Musculoskeletal and Neurological

Pages 162-174 in Course Packet / 7-10 questions on Exam II

Purpose of a ____________ examination is to asses function for ADLs and to screen for abnormalities

musculoskeletal

ADLs

activities of daily living

Ability to move and complete ADLs require the ____________________ systems be intact and coordinating

musculoskeletal and neurological

Aspects of the neurological and musculoskeletal systems can be completed ______________

simultaneously

For a hospitalized patient, ask the person to:

sit up and dangle legs off the bed

Note ________ as patient sits up

muscle strength

Begin the assessment from ___________

head to toe and from proximal outward to distal end of extremities

Means you will inspect upper extremities from:

fingertips to shoulder

Proceed to inspection of lower extremities from:

groin/buttocks to feet

Joint motion normally causes no:

tenderness, pain, or crepitation

ROM

range of motion

Person’s muscle tone and strength is able to support each movement with minimal effort and without assistance:

active ROM

person is unable to perform ROM on their own; nurse of physical therapist will move muscle for the patient

passive ROM

When performing passive ROM, do not extend a muscle any further than the ______________ or if patient gives indication of pain

point of resistance

Joint deformity that primarily affect one side (unilateral) and result in limited range of motion; result of disuse, atrophy, and shortening of muscles caused by injury/neurological damage

contractures

ball and socket joint in full ROM

circumduction

bending

flexion

straighten

extension

down

pronation

up

supination

away from midline or other reference point

abduction

toward midline or other reference point

adduction

towards inside reference point

internal rotation

toward outside reference point

external rotation

sole of foot out

eversion

sole of foot in

inversion

flexed toward dorm or upper surface

dorsal flexion

flex toward sole

plantar flexion

The _________ joints will “slide and glide” allowing for much flexibility such as hands wringing and wrist hyperextension, and “alphabet”

wrist and ankle

neck

pivotal

(neck) flexion

chin to chest

(neck) extension

erect posture

(neck) hyperextension

bend head back

(neck) lateral flexion

ears to shoulders

(neck) lateral rotation

chin to shoulders

shoulder

ball and socket

(shoulder) flexion

arm forward above head

(shoulder) extension

arm at side

(shoulder) hyperextension

arm behind body, elbows straight

(shoulder) abduction

arm raised at side

(shoulder) adduction

lowered straight arm brought across front of body

(shoulder) internal rotation

scarecrow arms

(shoulder) external rotation

traffic cop stop

(shoulder) circumduction

full circle, both directions

elbow

hinge and pivot

(elbow) flexion

biceps curl

(elbow) extension

curl at rest

(elbow) forearm supination

palm up

(elbow) forearm pronation

palm down

wrist

hang and gliding

(wrist) radial flexion

medial toward thumb

(wrist) ulnar flexion

lateral toward fifth finger

(wrist) “all together”

alphabet

fingers

condyloid

(fingers) flexion

fist

(fingers) extension

straight

(fingers) abduction

apart

(fingers) adduction

together

hip

ball and socket

(hip) flexion

leg forward

(hip) extension

legs together

(hip) hyperextension

leg back

(hip) internal rotation

toe in

(hip) external rotation

toe out

(hip) circumduction

leg circle

knee

hinge

ankle

hinge and gliding

(ankle) dorsal flexion

toes up

(ankle) plantar flexion

toes down

(ankle) inversion

sole in

(ankle) eversion

sole out

toes

condyloid

(toes) flexion

curl down

(toes) extension

straight

(toes) abduction

toes apart

(toes) adduction

toes together

Test the strength of:

prime mover muscle groups

Ask patient to flex and hold the muscle as you ________ against the flexion

apply opposing force

Compare muscle strength ________

bilaterally

Full ___________ requires complete active range of motion

muscle strength

no movement at all

Grade 0

slight contraction but extremity cannot move (muscle twitches as patient tries to lift)

Grade 1

Extremity can move, but not against gravity (can roll but not lift)

Grade 2

Full ROM against gravity only, not against resistance (patient can lift arm off the bed, but as soon as you touch it, it falls right back again)

Grade 3

Full ROM against moderate resistance and gravity (patient can actively lift arm up and push against your resistance, but you win - arm wrestle)

Grade 4

Normal movement against gravity and resistance

Grade 5

Assess patient’s motor coordination and cerebellar function by assessing the patient’s:

gait and tandem walking

manner or style of walking

gait

observe ______ when patient is walking across room in his or her regular walk, turns, and then walks back toward you in heel-to-toe fashion

gait

Will exaggerate any unexpected findings in gait evaluation

tandem walking

The gait should be _________________, and opposing arms swing should be coordinated

smooth, rhythmic, and effortless

(when assessing gait) Note any:

shuffling, widely placed feet, toe walking, foot flop, leg lag, scissoring, and loss of arm swing, staggering or reeling

Abnormal gait can place a patient at:

risk for injury, indicate intoxication, may indicate a neuromuscular disorder

test for sensory equilibrium

Romberg test

Loss of balance

positive Romberg

Loss of balance indicates:

cerebellar ataxia or vestibular dysfunction

cerebellum’s main function is to:

ensure balance and movement

To palpate epitrocochlear lymph node have patient:

flex elbow to 90° angle while palpating depression between tricep/bicep muscle

If epitrocochlear lymph node is palpable, note:

size, consistency, and any tenderness

Epitrocochlear lymph node drains the:

hand and lower arm