musculoskeletal system
normal findings of the hips
Buttocks are equally sized; iliac crests are symmetric in height. Hips are stable, nontender, and without crepitus.
what could Impaired ROM and neck pain associated with fever, chills, and headache indicate?
could be indicative of a serious infection such as meningitis.
Ask the client to repeat the cervical ROM movements against resistance.
normal findings-Client has full ROM against resistance. Strength 5/5. abnormal finding- Decreased ROM against resistance is seen with joint or muscle disease.
how do you Palpate the spinous processes and the paravertebral muscles
on both sides of the spine for tenderness or pain.
abnormal findings when inspecting size, shape, symmetry and palpate in hands and fingers?
pain, tenderness, swelling, shortened finger, depressed knuckle, finger crossing over adjacent finger when making a fist, or inability to move the finger may be seen with finger fractures (UCSF Medical Center, 2016). Swollen, stiff, tender finger joints are seen in acute rheumatoid arthritis. Boutonnière deformity and swan-neck deformity are seen in long-term rheumatoid arthritis Atrophy of the thenar prominence may be evident in carpal tunnel syndrome. In osteoarthritis, hard, painless nodules may be seen over the distal interphalangeal joints (Heberden nodes) and over the proximal interphalangeal joints (Bouchard nodes)
what are the different test for carparl tunnel syndrome
phalen test and tinel test
what is the anatomic snuffbox?
the hollow area on the back of the wrist at the base of the fully extended thumb; to assess you would palpate
normal finding when inspecting elbow for size
Elbows are symmetric, without deformities, redness, or swelling.
what is the abnormal finding of the cervical, lumbar and thoracic?
A flattened lumbar curvature may be seen with a herniated lumbar disc or ankylosing spondylitis. Lateral curvature of the thoracic spine with an increase in the convexity on the curved side is seen in scoliosis. An exaggerated lumbar curve (lordosis) is often seen in pregnancy or obesity. Unequal heights of the hips suggest unequal leg lengths.
what is the normal finding for the cervical rotation
About 70 degrees of rotation is normal
Test for ROM in hands in and fingers
Ask the client to (A) spread the fingers apart (abduction), (B) make a fist (adduction), (C) bend the fingers down (flexion) and then up (hyperextension), (D) move the thumb away from other fingers, and then (E) touch the thumb to the base of the small finger. Repeat these maneuvers against resistance.
How to test for ROM of lumbar spine?
Ask the client to bend forward and touch the toes (flexion;). Observe for symmetry of the shoulders, scapula, and hips. Sit down behind the client, stabilize the client's pelvis with your hands, and ask the client to bend sideways (lateral bending), bend backward toward you (hyperextension), and twist the shoulders one way then the other (rotation).
How to test for ROM in wrist
Ask the client to bend the wrist down and back (flexion and extension Next have the client hold the wrist straight and move the hand outward and inward (deviation;) Repeat these maneuvers against resistance.
How to test for ROM in elbow
Ask the client to perform the following movements to test ROM, flexion, extension, pronation, and supination. Flex the elbow and bring the hand to the forehead Straighten the elbow. Then hold arm out, turn the palm down, then turn the palm up Last, have the client repeat the movements against your resistance.
How to perform a phalen test
Ask the client to place the backs of both hands against each other while flexing the wrists 90 degrees with fingers pointed downward and wrists dangling . Have the client hold this position for 60 seconds. Phalen test is positive in about 70% of cases and has a false-positive rate of about 30%
how to test for lateral bending
Ask the client to touch each ear to the shoulder on that side
how to evaluate rotation of the cervical
Ask the client to turn the head to the right and left About 70 degrees of rotation is normal.Limited ROM is seen with neck injuries, osteoarthritis, spondylosis, or with disc degeneration.Ask the client to repeat the cervical
how to observe for the for the flick signal.
Ask the client, "What do you do when your symptoms are worse?"
What is the normal finding for cervical, lumbar, and thoracic spine
Cervical and lumbar spines are concave; thoracic spine is convex. Spine is straight (when observed from behind).
abnormal finding ROM for cervical spine
Cervical strain is the most common cause of neck pain. It is characterized by impaired ROM and neck pain from abnormalities of the soft tissue (muscles, ligaments, and nerves) due to straining or injuring the neck. Causes of strains can include sleeping in the wrong position, carrying a heavy suitcase, or being in an automobile crash. Cervical disc degenerative disease and spinal cord tumors are associated with impaired ROM and pain that radiates to the back, shoulder, or arms. Neck pain with a loss of sensation in the legs may occur with cervical spinal cord compression.
how to test for thumb weakness
Client can raise thumb up from the plane and stretch the thumb finger pad to the little finger pad.
normal findings for thumb weakness
Client can raise thumb up from the plane and stretch the thumb finger pad to the little finger pad.
abnormal findings for thumb weakness
Client cannot raise the thumb up from the plane and stretch the thumb pad to the little finger pad. This indicates thumb weakness in carpal tunnel syndrome.
normal findings of squeeze test
Client tolerates test without extreme pain
normal findings for flick signal
Client will not shake or flick wrist when asked this question.
what is the abnormal finding for the spinous processes and the paravertebral muscles?
Compression fractures and lumbosacral muscle strain can cause pain and tenderness of the spinal processes and paravertebral muscles.
how to test for ROM in arms
Explain to the client that you will be assessing ROM (consisting of flexion, extension, adduction, abduction, and motion against resistance). Ask client to stand with both arms straight down at the sides. Next, ask the client to move the arms forward (flexion), then backward with elbows straight Then have the client bring both hands together overhead, elbows straight, followed by moving both hands in front of the body past the midline with elbows straight (this tests adduction and abduction)
abnormal findings in ROM in elbow
Decreased ROM against resistance is seen with joint or muscle disease or injury
normal findings of the shoulders
Extent of external and internal rotation should be about 90 degrees, respectively. The client can flex, extend, adduct, abduct, rotate, and shrug shoulders against resistance.
abnormal findings of squeeze test
Extreme pain may indicate rheumatoid arthritis and psoriatic arthritis of the hand
abnormal finding when palpating elbow
Firm, nontender, subcutaneous nodules may be palpated in rheumatoid arthritis or rheumatic fever. Tenderness or pain over the epicondyles may be palpated in epicondylitis (tennis elbow) due to repetitive movements of the forearm or wrists.
abnormal findings of shoulders and arms
Flat, hollow, or less-rounded shoulders are seen with dislocation. Muscle atrophy is seen with nerve or muscle damage or lack of use. Tenderness, swelling, and heat may be noted with shoulder strains, sprains, arthritis, bursitis, and degenerative joint disease (DJD).
normal findings for the ROM of lumbar spine
Flexion of 75-90 degrees, smooth movement, lumbar concavity flattens out, and the spinal processes are in alignment. Lateral bending capacity of the thoracic and lumbar spines should be about 35 degrees (Fig. 24-10A); hyperextension about 30 degrees; and rotation about 30 degrees (Fig. 24-10B).
Normal finding ROM for the cervical spine
Flexion of the cervical spine is 45 degrees. Extension of the cervical spine is 45 degrees.
normal findings when inspecting size, shape, symmetry and palpate in hands and fingers?
Hands and fingers are symmetric, nontender, and without nodules. Fingers lie in straight line. No swelling or deformities. Rounded protuberance noted next to the thumb over the thenar prominence. Smaller protuberance seen adjacent to the small finger.
Phalen test is positive in about 70% of cases and has a false-positive rate of about 30%
However, if the test lasts longer than a minute, pain and tingling may occur even in clients without carpal tunnel syndrome.
abnormal findings of phanel test
If symptoms (tingling, numbness, burning, or pain) develop within a minute with Phalen test, carpal tunnel syndrome is suspected. Client may report tingling, numbness, and pain with carpal tunnel syndrome.
how to test for low back pain
If the client has low back pain that radiates down the back, perform the straight leg test to check for a herniated nucleus pulposus. Ask the client to lie flat and raise each relaxed leg independently to the point of pain. At the point of pain, dorsiflex the client's foot (Fig. 24-11). Note the degree of elevation when pain occurs, the distribution and character of the pain, and the results from dorsiflexion of the foot.
abnormal findings for flick signal
If the patient responds with a motion that resembles shaking a thermometer (flick signal), carpal tunnel may be suspected. However, the Flick signal was originally claimed to be 93% sensitive and 95% specific for carpal tunnel syndrome (CTS), but subsequent investigations have found it performs less well
the motion of the shoulders
In a continuous motion, have the client bring the hands together behind the head with elbows flexed (this tests external rotation; and behind the back (internal rotation; Repeat these maneuvers against resistance.
abnormal findings in ROM for hands and fingers
Inability to extend the ring and little fingers is seen in Dupuytren contracture. Painful extension of a finger may be seen in tenosynovitis (infection of the flexor tendon sheathes; Decreased muscle strength against resistance is associated with muscle and joint disease.
abnormal findings of shoulder
Inability to shrug shoulders against resistance is seen with a lesion of cranial nerve XI (spinal accessory). Decreased muscle strength is seen with muscle or joint disease.
how do you Inspect elbows for size
Inspect elbows in both flexed and extended positions.
how to inspect,size, shape, symmetry and palpate in hands and fingers?
Inspect size, shape, symmetry, swelling, and color. Palpate the fingers from the distal end proximally, noting tenderness, swelling, bony prominences, nodules, or crepitus of each interphalangeal joint. Assess the metacarpophalangeal joints by squeezing the hand from each side between your thumb and fingers. Palpate each metacarpal of the hand, noting tenderness and swelling.
what to look for/what do when examining the wrist.
Inspect wrist size, shape, symmetry, color, and swelling. Then palpate for tenderness and nodules
abnormal findings of the hips
Instability, inability to stand, and/or a deformed hip area are indicative of a fractured hip. Tenderness, edema, decreased ROM, and crepitus are seen in hip inflammation and DJD The most common injuries of the hip and groin region in athletes are groin pulls and hamstring strains (Hong, 2015). Strains, a stretch or tear of muscle or tendons, often occur in the lower back and the hamstring muscle
abnormal findings for the ROM of lumbar spine
Lateral curvature disappears in functional scoliosis; unilateral exaggerated thoracic convexity increases in structural scoliosis. Spinal processes are out of alignment. Low back strain from injury to soft tissues is a common cause of impaired ROM and pain in the lumbar and thoracic regions. Other causes of impaired ROM in the lumbar and thoracic areas include osteoarthritis, ankylosing spondylitis, and congenital abnormalities that may affect the spinal vertebral spacing and mobility.
what is the abnormal finding for lateral bending
Limited ROM is seen with neck injuries, osteoarthritis, spondylosis, or with disc degeneration.
what is the abnormal findings of the cervical rotation
Limited ROM is seen with neck injuries, osteoarthritis, spondylosis, or with disc degeneration.Ask the client to repeat the cervical
normal findings of leg length?
Measurements are equal or within 1 cm. If the legs still look unequal, assess the apparent leg length by measuring from a nonfixed point (the umbilicus) to a fixed point (medial malleolus) on each leg.
normal findings of the anatomic snuffbox
No tenderness palpated in anatomic snuffbox
normal findings of tinel test
No tingling or shocking sensation experienced with test for Tinel sign.
normal findings of phanel test
No tingling, numbness, burning, or pain result from Phalen test.
what is the normal finding for the spinous processes and the paravertebral muscles?
Nontender spinous processes; well-developed, firm and smooth, nontender paravertebral muscles. No muscle spasm.
normal finding when palpating elbow
Nontender; without nodules.
normal findings of the hips
Normal ROM: 90 degrees of hip flexion with the knee straight and 120 degrees of hip flexion with the knee bent and the other leg remaining straight. Normal ROM: 45-50 degrees of abduction 20-30 degrees of adduction 40 degrees internal hip rotation 45 degrees external hip rotation. 15 degrees hip hyperextension.
what are the normal and abnormal finding of ROM in arms
Normal finding-Extent of forward flexion should be 180 degrees; hyperextension, 50 degrees; adduction, 50 degrees; and abduction 180 degrees. Abnormal finding- Painful and limited abduction accompanied by muscle weakness and atrophy are seen with a rotator cuff tear. Client has sharp catches of pain when bringing hands overhead with rotator cuff tendinitis. Chronic pain and severe limitation of all shoulder motions are seen with calcified tendinitis.
normal findings in ROM for hands and fingers
Normal ranges are 20 degrees of abduction, full adduction of fingers (touching), 90 degrees of flexion, and 30 degrees of hyperextension. The thumb should easily move away from other fingers and 50 degrees of thumb flexion is normal. The client normally has full ROM against resistance.
normal findings of ROM in elbow
Normal ranges of motion are 160 degrees of flexion, 180 degrees of extension, 90 degrees of pronation, and 90 degrees of supination. Some clients may lack 5-10 degrees or have hyperextension. The client should have full ROM against resistance
normal findings in ROM for wrist
Normal ranges of motion are 90 degrees of flexion, 70 degrees of hyperextension, 55 degrees of ulnar deviation, and 20 degrees of radial deviation. Client should have full ROM against resistance.
what is normal finding of lateral bending
Normally the client can bend 40 degrees to the left side and 40 degrees to the right side.
How do you observe the cervical, thoracic, and lumbar spine?
Observe the cervical, thoracic, and lumbar curves from the side, then from behind. Have the client standing erect with the gown positioned to allow an adequate view of the spine. Observe for symmetry, noting differences in height of the shoulders, iliac crests, and buttock creases.
is kyphosis common in aging?
Older Adult Considerations An exaggerated thoracic curve (kyphosis) is common with aging.
abnormal findings when inspecting elbow for size
Redness, heat, and swelling may be seen with bursitis of the olecranon process due to trauma or arthritis
normal findings of shoulders and arms
Shoulders are symmetrically round; no redness, swelling, or deformity or heat. Muscles are fully developed. Clavicles and scapulae are even and symmetric. The client reports no tenderness.
abnormal findings of the anatomic snuffbox
Snuffbox tenderness may indicate a scaphoid fracture, which is often the result of falling on an outstretched hand.
abnormal findings of wrist
Swelling is seen with rheumatoid arthritis. Tenderness and nodules may be seen with rheumatoid arthritis. A nontender, round, enlarged, swollen, fluid-filled cyst (ganglion) may be noted on the wrists Signs of a wrist fracture include pain, tenderness, swelling, and inability to hold a grip; as well as pain that goes away and then returns as a deep, dull ache. Extreme tenderness occurs when pressure is applied on the side of the hand between the two tendons leading to the thumb
how to test for ROM of the cervical spine?
Test ROM of the cervical spine by asking the client to touch the chin to the chest (flexion) and to look up at the ceiling (hyperextension
abnormal findings of leg length
Unequal leg lengths are associated with scoliosis. Equal true leg lengths but unequal apparent leg lengths are seen with abnormalities in the structure or position of the hips and pelvis.
how to perform tinel test
Use your finger to percuss lightly over the median nerve (located on the inner aspect of the wrist; Compared to other tests, Tinel sign may be very unreliable to diagnose CTS with anything up to 50% false-positive and false-negative rates—essentially no better than tossing a coin
abnormal findings of tinel test
Tingling or shocking sensation experienced with test for Tinel sign. Median nerve entrapped in the carpal tunnel results in pain, numbness, and impaired function of the hand and fingers
abnormal findings for ROM in wrist
Ulnar deviation of the wrist and fingers with limited ROM is often seen in rheumatoid arthritis. Increased pain with extension of the wrist against resistance is seen in epicondylitis of the lateral side of the elbow. Increased pain with flexion of the wrist against resistance is seen in epicondylitis of the medial side of the elbow. Decreased muscle strength is noted with muscle and joint disease.
how do you inspect and palpate shoulders and arms?
With the client standing or sitting, inspect anteriorly and posteriorly for symmetry, color, swelling, and masses. Palpate for tenderness, swelling, or heat. Anteriorly palpate the clavicle, acromioclavicular joint, subacromial area, and the biceps. Posteriorly palpate the glenohumeral joint, coracoid area, trapezius muscle, and the scapular area.
how to inspect and palpate the hips
With the client standing, inspect symmetry and shape of the hips. Observe for convex thoracic curve and concave lumbar curve. Palpate for stability, tenderness, and crepitus.
test for ROM for hips
With the client supine, ask the client to: Raise extended leg Flex knee up to chest while keeping other leg extended Move extended leg away from midline of body as far as possible and then toward midline of body as far as possible (abduction and adduction). Bend knee and turn leg inward (rotation) and then outward (rotation). Ask the client to lie prone and lift extended leg off table. Alternatively, ask the client to stand and swing extended leg backward. Repeat these maneuvers against resistance.
how to palpate elbow
With the elbow relaxed and flexed about 70 degrees, use your thumb and middle fingers to palpate the olecranon process and epicondyles.
normal findings of wrist
Wrists are symmetric, without redness, or swelling. They are nontender and free of nodules.
How to perform squeeze test
by squeezing the client's hand across the knuckle joints as shown
how to measure leg length
if you suspect that the client has one leg longer than the other, measure them. Ask the client to lie down with legs extended. With a measuring tape, measure the distance between the anterior superior iliac spine and the medial malleolus, crossing the tape on the medial side of the knee (true leg length;
