Clinical Skills Institute CCMA Course: Chapters 3 and 4 [The Musculoskeletal System]

You're rooming a patient who came in holding their wrist after a fall. The provider asks you to document their pain. What are the 7 things you must capture?

Pain description (sharp/dull/shooting/radiating), onset time, measures taken to relieve it, current concerns, probable anatomic location, intensity on a scale of 1-10, and all OTC/prescription meds taken (name, dose, frequency, last dose time)

You hand the provider a hinged, scaled instrument to evaluate how far a patient can bend their knee. What is this tool called and what does it measure?

A goniometer — it measures range of joint movement in a single plane

A patient squeezed an inflated blood pressure cuff as hard as they could with each hand. What assessment was the provider performing?

Grip strength / muscle strength evaluation — comparing one hand to the other using a BP cuff

You're assisting with a new patient exam. The provider moves the patient's shoulder while the patient stays completely relaxed. Is this active or passive ROM, and what is your role?

Passive ROM — the provider moves the joint. Your role is to record the degree of motion and note any pain, tenderness, or crepitation

A patient rolled their ankle during a soccer game and comes in with swelling, bruising, and inability to bear weight. What structure is injured, what is this called, and what is the treatment?

The ligament is injured — this is a sprain. Treatment: RICE — Rest, Ice, Compression, Elevation, plus NSAIDs for pain

A patient strained their lower back lifting boxes at work. What structure is injured, where is this injury most commonly seen, and what does treatment include?

A strain injures the muscle or tendon. Most common in the lower back or hamstrings. Treatment: NSAIDs, rest, ice, compression, elevation — sometimes crutches, casting, or surgery

A patient comes in 2 hours after falling off a ladder. You're applying cold therapy to their swollen forearm. How long do you apply the ice pack, what do you check when you remove it, and what are you watching for?

Apply for 10 minutes on, 10 minutes off. After removing: inspect skin for color, sensation, and pain. Watch for numbness, pallor, or skin damage

A patient with chronic rheumatoid arthritis comes in for their follow-up. The provider orders a paraffin bath. What condition is this treatment most helpful for and what does it do?

Rheumatoid arthritis — a paraffin bath is a heat application that treats chronic joint inflammation and pain, improving circulation and reducing stiffness

You're about to use the heating pad on a patient's sore shoulder. Name 4 safety rules you must follow.

(Any 4): Inspect cord — do not use if frayed; keep cover on; place pad ON TOP of the body part; don't use more than 30 minutes; never use on infants, unconscious patients, or near oxygen; unplug when not in use; don't let patient lie on it

A patient is being discharged with crutches after knee surgery. They ask where the crutches should sit on their body. What do you tell them?

The crutches should sit 1 to 1.5 inches (two finger widths) below the armpits, with elbows bent about 30 degrees at the handgrip

You're teaching a patient to use crutches. They keep looking down at their feet. What do you correct, and name 3 other key safety instructions?

Tell them to look straight ahead, not at their feet. Also: wear flat non-skid shoes; bear weight on hands not armpits; keep crutch tips 2 inches to the side of each foot; remove rugs at home; report numbness or tingling to the provider

A patient cannot bear any weight on their left leg post-surgery. Which crutch gait do you teach them and how does it work?

Three-point gait — move both crutches and the affected leg forward together, bear weight through the crutches, then swing the unaffected leg forward

Both of a patient's legs are weak but they can bear some weight. Which crutch gait do you teach, and how does it work step by step?

Two-point gait — move the left crutch and right foot forward together, then the right crutch and left foot together

A patient with bilateral leg weakness needs the most stable crutch gait possible. Which one do you use and what is the sequence?

Four-point gait — right crutch forward, then left foot, then left crutch, then right foot. Slowest but most stable

A patient asks which side to use their cane on. Their right knee is the injured one. What do you tell them?

Use the cane on the LEFT side — the opposite side of the affected leg — to offload weight from the injured limb

A patient asks about walker use before discharge. What is your key instruction for how to step?

Take the first step with the WEAKER leg and lift the walker about an arm's length ahead while walking

You're transferring a patient from their bed into a wheelchair. What is the single most important safety step before the transfer begins?

Lock the wheelchair wheels before initiating any transfer

A patient's chart shows a diagnosis of osteoporosis. They ask what that means for their bones. How do you explain it in plain terms, and what lifestyle changes support management?

Osteoporosis means decreased calcium deposits make bones weak and fragile. Management includes increased calcium and vitamin D intake plus weight-bearing exercise

A 70-year-old patient is diagnosed with osteomalacia. How is this different from osteoporosis, and what causes it?

Osteomalacia = bones soften due to inadequate calcium AND vitamin D — bones become flexible, not just fragile. Osteoporosis = decreased bone density/strength from calcium loss. Rickets is osteomalacia in children

A patient with a history of autoimmune disease comes in with morning stiffness, joint swelling, malaise, and fever. Which musculoskeletal disorder does this suggest, and what drug classes treat it?

Rheumatoid arthritis — a chronic autoimmune inflammatory disorder. Treated with NSAIDs, corticosteroids, DMARDs (e.g., methotrexate), and biologics (e.g., etanercept)

A patient describes muscle pain and tenderness all over their body with no clear cause, chronic fatigue, and trouble sleeping. What condition is this, and what associated conditions often accompany it?

Fibromyalgia — muscle pain of unknown cause. Associated with sleep disorders and irritable bowel syndrome

A patient says their big toe is red, swollen, and excruciatingly painful. They drink heavily and have untreated hypertension. What condition does this suggest, and what is the underlying metabolic problem?

Gout — a metabolic disease involving increased production or decreased elimination of uric acid, commonly affecting the foot and big toe. Risk factors include alcohol use, kidney disease, obesity, and hypertension

A patient comes in after a tick bite with flu-like symptoms and a bullseye-shaped rash on their arm. What disease does this suggest, what causes it, and what antibiotics treat it?

Lyme disease — caused by Borrelia burgdorferi from a tick bite. The rash is called erythema migrans. Treated with doxycycline, amoxicillin, or IV ceftriaxone

A teen athlete comes in with an S-curve to their spine visible from behind. What is this condition, who is most commonly affected, and what are non-surgical treatments?

Scoliosis — abnormal lateral (left or right) curvature of the spine. Most common in adolescents. Non-surgical treatments: braces, chiropractic care, exercise, electrical muscle stimulation

An elderly patient comes in hunched forward significantly. What spinal condition is this, what is it also called, and what causes it?

Kyphosis — abnormal upper-back curvature ("hunchback"). Develops with aging or poor posture. Contrast with lordosis ("swayback") which is exaggerated lower-back curvature

A patient describes low back pain that radiates down their leg, making walking painful. What condition does this suggest, what causes it, and how is it treated?

Herniated disk — the soft nucleus of an intervertebral disk protrudes into the outer cartilaginous covering. Causes: improper lifting, smoking, obesity, repetitive strain. Treatment: NSAIDs, physical therapy, chiropractic care, epidural steroid injections

A patient's shoulder "popped out" during a fall and the bones are completely misaligned. What is the medical term for this, and what is the term if the bones are only slightly out of alignment?

Full dislocation = luxation. Partial dislocation = subluxation. Treatment: immediate reduction and immobilization; may need surgical reduction

A child under 10 fell off the monkey bars and has a partial break in their forearm consistent with a bending force rather than a complete snap. What type of fracture is this?

Greenstick fracture — caused by compression of long bones in children under 10; the bone bends and partially breaks rather than snapping completely

A patient's vertebra collapsed inward due to forces driving it together. What type of fracture is this, and where is it typically seen?

Compression fracture — caused by forces driving bones together; most commonly seen in the vertebrae

A patient's chart says they have myasthenia gravis. What type of disease is this, what muscles are most affected, and what are the two main treatments?

Autoimmune neuromuscular disease affecting voluntary muscles. Most commonly affects eyes/eyelids, facial expression, and swallowing. Treated with acetylcholinesterase inhibitors and thymectomy (surgical thymus removal)

The provider asks you to explain TENS therapy to a patient. What do you say it does, in plain terms?

TENS (Transcutaneous Electric Nerve Stimulation) uses low-voltage electrical current to stimulate the motor and sensory nerves that affect muscles, helping to reduce pain

A patient asks why the provider recommended therapeutic ultrasound for their muscle injury. How do you explain it?

Ultrasound therapy sends sound waves into muscle tissue (which has high water content), causing it to vibrate and generate heat — this increases metabolism and supports the body's natural healing process

You're differentiating muscle tissue types for a student shadowing you. Name all three, where each is found, and whether each is striated/non-striated and voluntary/involuntary.

Skeletal: attached to bones, striated, voluntary. Cardiac: walls of the heart, striated, involuntary. Smooth: walls of blood vessels/organs, non-striated, involuntary

A patient asks what connects their muscles to their bones vs. what connects their bones to each other. What do you tell them?

Tendons connect muscle to bone. Ligaments connect bone to bone (and form joints)

The provider asks you to describe the difference between synovial and non-synovial joints. What do you say?

Synovial joints are freely movable, filled with synovial fluid, and covered with cartilage (e.g., knee, elbow). Non-synovial joints are immovable with fibrous cartilage (e.g., skull sutures)