toe

plantar wart

Fall risk factors

unstable gait

imbalanced posture

reduced strength

previous fall

impaired mobility

meds

incontinence

HTN

cognitive loss

vision deficits

osteoporosis

Bone density

interaction of bone mass, new bone formation, and bone resorption

Bone quality

architecture, turnover, damage accumulation from microfractures and mineralization

Osteopososis nonmodifiable risk factors

age >50

female

family hx

PMH

ethnicity

menopause/hysterectomy

long term glucocorticoid therapy

RA

primary/secondary hypogonadism in men

Osteopososis modifiable risk factors

Alcohol

smoking

low BMI

poor nutrition

eating disorders

Vit D deficiency

low dietary Ca2+ intake

sedentary lifestyle

frequent falls

Osteoporosis risk reduction

nutritious diet, high in Ca2+

avoid protein malnutrition and undernutrition

maintain Vit D

physical activity

avoid second hand smoking