NURS 3016: Chapter 21 Musculoskeletal Assessment

Osteoporosis Risk Factors

• Age over 50 years

• Tobacco use

• Sedentary lifestyle

• Excessive alcohol use

• Low BMI

Tinel’s Test

• Tap at the inner aspect of the wrist to percuss the median nerve

• Positive: Tingling or “electric shock” sensation in median nerve distribution

• Nerve irritation

Gouty arthritis

• The metatarsophalangeal joint of the great toe is tender, painful, red, hot, and swollen

• A diet high in purine (risk factor)

Goniometer

Measures the angle of the joint at its maximum flexion and extension

5 types of connective tissue

• bone

• cartilage

• ligaments

• tendons

• fascia

Lumbar spine ROM abnormal findings

• flexion of 60 degrees

• incremental movements while bending

• unilateral exaggerated thoracic convexity

Lordosis

• Increased lumbar curvature

• Compensates for the enlarging uterus in pregnant individuals

Kyphosis

• Over curvature of the spine in the thoracic and sacral spine

• Arthritis, osteoporosis, or trauma

Scoliosis

• side to side curvature of the spine

• May cause elevation of one shoulder (EX: Left shoulder is higher than the right)

Red bone marrow

• Produces red blood cells

Yellow bone marrow

• Composed of fat

Phalen Test

• Asking the client to place the backs of both hands against each other while flexing the wrists 90 degrees downward (held for 60 seconds)

• Positive: tingling, numbness, and pain in the involved wrist

• Detects nerve compression (carpel tunnel syndrome)

Carpel Tunnel Syndrome

• A motion that resembles shaking a thermometer

Hematopoiesis

The process of blood cell production occurring in bone marrow cavities

Osteoporosis

• Decreased bone density, especially in postmenopausal women

• Increasing fracture risk

Muscle Atrophy

• Loss of muscle mass common in aging

• Managed with isometric exercises.

Cartilage Degeneration

• Breakdown of cartilage leading to joint stiffness

• Warm activity can help reduce stiffness

Estrogen effects

• Hormone that protects bone density

• decreases after menopause

• increasing osteoporosis risk.

GALS screening

• A quick locomotor screen assessing

• Gait, Arms, Legs, and Spine

Subluxation

• Partial dislocation

• often seen in stroke patients due to low muscle tone

Myalgia

• Muscle pain originating in the muscles

Arthralgia

• Pain in a bone or joint

Contracture

• Shortening of tendons, fascia, or muscles due to prolonged positioning

• may require surgery

Atrophy

• Wasting or shrinking of muscle (general or localized)

Ataxia

• Irregular, uncoordinated movements with loss of balance

• Cerebellar disorders such as Parkinson disease, MS, stroke, tumors, or inner ear problems

Acromegaly

• Enlarged skull

• increased size of hands, feet, and long bones

Spinal stenosis

• Positive/abnormal Romberg test

Crepitus

• Cracking/popping or grating sensation with joint movement indicating abnormality

Myofascial pain syndrome

• inflammation of the fascia surrounding the muscle

Degenerative joint disease

• Lateral tilting of the head and neck

• Torticollis (Lateral deviation of the neck)

Lateral epicondylitis

• Tennis elbow

• Inflammation of the forearm extensor and supinator muscles and tendons

Medial epicondylitis

• Golf elbow

• Same as tennis elbow, except it affects the flexor and pronator muscles and tendons

McMurray’s Test

• If the client reports a “giving in” or “locking” of the knee

• ask the client to flex one knee and hip while in supine position

Cervical Strain

• Most common cause of neck pain

• Sleeping in the wrong position

• Carrying a heavy load

• Being in an automobile accident

Cervical disc degenerative disease

• impaired range of motion and pain

• radiates to the back, shoulders, or arms

Cervical spinal cord compression

• neck pain

• loss of sensation in the legs

Osteoarthritis

• Degenerative (wear and tear)

• Gradual cartilage breakdown over time

• Worse with activity, better with rest

• Joint pain that is worse at the end of the day

Rheumatoid Arthritis

• Autoimmune disease

• Sudden or gradual onset

• Worse with rest, better with movement

• Joint paint that is worse in the mornings

Elbow motion

• Flexion/Extension

• Pronation/Supination

Late Menarche + Early Menopause

• Risk factors of osteoporosis

• Decreases estrogen levels

Rotator Cuff Tear

• Unable to externally rotate the left shoulder

• Shrugging of the shoulder

• Positive “drop arm” test

Rotator cuff tendonitis

• Acute, recurrent, or chronic pain of the supraspinatus tendon

Herniated intervertebral disc

• Shooting pain in both legs

Osteoporosis in older adults

• Increased bone resorption

• Decreased calcium absorption

• Decreased osteoblast production

Bulge Test

• Used to determine if knee swelling is due to accumulation of fluid or soft tissue swelling

Ballottement Test

• Used to detect large amounts of fluid in the knee

Lasegue's test

• detect low back pain

Straight Leg Test

• Ask the client to raise the leg to the point of pain and then dorsiflex the foot