ASSESSING MUSCULOSKELETAL SYSTEM

Bones

Bones

provide structure, give protection, serve as levers, store calcium, and produce blood cells.

206

A total of ______ bones make up the axial skeleton (head and trunk) and the appendicular skeleton (extremities, shoulders, and hips; Fig. 24-1).

osseous tissue

Composed of ___________________, bones can be divided into two types.

Compact Bone

which is hard and dense and makes up the shaft and outer layers

Spongy Bone

which contains numerous spaces and makes up the ends and centers of the bones.

osteoblasts, osteoclasts

Bone tissue is formed by active cells called _________________ and broken down by cells referred to as __________________.

red marrow, yellow marrow

Bones contain _________________ that produces blood cells and __________________ composed mostly of fat.

Periosteum

covers the bones; it contains osteoblasts and blood vessels that promote nourishment and formation of new bone tissues.

Skeletal, Smooth, Cardiac

The body consists of three types of muscles:

650

The musculoskeletal system is made up of _____ skeletal (voluntary) muscles, which are under conscious control.

tendons

Made up of long muscle fibers (fasciculi) that are arranged together in bundles and joined by connective tissue, skeletal muscles attach to bones by way of strong, fibrous cords called _____________.

Skeletal Muscles

assist with posture, produce body heat, and allow the body to move.

Abduction

Moving away from midline of the body

Adduction

Moving toward midline of the body

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 from ankle

Pronation

Turning or facing downward

Supination

Turning or facing upward

Protraction

Moving forward

Retraction

Moving backward

Rotation

Turning of a bone on its own long axis

Internal Rotation

Turning of a bone toward the center of the body

External Rotation

Turning of a bone away the center of the body

Joint

the place where two or more bones meet.

Joints

provide a variety of ranges of motion (ROM) for the body parts and may be classified as fibrous, cartilaginous, or synovial.

Fibrous Joints

are joined by fibrous connective tissue and are immovable.

Cartilaginous Joints

are joined by cartilage.

Synovial Joints

contain a space between the bones that is filled with synovial fluid.

Synovial Fluid

a lubricant that promotes a sliding movement of the ends of the bones.

ligaments

Bones in synovial joints are joined by ______________.

ligaments

are strong, dense bands of fibrous connective tissue.

Synovial Joints

are enclosed by a fibrous capsule made of connective tissue and connected to the periosteum of the bone.

Articular Cartilage

smooths and protects the bones that articulate with each other.

bursae

Some synovial joints contain ___________.

bursae

are small sacs filled with synovial fluid that serve to cushion the joint.

Temporomandibular

Articulation between the temporal bone and mandible.

Sternoclavicular

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

Elbow

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

Shoulder

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.

Wrist, Fingers, Thumb

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

Hip

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

7 concave shaped cervical, 12 convex shaped thoracic, 5 concave shaped lumbar, 5 sacral, 3-4 coccygeal

Vertebrae Composition

Intravertebral Discs

provide flexibility and posture to the spine.

Knee

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

Ankle and Foot

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.

Weight Gain

can increase physical stress and strain on the musculoskeletal system.

TMJ Dysfunction

Clients with ___________________________ may have difficulty chewing and may describe their jaws as “getting locked or stuck.”

Bone Pain

is often dull, deep, and throbbing. Joint or muscle pain is described as aching, but has been differentiated between mechanical- and inflammatory-type pains

Fibromyalgia

manifested by chronic pain and fatigue, affects about 5 million Americans.

Osteoporosis

is more common as a person ages because that is when bone resorption increases, calcium absorption decreases, and production of osteoblasts decreases as well.

T

T OR F:

Women who begin menarche late or begin menopause early are at greater risk for development of osteoporosis because of decreased estrogen levels, which tend to decrease the density of bone mass

Smoking

increases the risk of osteoporosis

protein, vitamin C, calcium deficiency

Adequate ___________ in the diet promotes muscle tone and bone growth; _______________ promotes healing of tissues and bones. A _______________________ increases the risk of osteoporosis. A diet high in purine (e.g., liver, sardines) can trigger gouty arthritis.

purine

A diet high in ___________ (e.g., liver, sardines) can trigger gouty arthritis.

Lactose Intolerance

a deficiency of the lactase enzyme

Osteoporosis

a disease in which bones demineralize and become porous and fragile, making them susceptible to fractures.

ankylosing spondylitis

A flattened lumbar curvature may be seen with a herniated lumbar disc or _______________________________.

Limited ROM

is seen with neck injuries, osteoarthritis, spondylosis, or with disc degeneration.

Muscle Atrophy

is seen with nerve or muscle damage or lack of use.

CN 11 (Spinal Accessory)

Inability to shrug shoulders against resistance is seen with a lesion of

Rheumatoid Arthritis

Swelling is seen with

Carpal Tunnel Syndrome

Client cannot raise the thumb up from the plane and stretch the thumb pad to the little finger pad. This indicates thumb weakness in

Boutonniere Deformity and Swan Neck Deformity

are seen in long-term rheumatoid arthritis

Osteoarthritis

hard, painless nodules may be seen over the distal interphalangeal joints (Heberden’s nodes) and over the proximal interphalangeal joints (Bouchard’s nodes).

Genu Valgum

Knees turn in with knock knees

Genu Varum

turn out with bowed legs

Patellofemoral Disorder

may be suspected if both crepitus and pain are present on examination.

torn meniscus

Pain or clicking is indicative of a _____________________ of the knee.

pes planus or flat fleet

feet with no arches

pes cavus

feet with high arches

corns

painful thickening of the skin over bony prominences and at pressure points

calluses

nonpainful thickened skin that occurs at pressure points

verruca vulgaris

painful warts

Kyphosis

A rounded thoracic convexity (kyphosis) is commonly seen in older adults.

Lumbar Lordosis

An exaggerated lumbar curve is often seen in pregnancy or obesity.

Scoliosis

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

Ganglion

Nontender, round, enlarged, swollen, fluid-filled cyst is commonly seen at the dorsum of the wrist

Tenosynovitis

Painful extension of a finger may be seen in ______________________ (infection of the flexor tendon sheaths).

Thenar Atrophy

Atrophy of the thenar prominence due to pressure on the median nerve is seen in carpal tunnel syndrome.

Acute Gouty Arthritis

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

Hammer Toe

Hyperextension at the metatarsophalangeal joint with flex ion at the proximal interphalangeal joint (hammer toe) commonly occurs with the second toe.

Leontiasis

large shaped it skull due to uncontrolled proliferation

Intention Tremor

becomes more apparent when an individual attempts a voluntary movement

boastia

Articular cartilage smooths and protects the __________ articulate with each other.

Resting Tremor

is more apparent when the client is relaxed and diminishes with activity

Fasciculation

an abnormal contraction of a bundle of muscle fibers that appears as a twitch.

Hemiplegia

Paralysis affects one side of the body (an arm and a leg on the same side).

Monoplegia

You can't move one limb

Paraplegia

Paralysis affects both legs and sometimes the torso.