Medical Surgical Nursing Chapter 62 Musculoskeletal Assessment

1 Crepitation is the grating sensation and sound produced when broken bone fragments rub against one another. Reabsorption is the loss of bone mass due to a loss of calcium resulting in porous, weak bones. Proliferation is reproduction or multiplication of similar forms, usually referring to increases of cells. Subluxation is a partial or incomplete dislocation or displacement of a bone from its normal position. Text Reference - p. 1500

A nurse is assessing a fracture of a patient's hand. Which phenomenon would the nurse note as the bone fragments rub against each other? 1 Crepitation 2 Reabsorption 3 Proliferation 4 Subluxation

2, 3, 5 It is important to question the patient regarding prescription, drugs, herbal products, and nutritional supplements, because these can have potential side effects on the musculoskeletal system. Episodes of premenopausal amenorrhea can contribute to the development of osteoporosis; even hormonal therapy has adverse effects on the musculoskeletal system. Potassium-depleting diuretics may cause muscle cramps and weakness. Antiseizure medications can increase the risk of osteomalacia; phenothiazines are associated with gait disturbances; corticosteroids increase the risk of avascular necrosis and decreased bone and muscle mass. Lovastatin and amlodipine are not associated with major musculoskeletal disorders. Text Reference - p. 1494

A nurse is interviewing a patient to assess the risk for developing musculoskeletal impairments. What are the conditions that increase the patient's risk of developing a musculoskeletal ailment? Select all that apply. 1 Patient has a history of hyperlipidemia and has been on lovastatin for a long time. 2 Patient has a history of premenopausal amenorrhea and is taking oral contraceptives. 3 Patient has renal disease and has been taking a potassium-depleting diuretic for a long time. 4 Patient suffers from hypertension and has been on treatment with amlodipine for a long time. 5 Patient has a seizure disorder and has been taking antiseizure medications for a long time.

2, 3, 5 While assessing the elimination pattern of a patient suffering from knee pain, it is important to know if the patient requires assistive devices or equipment to achieve a bowel movement, because it gives an idea about severity of the ailment. Similarly, knowing if the person has difficulty in reaching the commode in time due to a musculoskeletal ailment suggests the severity of the disorder. The nurse should also understand if the patient experiences constipation related to decreased mobility or to drugs taken for a musculoskeletal problem. The frequency and character of the bowel movements are important parameters in the assessment of the gastrointestinal system of a patient, but not in the musculoskeletal system. Bowel problems related to any specific food do not directly affect the musculoskeletal system. Text Reference - p. 1495

A nurse is making note of the elimination pattern of a patient suffering from severe knee pain. What are the points that she should include in the assessment? Select all that apply. 1 How many times in a day do you have to have a bowel movement? Is it satisfactory? 2 Do you need any assistive devices or equipment to achieve a bowel movement? 3 Does your functional ability make it difficult for you to reach the toilet in time? 4 Do you find that problems related to moving your bowels occur after eating a particular food? 5 Do you experience constipation?

1, 4, 5, 6 The components of a normal musculoskeletal system include muscle strength of 5, no joint swelling, deformity, or crepitation, a full range of motion of all joints without pain or laxity, and no tenderness on palpation of spine, joints, or muscles. Eruptions and pigmentations are characteristics of a skin assessment and are not included in musculoskeletal assessment. Text Reference - p. 1499

A nurse is performing a musculoskeletal assessment on a patient. What are the findings that denote a normal musculoskeletal system? Select all that apply. 1 Muscle strength of 5 2 No eruptions on the joints 3 No pigmentation on the joints 4 No joint swelling, deformity, or crepitation 5 Full range of motion of all joints without pain or laxity 6 No tenderness on palpation of spine, joints, or muscles

1, 2, 4 Stiffness and loss of range of motion are very commonly seen symptoms in musculoskeletal impairments. Weakness is also a common symptom. Joint crepitation is also seen in such disorders. Redness and blisters are not common symptoms seen in musculoskeletal impairments. Redness and blisters are associated with burns and infections. Similarly, a change in pigmentation is not a common symptom. It is usually a result of hormonal changes, aging, or other dermatologic conditions. STUDY TIP: Laughter is a great stress reliever. Watching a short program that makes you laugh, reading something funny, or sharing humor with friends helps decrease stress. Text Reference - p. 1494

A nurse is taking a patient's health history related to musculoskeletal system. What are the common symptoms of musculoskeletal impairments? Select all that apply. 1 Stiffness 2 Weakness 3 Changes in pigmentation 4 Joint crepitation 5 Redness and blisters

1, 2, 5 The nurse should ask if the patient tried lifting any heavy object. The nurse should record the patient's daily activities and ask if the patient experiences any discomfort in performing them. This gives an idea of the severity of the ailment. Vision problems do not have a direct bearing on backache. Having unsafe sexual activity exposes the person to various serious, sexually transmitted infections (STIs) but does not affect the musculoskeletal system. Text Reference - p. 1495

A nurse is taking the health history of a patient with a backache. What are the questions that should be included in the health history related to this condition? Select all that apply. 1 Did you lift a heavy object? 2 Describe your usual daily activities. 3 Did you have any unsafe sexual activity? 4 Do you have any vision problems? 5 Do you find it difficult to perform your daily activities?

2, 3, 5, 6 When assessing a patient with musculoskeletal problems, it is extremely important to ask questions related to sleep-rest pattern. Questions relating to whether the patient requires frequent position changes during sleep and whether the patient wakes due to pain help in understanding the severity of the pain. Knowing whether the patient is taking any complementary and alternative therapy is also important in assessment. Sleeping during the day and frequency of urination are not related to musculoskeletal problems directly. STUDY TIP: Focus your study time on the common health problems that nurses most frequently encounter. Text Reference - p. 1495

A nurse is taking the health history of a patient with severe lumbar back pain. What are the questions related to sleep-rest patterns that the nurse should ask this patient? Select all that apply. 1 Do you sleep often during the day? 2 Do you require frequent position changes at night? 3 Do you wake up at night because of pain? 4 Do you have disturbed sleep at night due to frequent urination? 5 Do you use complementary and alternative therapies to help you sleep at night? 6 Do you experience any difficulty sleeping because of a musculoskeletal problem?

1, 2 Boutonnière deformity is the deformity of rheumatoid and psoriatic arthritis caused by the rupture of the extensor tendons over the fingers. It is characterized by the flexion of the proximal interphalangeal (PIP) joint and hyperextension of the distal interphalangeal (DIP) joints of the fingers. Flexion of the metacarpophalangeal joint occurs in swan neck deformity. Ulnar drift refers to the deformity of rheumatoid arthritis due to tendon contracture. Dislocation of the finger joints does not happen in Boutonnière deformity. Text Reference - p. 1500

A patient is admitted to the hospital with Boutonnière deformity. What are the signs and symptoms that the nurse is likely to find during assessment? Select all that apply. 1 Flexion of proximal interphalangeal joint 2 Hyperextension of the distal interphalangeal joint 3 Flexion of the metacarpophalangeal joint 4 Fingers drift to ulnar side of forearm 5 Partial dislocation of finger joints

1, 3, 4 Cartilage erosion can result in direct contact between ends of two bones. This presents as possible crepitation on movement, joint stiffness, decreased mobility, and limited range of motion. There is pain with motion and/or weight bearing. Deformity and complete inability occur in severe and chronic cases, not in slight erosion of cartilage. STUDY TIP: In the first pass through the exam, answer what you know and skip what you do not know. Answering the questions you are sure of increases your confidence and saves time. This is buying you time to devote to the questions with which you have more difficulty. Text Reference - p. 26

A patient is admitted with slight erosion of cartilage in the knee joint. What are the symptoms that the nurse is likely to find in this patient? Select all that apply. 1 Crepitation 2 Deformity 3 Joint stiffness 4 Limited range of motion 5 Complete inability to walk

2, 3, 5 Arthroscopy allows for visualization of the interior portion of the joint capsule through a small fiberoptic tube. This procedure is performed under anesthesia. A needle is inserted in the joint, it is distended with fluid or air, and the joint cavity is examined. Fluids from the joints are aspirated by a procedure called arthrocentesis, in which a needle is inserted into the joint cavity, and the synovial fluid is aspirated; however, the procedure does not allow visualization of the joint cavity. Arthroscopy is not done to give corticosteroid injections; intraarticular injections can be given when arthrocentesis is done. Text Reference - p. 1499

A patient is scheduled for an arthroscopy. The patient wants to know what an arthroscopy is. What information should the nurse provide to this patient? Select all that apply. 1 Fluid from the joints will be aspirated during this procedure. 2 This procedure allows visualization of the interior portion of the joint capsule. 3 The procedure will be performed under anesthesia. 4 In case of inflammatory joint diseases, intraarticular injections of corticosteroids may be given. 5 A needle is inserted in the joint, it is distended with fluid or air, and the joint cavity is examined.

1, 3, 4 The nature of work helps in knowing about potential injuries in the workplace. The safety practices at work also aid the nurse in assessing the severity of the condition. Knowing how the injury exactly occurred is an important factor that enables the nurse to determine the cause and severity of the injury. Food preferences affect the general health and nutritional status but do not specifically lead to wrist joint problems. Respiratory functioning is an important component of overall general health but is not specifically related to this scenario involving the musculoskeletal problem. STUDY TIP: Becoming a nursing student automatically increases stress levels because of the complexity of the information to be learned and applied and because of new constraints on time. One way to decrease stress associated with school is to become very organized so that assignment deadlines or tests do not come as sudden surprises. By following a consistent plan for studying and completing assignments, you can stay on top of requirements and thereby prevent added stress. Text Reference - p. 1496

A patient presents with pain in the wrist joint radiating up the entire arm. What should the nurse ask the patient while taking the health history? Select all that apply. 1 Nature of work 2 Food preference 3 Safety practices followed at work 4 Mechanism of injury if any 5 Respiratory function

1, 3, 5 While assessing a patient with a musculoskeletal complaint, inspection assists the nurse to note any wound or deformity. Palpation helps the nurse to assess the muscles and bones and also feel for crepitation. It is important to obtain a proper health history to know the severity and causative factors. Percussion is a technique used to assess the abdomen and not musculoskeletal system. Arthroscopy is not a nursing assessment; it is a procedure to view the inner surface of a joint cavity and is done only when indicated. Text Reference - p. 1497

A patient presents with severe shoulder pain. Which techniques should the nurse use for assessing this patient? Select all that apply. 1 Inspection 2 Percussion 3 Palpation 4 Arthroscopy 5 Obtain health history

1, 3, 4 Electromyography helps to evaluate electrical potential associated with skeletal muscle contraction. Small-gauge needles are inserted into certain muscles. Needle probes are attached to leads that feed information to an electromyogram (EMG) machine. Recordings of electrical activity of the muscle are traced on audio transmitter and on oscilloscope and recording paper. There may be some discomfort because of the needles. It is useful in identifying any lower motor neuron dysfunction or primary muscle diseases. The procedure is usually done in an EMG laboratory while the patient lies supine on a special table. It is not performed at the bedside. There is no major bleeding, and it is not performed under anesthesia. Text Reference - p. 1503

A patient will undergo electromyography. What information should the nurse give to the patient? Select all that apply. 1 Small-gauge needles are inserted into certain muscles. 2 This test can be carried out at the bedside. 3 There may be some discomfort because of the needles. 4 It is useful in identifying any lower motor neuron dysfunction or primary muscle diseases. 5 There may be severe bleeding and pain, and local anesthesia may be given.

1, 2 In the patient with gout, the fluid aspirated from arthrocentesis would be whitish yellow in color. Purulent and thick fluid indicates infection; floating fat globules are found when there is a bone injury. Protein content is elevated in septic arthritis. Text Reference - p. 1503

A patient with gout underwent arthrocentesis. What would be the characteristics of the fluid aspirated? Select all that apply. 1 Whitish yellow in color 2 Presence of uric acid crystals 3 Purulent and thick fluid 4 Floating fat globules 5 Elevated protein content

4 The musculoskeletal system's normal changes of aging include decreased muscle mass and strength, increased rigidity in the hips, neck, shoulders, back, and knees, decreased fine motor dexterity, and slowed reaction times. Going on a diet and exercising will help, but will not stop these changes. Telling the patient "Something must be wrong with you" will not be helpful to the patient's frustrations. The patient does not have arthritis or need NSAIDs. Text Reference - p. 1494

An older adult patient states, "I am frustrated by my flabby belly and rigid hips." What is the best response by the nurse? 1 "You should go on a diet and exercise more to feel better about yourself." 2 "Something must be wrong with you because you should not have these problems." 3 "You have arthritis and need to go on nonsteroidal antiinflammatory drugs (NSAIDs)." 4 "Decreased muscle mass and strength, and increased hip rigidity are normal changes of aging."

2 To perform inversion movements of the foot, the nurse should instruct the patient to turn the sole inward toward the midline of the body. Flexion of the ankle and toes toward the shin is called dorsiflexion. Turning the sole outward away from the midline of the body is called eversion, and flexion of ankle and toes toward the plantar surface of the foot is called plantar flexion. Text Reference - p. 1498

During a physical assessment, the nurse asks the patient to perform inversion movement of the foot. What instruction should the nurse give to the patient? 1 Flex your ankle and toes toward the shin. 2 Turn the sole inward toward the midline of the body. 3 Turn the sole outward away from the midline of the body. 4 Flex your ankle and toes toward the plantar surface of the foot.

1 Presence of a lateral S-shaped curvature of the thoracic and lumbar spine indicates that the patient has scoliosis. Due to lateral spine curvature, the patient's shoulders rise asymmetrically; therefore, the nurse would find asymmetric shoulders in the patient. A patient with cerebral palsy or hemiplegia would have cross-knee movement due to spastic gait. A patient with tendon contracture would have fingers drifted to the ulnar side of the forearm. A patient with muscle paralysis, mild cerebral palsy, or early muscular dystrophy would have abnormal flatness of the sole of the foot. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation. Text Reference - p. 1498

During an assessment, the nurse observes a lateral S-shaped curvature of the patient's thoracic and lumbar spine. The nurse anticipates which other clinical manifestation? 1 Asymmetric shoulders 2 Cross knee movement 3 Fingers drifted to ulnar side of forearm 4 Abnormal flatness of the sole of the foot

2 Crepitation is associated with fracture, dislocation, temporomandibular joint dysfunction, and osteoarthritis. It manifests as frequent, audible crackling sounds with palpable grating during movement. Scoliosis is the asymmetric elevation of shoulders, scapulae, and iliac crests with lateral spine curvature. It is often a congenital condition or occurs due to fracture or dislocation. Contracture is the resistance to movement of a muscle or a joint as a result of fibrosis of the supporting soft tissues. Festinating gait is a condition where the neck, trunk, and knees flex but the body is rigid while walking. Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger your mind with the answer or provide an important clue to an earlier question. Text Reference - p. 1500

The nurse finds that a patient has frequent, audible crackling sounds and grating upon joint movement. Which condition does the nurse suspect based on these findings? 1 Scoliosis 2 Crepitation 3 Contracture 4 Festinating gait

4 An electromyogram helps to record electrical activity of the muscles. The nurse should advise the patient to refrain from taking stimulants such as caffeine for 24 hours before the test. If a patient drinks two cups of coffee on the day of the scheduled test, it may alter the test results. The nurse should alert the primary care provider of the finding so the test can be rescheduled for more accurate results. Drinking apple juice does not impair the electrical activity of the muscles. Antibiotics do not alter the test results. An electromyogram helps to assess muscle activity but not knee pain; therefore, knee pain will not affect the test results. Test-Taking Tip: Be alert for details. Details provided in the stem of the item, such as behavioral changes or clinical changes (or both) within a certain time period, can provide a clue to the most appropriate response or, in some cases, responses Text Reference - p. 1503

The nurse interacts with a patient who has arrived at the hospital for a scheduled electromyogram. The nurse concludes that that the test will need to be rescheduled based on what patient statement? 1 "I drank apple juice last night." 2 "I have been taking antibiotics for one week." 3 "I have had knee pain since early this morning." 4 "I drank two cups of coffee this morning."

2 MRI produces loud noises, so the patient can be allowed to listen to music or use earplugs during the test. Coffee is not allowed to be drunk during the test, because it may alter the test results. MRI is contraindicated in the patient who is wearing hearing aids, because it may absorb the radio and magnetic waves and cause adverse effects. The patient should not have metallic objects like credit cards and jewelry, because they may absorb magnetic waves that decrease the image quality. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation. Text Reference - p. 1501

The nurse is assisting the radiologist while doing magnetic resonance imaging (MRI) for a patient. Which action of the nurse would be helpful to the patient during the test? 1 The nurse allows the patient to drink coffee. 2 The nurse allows the patient to listen to music. 3 The nurse allows the patient to wear a hearing aid. 4 The nurse allows the patient to keep credit cards in the pocket.

4 Steppage gait is a neurogenic disorder associated with increased hip and knee flexion to clear the foot from the floor, along with footdrop. The client's foot may slap down and along the walking surface. Pes planus, also called flatfoot, is an abnormal flatness of the sole and arch of the foot. It may be hereditary or due to muscle paralysis, early muscular dystrophy, or injury to posterior tibial tendon. Spastic gait is characterized by short steps, along with dragging of the foot and jerky, uncoordinated, cross-knee movement. It generally results from neurogenic disorders. Short-leg gait is characterized by limp leg and leg length discrepancy of more than one inch. It is structural in origin and may be caused by arthritis or fracture. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Text Reference - p. 1500

The nurse is caring for a patient who exhibits increased flexion in the hip and knee to clear the foot from the floor. The patient also exhibits footdrop, and the foot slaps down and along the walking surface. Which condition does the nurse suspect based on these findings? 1 Pes planus 2 Spastic gait 3 Short-leg gait 4 Steppage gait

1 Passive ROM should be performed with extreme caution, and may be best avoided when assessing older patients. Observing the patient's active ROM is more accurate and safer than asking the patient to lift weights with her legs. Text Reference - p. 1497

The nurse is performing a musculoskeletal assessment of an older adult patient whose mobility has been decreasing progressively in recent months. How should the nurse best assess the patient's range of motion (ROM) in the affected leg? 1 Observe the patient's unassisted ROM in the affected leg 2 Perform passive ROM, asking the patient to report any pain 3 Ask the patient to lift progressive weights with the affected leg 4 Move both of the patient's legs from a supine position to full flexion

2, 3, 4 When palpating, it is important that the nurse palpates the muscles as well as the joints to allow for evaluation of skin temperature, local tenderness, swelling, and crepitation. Rubbing the hands together before performing palpation prevents muscle spasm. Spasm can interfere with the identification of essential landmarks or soft tissue structures. When palpating, the nurse should palpate the affected area as well as the neighboring area. It is necessary to palpate from above to below so that no part is missed. Palpation of the affected joint is important, and, therefore, palpating the knee is important. Text Reference - p. 1497

The nurse is performing a physical examination on a patient who is suffering from extreme pain in the right knee as well as weakness in the right leg. What should the nurse consider when performing palpation? Select all that apply. 1 Palpate only the affected region. 2 Palpate the muscles as well as joints. 3 Rub your hands together before palpating. 4 Palpate from above to below (cephalopedal direction). 5 Do not palpate the knee region, because it will cause discomfort for the patient.

3, 4, 5 The straight-leg-raising test is performed on a patient with sciatica or leg pain. The test is positive if the patient complains of pain along the distribution of the sciatic nerve when the leg is raised to 60 degrees or less. A positive test indicates nerve root irritation from intervertebral disc prolapse and herniation; usually, the nerve root at the level of L4-5 or L5-S1 is involved. The test is conducted with the patient in supine position. The nurse passively raises the patient's legs 60 degrees or less. Text Reference - p. 1498

The nurse is performing a physical examination on a patient with sciatica. Which statements are correct for the straight-leg-raising test? Select all that apply. 1 The patient should lie prone for the test. 2 The patient is instructed to actively raise his or her legs to 60 degrees. 3 The test is positive if the patient complains of pain along the distribution of the sciatic nerve. 4 A positive test indicates nerve root irritation from intervertebral disc prolapse and herniation. 5 The nerve root at the level of L4-5 or L5-S1 may be involved.

2 Presence of whitish yellow synovial fluid with uric acid crystals in the synovial fluid indicates that the patient has gout; therefore, administering antigout medication will be most beneficial for the patient. Lactated Ringer's solution helps to maintain fluid and electrolyte balance but does not reduce symptoms of gout. Antidiabetic medications reduce blood glucose levels, but do not eliminate uric acid from the body and do not decrease symptoms of gout. Intravenous calcium supplements prevent osteoporosis but do not alleviate symptoms of gout. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation. Text Reference - p. 1503

The nurse is providing postprocedural care for a patient that has undergone an arthrocentesis. The patient's synovial fluid is whitish yellow in color and has uric acid crystals. Which treatment strategy would be most beneficial for this patient? 1 Infusing lactated Ringer's solution 2 Administering antigout medications 3 Administering antidiabetic medications 4 Infusing intravenous calcium supplements

1 Normal serum calcium levels are 8.6 to 10.2 mg/dL. A decrease in calcium levels corresponds with hypoparathyroidism; therefore, the nurse concludes that Patient A has hypoparathyroidism. Normal uric acid levels in females are 2.3 to 6.6 mg/dL; therefore, Patient D, whose uric acid levels are 4.4 mg/dL, does not have gout. If rheumatic factor is less than 1:60, then it indicates that the patient has rheumatoid arthritis; therefore, Patient C, whose rheumatic factor is 1:80, does not have rheumatoid arthritis. Normal alkaline phosphatase levels are 38 to 126 U/L. Alkaline phosphatase levels are high in the patient with Paget's disease. Because Patient B's alkaline phosphatase levels are not elevated, the nurse does not conclude that the patient has Paget's disease. Test-Taking Tip: Chart/exhibit items present a situation and ask a question. A variety of objective and subjective information is presented about the client in formats such as the medical record (e.g., laboratory test results, results of diagnostic procedures, progress notes, health care provider orders, medication administration record, health history), physical assessment data, and assistant/patient interactions. After analyzing the information presented, the test taker answers the question. These questions usually reflect the analyzing level of cognitive thinking. Text Reference - p. 1501

The nurse is reviewing the laboratory reports of four patients. What should the nurse conclude from these laboratory reports? 1 Patient A has hypoparathyroidism. 2 Patient B may have Paget's disease. 3 Patient C has rheumatoid arthritis. 4 Patient D has a risk of gout.

1 A bone scan is a radiographic technique that helps diagnose malignant lesions in the bone. When explaining the procedure, the nurse should instruct the patient to empty the bladder before the test, because it prevents discomfort in the patient. A bone scan is a noninvasive procedure; the patient should not experience pain during the test. The nurse should instruct the patient to lie in the supine position during the test, because it helps to clearly visualize the organs under examination. Because a bone scan is a radiographic technique, the patient will receive an injection of radioisotope two hours before the test for clear imaging. Test-Taking Tip: Multiple-choice questions can be challenging, because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response. Text Reference - p. 1501

The nurse provides instructions to a patient with osteomyelitis who is scheduled for a bone scan. Which statement made by the patient indicates a need for further teaching or clarification? 1 "Before the test, I should refrain from voiding." 2 "The test is noninvasive; I should not have pain during the procedure." 3 "The test will take about an hour; I should remain in a supine position during the procedure." 4 "Two hours before the test, I will receive an injection of radioisotope."

2, 3, 5, 6 Lifting heavy objects can lead to back pain; therefore, it is important to know whether the patient's work involves lifting heavy objects. Knowing if the pain has affected the patient's social and professional life helps to determine the severity of the problem. Knowing if the patient is taking dietary supplements like calcium and Vitamin D helps to understand how the patient is treating self and also helps in planning future interventions for the patient. Similarly, knowing if the patient has frequent changes in position while asleep helps to understand the severity of the complaint. Vaccination against hepatitis is not connected to back pain. Similarly, antibiotic therapy is not relevant in the back pain assessment. Text Reference - p. 1495

What questions should the nurse ask a patient with severe back pain in the lumbar region when taking the health history? Select all that apply. 1 Have you been vaccinated against hepatitis? 2 Does your work involve lifting any heavy objects? 3 Has this pain affected your social or professional life? 4 Have you taken any high-dose antibiotic recently? 5 Do you consume any dietary supplements like calcium or vitamin D? 6 Do you require frequent change of position while you are sleeping because of the pain?

3 The joint between carpal bones is a gliding joint because the bones move over the surface of each other. The wrist joint is a condyloid joint capable of flexion, extension, abduction, adduction and circumduction. The shoulder joint is a ball and socket joint also capable of flexion, extension, adduction, abduction and circumduction. The carpometacarpal joint of the thumb is a saddle joint which allows thumb-finger opposition along with flexion, extension, adduction, abduction and circumduction. Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger your mind with the answer or provide an important clue to an earlier question. Text Reference - p. 1492

Which is an example of a gliding joint? 1 Wrist 2 Shoulder 3 Between carpal bones 4 Carpometacarpal of thumb