NU220- Musculoskeletal

Atrophy

Muscles get smaller

How is muscle strength graded and documented?

0 - No contraction 1 - Flicker or trace of contraction, but no movement 2 - Active movement with gravity eliminated 3 - Active movement against gravity 4 - Active movement against gravity and some resistance 5 - Normal strength

How can a goniometer aid in the application of the nursing process?

A goniometer is a tool used to measure how much a joint can move. It has two arms and a protractor or dial to measure the angle of movement. You place the goniometer over the joint, move the arms to line up with the bones, read the angle, and record it. It helps assess joint mobility and create treatment plans for musculoskeletal conditions.

Through which part(s) of the standard assessment process (inspection, palpation, ROM, Strength Testing) can a joint effusion be identified? What physical assessment finding(s) would suggest an effusion of a joint? What tests assess for effusions of the knee joint? How are these tests performed? What are the expected findings when an effusion is present? When an effusion is not present?

A joint effusion, which is an abnormal accumulation of fluid in a joint, can be identified through inspection and palpation during a musculoskeletal examination. that suggest an effusion of a joint include swelling, warmth, and tenderness around the joint. The skin around the joint may also appear stretched or shiny, and the patient may experience pain or limited range of motion. Ballottement Test: The patient is seated with the knee extended. The examiner presses the superior aspect of the patella (kneecap) firmly against the femur (thigh bone), then pushes the patella down toward the tibia (shin bone) and releases it. If an effusion is present, the patella will rebound and feel like it is floating. Bulge Sign: The patient is supine with the knee extended. The examiner strokes the medial (inner) aspect of the knee several times to displace any fluid. The examiner then taps on the lateral (outer) aspect of the knee, just above the patella, to force any fluid to move medially. The examiner then strokes the medial aspect again, looking for a bulge of fluid. When an effusion is present in the knee joint, the patella may appear to be floating or may feel spongy on palpation When an effusion is not present, the patella should feel stable and there should be no visible bulge on the medial side of the knee during the bulge sign test.

Why is it important to ask about ADLs when assessing the musculoskeletal system?

ADLs are apart of using your joints, bones and muscles everyday

What are some examples of musculoskeletal conditions or medical musculoskeletal history that are important to ask about in taking a history?

Arthritis: Including osteoarthritis, rheumatoid arthritis, and other types of arthritis. Back pain: Including low back pain, upper back pain, and neck pain. Fractures: Including any previous history of bone fractures. Osteoporosis: A condition in which bones become brittle and fragile. Joint pain and stiffness: Including conditions such as bursitis, tendonitis, and synovitis. Muscle weakness: Including conditions such as muscular dystrophy and myasthenia gravis. Deformities: Including any congenital or acquired deformities such as scoliosis, kyphosis, or clubfoot. Trauma: Including any history of falls or accidents that may have caused musculoskeletal injuries. Sports injuries: Including any history of sports-related injuries or repetitive strain injuries. Chronic pain syndromes: Including fibromyalgia and complex regional pain syndrome (CRPS).

When might a nurse test active range of motion? When might a nurse test passive range of motion?

Active ROM: when a patient is able to the ROM themselves Passive ROM: when you have to do it for the patient

What are some examples of bone deformities? What are some examples of joint deformities?

Bone: Scoliosis, Kyphosis, Lordosis, Osteogenesis Imperfecta, Achondroplasia Joint: Osteoarthritis, Rheumatoid Arthritis, Gout, Ankylosing Spondylitis, Contractures

Compare and contrast the signs of Rheumatoid arthritis and Osteo arthritis

Cause: RA is an autoimmune disorder in which the body's immune system attacks the joints, leading to inflammation and damage, while OA is a degenerative joint disease that occurs when the cartilage that cushions the ends of bones in a joint wears down over time. Age of onset: RA usually develops in middle age, while OA is more common in older adults. Pattern of joint involvement: RA typically affects the small joints of the hands and feet symmetrically, while OA usually affects the larger weight-bearing joints, such as the hips and knees, in an asymmetrical pattern. Symptoms: RA is characterized by joint pain, stiffness, and swelling that is worse in the morning and improves with activity, as well as fatigue, fever, and weight loss. OA is characterized by joint pain, stiffness, and limited range of motion that is worse with activity and improves with rest, as well as the formation of bony growths called osteophytes. Laboratory findings: RA is associated with elevated levels of rheumatoid factor and anti-cyclic citrullinated peptide (CCP) antibodies in the blood, while OA typically does not show any specific laboratory abnormalities. Imaging findings: RA can cause erosions and joint space narrowing on X-rays and magnetic resonance imaging (MRI), while OA can cause the formation of osteophytes and joint space narrowing on X-rays. Treatment: RA is treated with disease-modifying antirheumatic drugs (DMARDs), biologic agents, and nonsteroidal anti-inflammatory drugs (NSAIDs), while OA is treated with acetaminophen, NSAIDs, corticosteroid injections, physical therapy, and in severe cases, joint replacement surgery.

What types of occupations might pose hazards to the musculoskeletal system? What possible safety measures can help prevent musculoskeletal injuries at work?

Construction workers, Healthcare workers, Retail workers, Manufacturing workers, Office workers. Providing ergonomic equipment - This includes adjustable chairs, workstations, and tools designed to reduce strain and stress on the musculoskeletal system. Encouraging stretching and exercise - Regular stretching and exercise can help reduce the risk of musculoskeletal injuries and promote overall health. Providing training on safe lifting and movement techniques - Employees should be trained on proper lifting techniques and movement patterns to reduce the risk of injury. Rotating tasks and breaks - Rotating tasks and providing breaks can help reduce the risk of repetitive strain injuries and allow for recovery time. Providing personal protective equipment - This includes gloves, knee pads, and other equipment designed to reduce the risk of injury while performing physically demanding tasks.

What is dislocation? Through which part(s) of the standard assessment process (inspection, palpation, ROM, Strength Testing) can dislocation be identified? What findings might be observed when encountering a dislocation?

Dislocation is a condition where two bones that form a joint are separated from each other, causing the joint to become unstable and the surrounding muscles, ligaments, and other soft tissues to become damaged. Can be found by all of the assessment process. Other findings that are observed- deformity, asymmetry, and joint instability pain, swelling, and bruising

Define the anatomical terms for each possible motion of the joints

Flexion: Movement that decreases the angle between two bones or brings them closer together. Extension: Movement that increases the angle between two bones or moves them farther apart. Abduction: Movement of a body part away from the midline of the body. Adduction: Movement of a body part toward the midline of the body. Rotation: Movement of a body part around its own axis. Circumduction: Movement of a body part in a circular motion, combining flexion, extension, abduction, and adduction. Supination: Movement of the forearm so that the palm faces up or forward. Pronation: Movement of the forearm so that the palm faces down or backward. Dorsiflexion: Movement of the ankle joint so that the foot moves upward or toward the shin. Plantar flexion: Movement of the ankle joint so that the foot moves downward or away from the shin. Inversion: Turning the sole of the foot inward. Eversion: Turning the sole of the foot outward. Protraction: Movement of a body part forward or away from the midline of the body. Retraction: Movement of a body part backward or toward the midline of the body Hyperextension: the extension movement that goes beyond the anatomical position, resulting in the joint being extended beyond its neutral position.

Abduction

Movement away from the midline of the body

Adduction

Movement toward the midline of the body

How does weight, particularly rapid weight gain, affect the musculoskeletal system?

Increased pressure on joints, Decreased mobility, Increased risk of fractures, Increased risk of back pain, Increased risk of tendonitis and other overuse injuries, Increased risk of sleep apnea

Through which part(s) of the standard assessment process (inspection, palpation, ROM, Strength Testing) can nodes be identified? What are some examples of conditions where nodes are common?

Inspection and palpation. In the musculoskeletal system, nodes are commonly associated with rheumatoid arthritis, osteoarthritis, gout, and other inflammatory joint conditions.

Through which part(s) of the standard assessment process (inspection, palpation, ROM, Strength Testing) can scoliosis be identified? What physical assessment finding(s) would suggest scoliosis? Why is it important to identify scoliosis on an exam? What is the benefit of identifying scoliosis earlier in life?

Inspection, asymmetrical shoulder or hip height, a prominent rib or scapula, or a noticeable curve in the spine when the patient is bent forward and important to identify scoliosis on an exam because it can lead to chronic back pain, breathing difficulties, and decreased mobility if left untreated. Interventions can be initiated while the spine is still growing and more responsive to treatment, potentially preventing the need for surgery or more invasive interventions in the future.

What are the four components of musculoskeletal examinations?

Inspection, palpation, ROM and strength testing

What is the order of exam for the musculoskeletal system?

Inspection, palpation, ROM and strength testing

What types of symptoms are associated with common musculoskeletal concerns in the HPI?

Pain: Pain is a common symptom associated with musculoskeletal conditions. The pain may be sharp, dull, or aching, and may be localized or diffuse. Stiffness: Stiffness can occur in the muscles or joints and may be worse in the morning or after a period of inactivity. Swelling: Swelling can occur in the joints and may be accompanied by warmth and redness. Weakness: Weakness in the muscles can occur with some musculoskeletal conditions and may make it difficult to perform daily activities. Limited range of motion: Limited range of motion in the joints can occur with some musculoskeletal conditions and may make it difficult to perform daily activities. Instability: Instability in the joints may occur with some musculoskeletal conditions, which may result in a feeling of the joint "giving way" or a feeling of being unsteady. Fatigue: Fatigue can occur with some musculoskeletal conditions, which may make it difficult to perform daily activities.

What aspects of the musculoskeletal system can be assessed during a general survey?

Posture, Gait, Muscle tone, Joint mobility, Muscle strength, Pain, Swelling, Deformities

How might we assess for functional limitations in the musculoskeletal system?

Self report, physical performance tests, observations and image testing

Extension

Straightening of a joint

Tendons

Strong fibrous cord

Effusion

Swelling may be excess joint fluid

What could wincing during an active range of motion test suggest?

They are in pain

Ballottement

This test is reliable when larger amounts of fluid are present. Use your left hand to compress the suprapatellar pouch to move any fluid into the knee joint. With your right hand push the patella sharply against the femur. If no fluid is present, the patella is already snug against the femur

Muscle

Tissues in the body that are responsible for movement, stability, and control. They work by contracting and relaxing in response to nerve impulses, which allows the body to perform a wide range of physical activities

What does emaciated mean?

To be extremely thin, weak, and malnourished

Deformity

Visual abnormality of a bone or anatomical structure

What do we palpate muscles for? What do we palpate joints for? Why is it important to palpate bilaterally? Through which part(s) of the standard assessment process (inspection, palpation, ROM, Strength Testing) can crepitus be identified? What does it mean if a joint is described as "boggy"?

We palpate muscles to assess for any areas of tenderness, swelling, or abnormal masses. We palpate joints to assess for any tenderness, swelling, or warmth, which may suggest inflammation or injury. We also assess for any crepitus, which is a grating, cracking, or popping sensation felt or heard when a joint moves Crepitus can be identified through palpation during the standard assessment process. If a joint is described as "boggy," it means that it feels soft and spongy to the touch

What is an examiner testing when assessing strength in the shoulders?

When assessing strength in the shoulders, an examiner is testing the integrity of the rotator cuff muscles and other muscles that stabilize and move the shoulder joint.

Fracture

a break in a bone

Hypertrophy

an increase in the size of cells or tissues in the body

Ligaments

are fibrous bands running directly from one bone to another bone that strengthen the joint and help prevent movement in undesirable directions

Subcutaneous Nodules

are raised, firm, and nontender, and overlying skin moves freely. Common sites are in the olecranon bursa and along the extensor surface of the ulna. These nodules occur with RA

How would a nurse proceed if resistance was felt while performing a passive range of motion test?

ask if there is any pain

Flexation

bending a joint

Circumduction

circular movement of a limb at the far end

Dislocation

complete loss of contact between the two bones in a joint

Bulge Sign

confirms the presence of small amounts of fluid as you try to move the fluid from one side of the joint to the other. Firmly stroke up on the medial aspect of the knee 2 or 3 times to displace any fluid

Extra articular disease

disease (injury to a specific tendon, ligament, nerve) produces swelling and tenderness to that one spot in the joint and affects only certain planes of ROM, especially during active (voluntary) motion

Hyperextension

extension beyond anatomical position

Myalgia

felt as cramping or aching in the muscles

Ulnar deviation

fingers list to ulnar side

Thenar eminence

fleshy part of the hand at the base of the thumb. It's made up of three important muscles that help us move and control the thumb

Synovial Joint

freely movable because their bones are separated from one another and enclosed in a joint cavity

Bone

hard, rigid organs that make up the skeletal system in the human body. They provide structural support, protect internal organs, and assist in movement by providing attachment points for muscles. Bones are composed of collagen fibers and minerals such as calcium, phosphorus, and magnesium.

What could it mean when a muscle is hypertrophied? What could it mean when a muscle is atrophied? Through which part(s) of the standard assessment process (inspection, palpation, ROM, Strength Testing) can atrophy or hypertrophy be identified? What physical assessment finding(s) would suggest muscle atrophy or muscle hypertrophy?

hypertrophied, it means that it has increased in size due to an increase in the size of its individual muscle fibers. This can occur as a result of strength training exercises, repetitive use, or due to underlying medical conditions such as hormonal imbalances or diseases affecting the neuromuscular system. Atrophied, it means that it has decreased in size due to a loss of muscle fibers. This can occur as a result of disuse, injury, or nerve damage.

Crepitation

is an audible and palpable crunching or grating that accompanies movement. It occurs when the articular surfaces in the joints are roughened, as with RA

Bursa

is an enclosed sac filled with viscous synovial fluid, much like a joint

Skeletal muscle

is composed of bundles of muscle fibers or fasciculi

Supination

movement that turns the palm up

What do we inspect joints for? What do we inspect muscles for? Why is it important to inspect bilaterally?

musculoskeletal examination, we inspect joints for any signs of swelling, redness, warmth, tenderness, deformity, or range of motion limitations. We inspect muscles for any asymmetry, atrophy, hypertrophy, or abnormal movements, such as fasciculations (involuntary muscle twitches). To assess for symmetry and identify any differences in appearance or function between the two sides

What are the four primary signs of inflammation in a joint or muscle?

pain, swelling, redness, warmth

Edema

puffy swelling of tissue from the accumulation of fluid

Give an example of a condition where ulnar deviation occurs.

rheumatoid arthritis

Functional Assessment

screens the safety of independent living, the need for home health services, and quality of life

Cartilaginous joints

separated by fibrocartilaginous discs and are only slightly movable

Contracture

shortening of a muscle leading to limited ROM of joint

Bogginess

soft and spongy texture or consistency of tissue, such as that found in swollen or inflamed areas

Ankylosis

stiffness or fixation of a joint

Fibrous joints

the bones are united by interjacent fibrous tissue or cartilage and are immovable

Range of motion (ROM)

the movement of a joint to the extent possible without causing pain

Internal rotation

turning the joint inward

External rotation

turning the joint outward

Pronation

turning the palm downward

Subluxation

two bones in a joint stay in contact, but their alignment is off

How do we use the plumb line to assess a patient's musculoskeletal system? What are some expected and abnormal findings?

used to assess the alignment of the musculoskeletal system, particularly the spine and lower limbs. To use the plumb line, the patient stands with their feet shoulder-width apart and their arms at their sides. The healthcare provider then suspends a weighted line from a point just above the patient's head, allowing it to hang straight down and pass through the midpoint of the patient's pelvis, between their feet. Normal findings: The line should pass through the midpoint of the patient's pelvis, between their feet. The spine should appear straight and vertical. The shoulders and hips should be level. The patient's weight should be evenly distributed between both feet. Abnormal Findings: Scoliosis, Kyphosis, Lordosis, Leg length discrepancy, Forward head posture

Articular disease

​​inside the joint capsule e.g., arthritis produces swelling and tenderness around the whole joint, and it limits all planes of ROM in both active and passive motion