Chapter 23 - Musculoskeletal System
What is eversion?
Moving the sole of the foot outward at the ankle
What is the knee joint?
Articulation of 3 bones (femur, tibia and patella) in one common articulation cavity, largest joint in the body, a hinge joint that permits flexion and extension with the largest synovial membrane
How do we perform the Phalen test? What is considered normal/NOT normal?
- Ask person to hold both hands back to back while flexing the wrists 90 degrees - Normal is acute flexion of wrist for 60 seconds produces no symptoms - Not normal is produces numbness and burning (carpal tunnel syndrome)
What is the wrist? (Radiocarpal joint)
Articulation of the distal radius (thumb side) and a row of 8 carpal bones, permits movement in two planes at right angles (flexion/extension, side to side deviation)
What is the glenohumeral joint?
Articulation of the humerus with the glenoid fossa of the scapula, ball and socket action allow for great mobility of the arms on many axes
What is the temporomandibular joint?
Articulation of the mandible and the temporal bone and permits jaw function for speaking/chewing by allowing 3 motions.
What is the ankle (tibiotalar joint)?
Articulation of the tibia , fibula and talus, a hinge joint that is limited to flexion and extensions on one plane
As a nurse - how do we test ROM of joints?
Ask for voluntary ROM while modeling the movements yourself as appropriate, stabilize the body proximal to being moved, if you see a limitation gently attempt passive range of motion while you move the person muscles relaxed
What are the elbow joints?
Contain 3 bony articulations of the humerus, radius and ulna and its hunger action moves forearm on one plane allowing for flexion and extension.
What is the cruciate ligament?
Crisscross within the knee and give anterior and posterior stability and help control rotation
Anterior and posterior stability are provided to the knee joint by the: A. Medial and lateral menisci B. Patellar tendon and ligament. C. Medial collateral ligament and quadriceps muscle. D. Anterior and posterior cruciate ligaments.
D. Anterior and posterior cruciate ligaments
Hematopoiesis takes place in which of the following. A. Liver. B. Spleen. C. Kidneys. D. Bone marrow.
D. Bone marrow
During the assessment of the spine, the patient would be asked to: A. Adduct and extend B. Supinate, evert, and retract C. Extend, adduct, invert, and rotate D. Flex, extend, abduct, and rotate
D. Flex, extend, abduct, and rotate
Fibrous bands running directly from one bone to another that strengthen the joint and help prevent movement in undesirable directions are known as: A. Bursa. B. Tendons. C. Cartilage. D. Ligaments.
D. Ligaments
What is the bursa?
Enclosed sac filled with viscous synovial fluid and is located in areas of potential friction and helps muscles and tendons glide smoothly over bone
As a nurse - how do we inspect and palpate the wrist and hand?
- Check on dorsal and palmar sides, noting position, contour and shape - Test each joint while facing person, support hand with fingers under it an palpate the wrist firmly with both thumbs on its dorsum, persons hand is relaxed and in straight alignment, move thumbs side to side to check normal depressed areas, check metacarpophalangeal joints with thumbs just distal to and on either side of knuckle, use thumb and index finger in pinching motion to palpate sides of interphalangeal joints
As a nurse - how do we inspect and palpate the shoulder joint?
- Compare both shoulders posteriorly and anteriorly, check size and contour of joint and compare for equality of bony landmarks, if reports any shoulder pain, ask them to point to spot and be aware during examination - While standing in front of person test both shoulders by starting at the clavicle and methodically explore the acromioclavicular joint, scapula, greater tubercle of humerus, area of subacromial bursa, biceps groove and anterior aspect of glenohumeral joint, also check pyramid shaped axilla
How do we perform Tinel sign? What is considered normal/NOT normal?
- Direct percussion of location of the median nerve at the wrist - Normal is no symptoms - Not normal is percussion produces burning and tingling (carpal tunnel syndrome)
How do we inspect and palpate the ankle and foot?
- Have person sitting, non weight bearing position and also inspect when standing and walking, compare both feet, noting position of feet and toes, contour of joints and skin characteristics - Support ankle by grasping heel and palpate with thumb, explore joint spaces, check metatarsophalangeal joints between thumb on dorsum and fingers on plantar surface, using pinching motion of thumb and forefinger to palpate interphalangeal joint on medial and lateral sides of toes
How do we inspect and palpate the spine?
- Have person standing, draped in a gown at the back, place yourself far enough back to you can see entire back, note where the spin is straight by following and imaginary vertical line from head down to gluteal cleft - Palpate down spinous processes and check paravertebral muscles
What are examples of objective data pertaining to the musculoskeletal system?
- Inspect joints - Palpate joints - ROM with joints - Muscle testing - Inspect Temporomandibular Joint - Palpate Temporomandibular Joint - Test ROM of Temporomandibular Joint - Inspect and palpate cervical spine - Test ROM of cervical spine - Inspect shoulder joint - Palpate shoulder joint - Test ROM of shoulder joint - Inspect and palpate the elbow - Test ROM of the elbow - Inspect the wrist and the hand - Palpate the wrist and the hand - Test ROM of wrist and hand - Phalen test - Tinel sign - Inspect the hip - Palpate the hip - Test ROM of hip - Inspect and palpate the knee - Bugle sign - Ballottement of the patella - Test ROM of the knee - Mcmurray test - Inspect and palpate the ankle and foot - Test ROM of the ankle and foot - Inspect and palpate the spine - Test ROM of spine - Straight leg raising (Lasegue test) - Measure leg length discrepancy
As a nurse - how do we inspect and palpate the temporomandibular joint?
- Inspect the area just anterior to the are, place tips of your fingers in front of each ear and ask person to open and close the mount, drop fingers into the depressed area over the joint and note motion of mandible - Test contracted temporalis and masseter muscle as the person clenches their teeth, compare right and left sides for size, firmness and strength, ask person to move jaw forward and laterally against your resistance and open mouth against resistance
What are examples of subjective data pertaining to joints?
- Joint pain (location, quality, onset, timing, aggravated by something) - Joint Stiffness - Joint Swelling/Heat/Redness (can suggest acute inflammation) - Limited ROM of Joint (which one, aggregated by something) - Check Knee Joint if Injury Reported (how, when, hear a "pop", can you stand)
As a nurse - how do we inspect and palpate the elbow?
- Look at size and contour of the elbow in both flexed and extended positions, look for any deformities, redness or swelling, check olecranon bursa and the normally present hollows on either side for abnormal swelling - Check with elbow flexed about 70 degrees and as relaxed as possible, use left hand to support the persons left forearm and palpate extensor surface of the elbow, the olecranon process and the medial/lateral epicondyles of the humerus, with thumb in lateral groove and index fingers in medial groove and palpate both sides of olecranon process
How do we perform the straight leg raising (Lasegue test)? What is considered normal/NOT normal?
- Maneuvers that reproduce back and leg pain to help confirm the presence of sciatica and herniated nucleus pulposus, straight leg raising while keeping the knee extended, raise effected leg just short of the point where it produces pain and then dorsiflex the foot - Normal is no pain - Not normal is stretches nerve route over disc protrusion and gives painful response of muscle contractions, if lifting unaffected leg reproduces sciatic pain it strongly suggest herniated nucleus pulposus
When testing ROM of the temporomandibular joint what is considered normal/NOT normal?
- Normal is 3-6cm or 3 fingers inserted sideways —Partially open mouth and protrude lower jaw and move it side to side (lateral motion) - Normal is extent is 1-2cm —Stick out lower jaw -Normal is protrude without deviation
When inspecting and palpating the spine, what is considered normal/NOT normal?
- Normal is equal horizontal positions for shoulders, scapulae, iliac crests and gluteal folds and equal spaces between arm and lateral thorax on two sides, convex thoracic curve - Not normal is difference in shoulder elevation and in level of scapulae and iliac crests(scoliosis), lateral tilting and forward bending (herniated nucleus pulposus) - Normal is straight and non tender, muscles should feel firm with no tenderness or spasms - Not normal is spinal curvature, tenderness, low back pain and spasms, chronic axial skeletal pain (fibromyalgia syndrome)
When inspecting and palpating the ankle and the foot, what is considered normal/NOT normal?
- Normal is foot aligns with long axis of lower leg, weight bearing falls on middle of foot, from heel along the mid foot to between the 2nd and 3rd toes, toes point straight forward and lie flat, skin is mouth with even coloring and no lesions - Not normal is hallux valgus where distal part of great toe is directed away from the body midline, hammertoes, calluses and ulcers - Normal is smooth and depresses with no fullness, swelling or tenderness - Not normal is swelling, inflammation, tenderness, plantar fasciitis (localized tenderness under heel)
When inspecting and palpating the shoulder joint, what is considered normal/NOT normal?
- Normal is no redness, muscular atrophy, deformity or swelling present, equality of bony landmarks - Not normal is redness, inequality of bony landmarks, atrophy, dislocated shoulder (loses normal round shape) and swelling (excess fluid) - Normal is no adenopathy or masses are present - Not normal is swelling, hard muscles with muscle spasm, tenderness and pain
When inspecting and palpating the elbow, what is considered normal/NOT normal?
- Normal is no redness, swelling or deformities, symmetric on both sides - Not normal is subluxation (dislocated posteriorly), swelling, redness, effusion or synovial thickening (bulge or fullness in groove) - Normal is tissue and fat pads are fairly solid, no heat, swelling or nodules and symmetric on both sides - Not normal is soft, boggy or fluctuant swelling in both grooves, local heat and redness or subcutaneous nodules (raised, firm and nontender)
When testing ROM of the joints, what is considered normal/NOT normal?
- Normal is ranges of active and passive motion should be the same, causes no tenderness, pain or crepitation - Not normal is limitation in ROM signaling joint disease, swelling/tenderness (articular disease or extrarticular disease) and crepitation (palpable crunching/grating sound that accompanies movement)
When inspecting and palpating the knee, what is considered normal/NOT normal?
- Normal is skin is smooth with even coloring and no lesions, distinct concavities/hollows are present on either side of patella, no atrophy in quadriceps and lower leg is extended on same axis as thigh - Not normal is shiny/atrophic skin, swelling, inflammation, genu varum (bowlegs), genu valgum (knock knees), flexion contracture, hollows disappear, atrophy of quadriceps - Normal is muscles feel soft, tissues feel solid, joint feels smooth with no warmth, tenderness, thickening or nodularity - Not normal is feels fluctuant or boggy with synovitis of suprapatellar pouch, swelling
When inspecting and palpating the wrist and hand, what is considered normal/NOT normal?
- Normal is slight extension, fingers flex efficiently and thumb can oppose them from grip and manipulation, fingers lie straight, no swelling/redness/deformity or nodules, skin is mouth with knuckle wrinkles, muscles are full with palm showing rounded mound proximal to thu,n and small rounded mound proximal to little finger - Not normal is subluxation (partial discoloration of wrist), ulnar deviation, ankylosis (extreme flexion), dupuytren contracture, swan neck deformities in fingers and atrophy of thenar eminence with carpal tunnel syndrome - Normal is joint surfaces feel smooth, no swelling, bogginess, nodules or tenderness, no synovial thickening, and warmth - Not normal is ganglion cysts (localized swelling of wrist), synovial swelling, generalized swelling, tenderness, rheumatoid arthritis (boggy/tender MCPs), heberden and Bouchard nodules (hard, nontender and occur with osteoarthritis)
When inspecting and palpating the temporomandibular joint, what is considered normal/NOT normal?
- Normal is smooth motion of mandible, possible audible snap/click occurs - Not normal is swelling (round bulge over joint), crepitus and pain (TMJ dysfunction during movement or chewing) - Not normal is TMJ dysfunction causes tenderness with palpation
When inspecting and palpating the cervical spine, what is considered normal/NOT normal?
- Normal is spine is straight, heard erect, points should feel firm with no muscle spams or tenderness - Not normal is head tilted to one side, asymmetry of muscles, tenderness and head muscles
When inspecting and palpating the hips, what is considered normal/NOT normal?
- Normal is symmetric levels of iliac crest, gluteal folds and equally size buttocks, smooth, even gait reflects equal leg length and functional hip motion - Normal is feels stable and symmetric with no tenderness or crepitus - Not normal is pain with palpation and crepitation
When inspecting and palpating the joints, what is considered normal/NOT normal?
- Normal should be even size and contour with no swelling, masses of deformities - Not normal is swelling (excess joint fluid, thickening of synovial lining or bony enlargement), deformities (fracture, dislocation, subluxation, contracture or ankylosis) - Normal is joints are nontender and synovial membrane is not palpable - Not normal is tenderness, warmth (inflammation), palpable synovial fluid that is thickened and feels "doughy" or "boggy"
As a nurse - how do we inspect and palpate the joints?
- Note size and contour, skin and tissues over the joints for color, swelling and any masses of deformities - Check temp, muscles, bony articulations and area of joint capsules
What are examples of subjective data pertaining to bones?
- Pain (affected by movement, onset, location) - Deformity (caused by injury/trauma, affect ROM) - Accidents/Trauma (strain, sprain, dislocation, which ones)
What are examples of subjective data pertaining to muscles?
- Pain/Cramping (which one, while walking, muscle aches, associated with anything) - Weakness (location, how long, onset, does it look smaller)
How do we measure leg length discrepancy? What is considered normal/NOT normal?
- Perform measurement if you need to determine whether one leg is shorter than the other, measure between fixed points from anterior iliac spine to the medial malleolus, crossing the medial side to the knee - Normal is measurements are equal or within 1cm indicating not true bone discrepancy's - Not normal is unequal leg lengths
How do we perform the Mcmurray test? What is considered normal/NOT normal?
- Perform this when the person has a reported history of trauma followed by locking, giving way or local pain in knee, position person supine and stand on effected side while holding the heel and flex the knee and hip, place other hand on knee with fingers on medial side and rotate leg in and out to loosen the joint - Normally the leg extends smoothly with no pain - Not normal is hearing a "click" its positive for a torn meniscus
As a nurse - how do we inspect and palpate the knee?
- Should remain supine with legs extended or possibly knees flexed and dangling, check lower leg alignment and check knees shape and contour as well as the quadriceps muscle - Have knee supine with complete relaxation of quadriceps, start high on anterior thigh (10cm above patella), palpate with left thumb and fingers in grasping fashion and proceed down the knee, exploring regions of suprapatellar pouch, noting consistency of the tissues
As a nurse - how do we test ROM of the elbow?
- Test flexion and extension by bending and straightening the elbow - Test pronation and supination by moving touching front and back sides of hand to table - Test muscle strength by stabilizing person arm with one hand and have them flex elbow against your resistance applied just proximal to the wrist and then ask them to extend elbow against resistant
As a nurse - how do we test ROM of the shoulder joint?
- Test flexion and extension by instructing them to move arms forward and up and then move them back - Test internal rotation by having them rotate arm internally behind back and place hands as high as possible toward scapula - Test abduction and adduction by having them raise both arms in wide arcs and touch palms together above head - Test external rotation by having them touch both hands behind head with elbows flexed and rotated posteriorly - Test strength by asking person to shrug shoulders, flex forward and up and abduct against your resistance
How do we test ROM of the knee?
- Test flexion by bending each knee - Test extension of knee by extending each knee straight out - Test muscle strength by asking person to maintain knee flexion while you oppose by trying to pull leg forward, muscle extension by having them rise from a chair or by squatting without using hand for support
As a nurse - how do we test ROM of the cervical spine?
- Test flexion by touching chin to chest, repeat while opposing force - Test Extension by lifting chin toward the ceiling, repeat while opposing force - Test lateral bending by touching each ear toward the corresponding should while not lifting the shoulder, repeat while opposing force - Test rotation by turning the chin toward each shoulder, repeat while opposing force
As a nurse - how do we perform the Bugle sign test? What is normal/NOT normal?
- Test for swelling in the suprapatellar pouch to confirm the presence of small amounts of fluid as you try to move the fluid from one side to the other, firmly stroke up on the medial aspect of the knee 2-3x to displace any fluid, tap lateral aspect, watch medial side for distinct bulge from fluid wave - Normal is non is present - Not normal is very small amounts of effusion (4-8mL) from fluid flowing across the joint
How do we perform Ballottement of the patella? What is considered normal/NOT normal?
- Test for swelling with larger amounts of fluid are present, use left hand to compress suprapatellar pouch to move any fluid into knee joint, with right hand push patella sharply against the femur - Normal is no fluid present and patella already snug against the femur - Not normal is fluid has collected and when you tap the patella it moves it through fluid and will hear it tap on femoral condyles
As a nurse - how do we test ROM of the hip?
- Test hip flexion by raising each leg with knee extended and also bend knee up to chest while keeping the other leg straight - Test internal and external rotation by flexing the knee and hip 90 degrees, stabilize by holding thigh with one and hand and hip with the other, swing foot outward and in inward - Test abduction and adduction by swinging leg laterally and then medially with knee straight, stabilize pelvis by pushing down on opposite anterior superior iliac spine
As a nurse - how do we test ROM of the wrist and hand?
- Test hyperextension by bending hand up at wrist - Test Palmar Flexion by bending hand down at wrist - Test flexion and hyperextension by bending fingers up and down at metacarpophalangeal joints - Test Ulnar Deviation and Radial Deviation by having palms flat on table and turning them outward and inward - Test abduction by spreading fingers apart - Test responses by touching thumb to each finger and to base of little finger and making a fist ——Normal is equal bilaterally - Test muscle strength by positions persons forearm supinated and resting on a table, stabilize by holding your hand at persons mid forearm, ask person to flex wrist against your resistance at the palm
How do we test ROM of the spine?
- Test lateral bending by bending sideways - Test hyperextension by bending backward - Test rotation by twisting shoulders to one side then the other
How do we test ROM of the ankle and the foot?
- Test plantar flexion by pointing toes toward the floor - Test dorsiflexion by pointing toes toward the nose - Test eversion and inversion by turning soles of feet out and back in - Test Muscle strength by asking person to maintain dorsiflexion and plantar flexion against your resistance
What are the 3 motions of the temporomandibular joint?
1) Hinge action to open and close the jaw 2) Gliding action for protrusion and retraction 3) Gliding for side to side movement of the lower jaw
What are bones?
206 bones which support the body like the posts and beams of a building, specialized form of connective tissue that is hard, rigid and very dense with cells that continuously grow and remodel
What are the vertebrae?
33 connecting bones stacked in a vertebral column, can feel spinous process down midline of back, 7 cervical, 12 thoracic, 5 lumbar, 5 sacral and 3-4 coccygeal vertebrae
What are the stages of ROM?
5+ is full ROM against gravity and full resistance-best score 4+ is full ROM against gravity and some resistance-good 3+ is full ROM with gravity and no resistance-fair 2+ is full ROM with gravity eliminated (passive)-poor 1+ is slight contraction-trace 0 is no contraction-none
Examination of the shoulder includes 4 motions. These are: A. Forward flexion, internal rotation, abduction, and external rotation. B. Abduction, abduction, pronation and supination. C. Circumduction, inversion, eversion, and rotation. D. Elevation, retraction, protraction, and circumduction.
A. Forward flexion, internal rotation, abduction, and external rotation
The bulge sign is a test for: A. Swelling in the suprapatellar pouch. B. Carpal tunnel syndrome. C. Herberden nodes. D. Olecranon bursa inflammation.
A. Swelling in the suprapatellar pouch
What are the hip joints?
Articulation between the cup shaped acetabulum and the head of the femur, has somewhat less ROM than the shoulder but has more stability
What is the midcarpal joint?
Articulation between the two parallel rows of carpal bones allowing flexion, extension and some rotation
What are muscles?
Account for 40-50% of body weight and when they contract they produce movement, three types known as skeletal, smooth and cardiac
When assessing an infant, the examiner completes the Ortolani maneuver by: A. Lifting the new one and noting a C-shaped curvature of the spine. B. Gently lifting and abducting the infants flexed knees while palpating the greater trochanter with the fingers. C. Comparing the height of the tops of the knees when the knees are flexed up. D. Palpating the length of the clavicle's.
B. Gently lifting and abducting the infants flexed knees while palpating the greater trochanter with the fingers.
A two-year-old child comes to the clinic for a health examination. A common finding for this age group is: A. Kyphosis. B. Lordosis. C. Scoliosis. D. No deviation is normal.
B. Lordosis
Pronation and supination of the hand and forearm are the result of the articulation of the: A. Scapula and clavicle B. Radius and ulna C. Patella and condyle of fibula D. Femur and acetabulum
B. Radius and ulna
What is shoulder girdle?
Belt of three large bones (humerus, scapula, clavicle), joints and muscles
What is flexion?
Bending a limb at a joint
What is a fibrous joint?
Bones united by interjacent fibrous tissue or cartilage and are immovable (structures of the skull)
What is the acromian process?
Bump felt at the very top of the shoulder
What is the greater tubercle?
Bump of the humerus a few centimeters down and laterally from acromian process
A positive Phalen test and Tinel sign are found in a patient with: A. A torn meniscus. B. Hallux valgus. C. Carpal tunnel syndrome. D. Tennis elbow.
C. Carpal tunnel syndrome
A 70-year-old woman has come for a health examination. Which of the following is a common age related change in the curvature of the spinal column? A. Lordosis. B. Scoliosis. C. Kyphosis. D. Lateral scoliosis.
C. Kyphosis
The examiner measures a patient's legs for length discrepancy. Which is a normal finding? A. No difference in measurements. B. 0.5 cm difference. C. Within 1 cm of each other. D. 2 cm difference.
C. Within 1 cm of each other
As a nurse - how do we inspect and palpate the cervical spine?
Check the alignment of head/neck and palpate spinous process and the sternomastoid, trapezius and paravertebral muscles
What is rheumatoid arthritis?
Chronic, systemic inflammatory disease of joints and surrounding connective tissue, inflammation of synovial joint leased to thickening, limits movement, patient will state they have morning stiffness, lack of appetite, widespread muscle aches and overall fatigue and weakness
What is skeletal muscle?
Composed of bundles of muscle fibers (fasciculi) and is attached to bone by a tendon, produces different movements such as flexion/extension, pronation/supination, abduction/adduction, eversion/inversion, protraction/retraction, elevation/depression, rotation and circumduction
What is the collateral ligament?
Connect the join on both sides and give medial and lateral stability to prevent dislocation
What parts of the body are included in the musculoskeletal system?
Consists of the bones, joints and muscles
What is osteoporosis?
Decrease in skeletal bone mass when bone reabsorption is greater than bone formation, weakened bones (stress fractures), lead to disability/death, may have no symptoms until a fracture, dowagers hump
What are the functional assessments of ADL's?
Does it cause any issues with normal ADL's? Such as bathing, toileting, dressing, grooming, eating, mobility or communicating
What are intervertebral discs?
Elastic fibrocartilaginous that constitute ¼ of the length of the column and each disc center contains a nucleus pulposus
What is the coracoid process?
Few centimeters from the greater tubercle on the scapula and projects anteriorly and laterally from the neck of the scapula
What is a synovial joint?
Freely movable because their bones are separated from one another and enclosed in a joint cavity that is lined with synovial membrane that secrets lubricant (synovial fluid)
What is the function of the musculoskeletal system?
Function is to provide support to stand erect, movement, encase and protect the inner vital organs (brain, spinal cord, heart), produce the RBC, WBC and platelets and act as a reservoir for storage of essential minerals (calcium, phosphorus)
What is the rotator cuff?
Group of 4 powerful muscles (supraspinatus, infraspinatus, teres minor and subscapularis SITS) and tendons to for a cover around the head of the humerus
As a nurse - how do we inspect and palpate the hip?
Have person in supine position and palpate hip joints
What is the subacromial bursa?
Helps during abduction of the arm so that the greater tubercle of the humerus moves easily under the acromion process of the scapula
What is retraction?
Moving a body part backward and parallel to the ground
What is protraction?
Moving a body part forward and parallel to the ground
What is abduction?
Moving a limb away from the midline of the body
What is adduction?
Moving a limb toward the midline of the body
What are the landmarks of the ankle (tibiotalar joint)?
Landmarks include two bony prominences known as medial malleolus and lateral malleolus which are strong, tight medial and lateral ligaments extending to each malleolus of the foot
What are the landmarks of the knee?
Landmarks of the knee include the large quadriceps muscle which you feel on anterior and lateral thigh that has 4 heads that merge to form into a common tendon which inserts down onto the tibial tuberosity
What is cartilage?
Layer in synovial joint that covers the surface of opposing bones, a vascular and receives its nourishment from synovial fluid that circulates during joint movement, tough/firm and flexible, cushions the bones and gives a smooth surface to facilitate movement
What is the prepatellar bursa?
Lies between patella and skin to prevent friction
What is synovitis?
Loss of normal hollows on either side of patella which are replaced by mild distention, occurs with synovial thickening or effusion as in RA, note mild distention of suprapatellar pouch
What is depression?
Lowering a body part
What is osteoarthritis?
More common than RA, non inflammatory, localized, progressive disorder involving deterioration of articular cartilage and subchondral bone and formation of new bone, common over 50 usually with a family history, obesity, joint abnormality (asymmetric), history of trauma, pain at affected joint, most common for knee replacement
What is scoliosis?
Most is idiopathic, lateral curvature of thoracic lumbar segments of the spine, shoulder have different heights, one blade more prominent than other, prominent raised hip (unilateral), may lean to one side or have rib prominence while bending, may be corrected if detected pre-teen years
What is circumduction?
Moving the arm in a circle around the shoulder
What is rotation?
Moving the head around a central axis
What is inversion?
Moving the sole of the foot inward at the ankle
When performing muscle testing, what is considered normal?
Normal muscles should be equal bilaterally and should full resist our opposing force without pain or limitation
What are examples of patient centered care pertaining to the musculoskeletal system?
Occupational hazards, heavy lifting, efforts to alleviate, exercise, recent weight gain, medications, disability, cigarettes or alcohol usage
What is gout?
Painful inflammatory arthritis characterized by excess Uris acid in the blood and deposits of irate crystals in joint space, acute is triggered by surgery/trauma/diuretics/alcohol intake and causes redness, swelling, heat and extreme pain
What are the palpable landmarks of the hip joints?
Palpable landmarks include entire iliac crest, ischial tuberosity under then gluteus maximus and greater trochanter of the femur below the iliac crest
What are the palpable landmarks of the elbow joints?
Palpable landmarks include medial epicondyles (humerus), lateral epicondyles (humerus) and olecranon process (ulna)
What is the interphalangeal joint?
Permits finger flexion and extension
What is the metacarpophalangeal joint?
Permits finger flexion and extension
What is elevation?
Raising a body part
What is the suprapatellar pouch (bursa)?
Sac at superior border of the patella that extends up as much as 6cm behind the quadriceps muscle
What is a cartilaginous joint?
Separated by fibrocartilaginous discs and are only slightly moveable (vertebrae)
What is the infrapatellar fat pad?
Small, triangular fat pad below the patella behind the patellar ligament that prevents friction
What is the nucleus pulpsus?
Soft, semi fluid, mucoid material that has the consistency of toothpaste in young adults and help cushion the spine like a shock absorber, disc can rupture and nucleus pulposus can herniate out causing spinal cord to compress and cause pain
What is extension?
Straightening a limb at a joint
What is a tendon?
Strong, fibrous cord that attached muscle to bone
What are ligaments?
Support joints, is a fibrous band running directly from one bone to another that strengthens the joint and help prevent movement in undesirable directions
As a nurse - how do we perform muscle testing?
Test the strength of the prime mover muscle groups for each joint, repeat the motions that you elicit for active ROM
What are joints?
The place of union of two or more bones and are consider functional units of the the system because they permit the mobility needed for activities of daily living (ADL's)
What is pronation?
Turning the forearm so that the palm is down
What is supination?
Turning the forearm so that the palm is up
What is the calcaneus (heel)?
Under the talus and points posteriorly
What is the medial and lateral menisci?
Wedge shaped cartilage that cushion the tibia and femur and is stabilized by two sets of ligaments