Health Assessment Week 5 Musculoskeletal Assessment

The bulge sign is a test for: A-swelling in the suprapatellar pouch B-carpal tunnel syndrome C-Heberden's nodes D-Olecranon bursa inflammation

A-swelling in the suprapatellar pouch

What type of joint provides a wide range of motion?

Ball and socket ex. shoulder, hip

When would a COMPLETE exam be appropriate?

Articular disease History of musculoskeletal symptoms Difficulties with ADL's

Why would you want to complete a musculoskeletal assessment for a patient?

Assess function for ADL's Screen for admornalities know of any pain

Skeletal muscle is composed of bundles of fibers called _____________.

Fasciculi

What causes gout? How do you make a diagnosis of gout?

Metabolic disorder of disturbed purine metabolism, associated with elevated serum uric acid

What tests would you use to check for carpal tunnel?

Phalen's Test - ask pt to press back of hands together for 60 seconds. If there is any tingling or numbness in the fingers or hands it is a Positive sign Tinnel's Sign-percuss the tunnel with finger if pt complains of tingling sensation or pain this indicates a Positive sign for carpal tunnel syndrome

The ankle joint is the articulation of _____________

Tibia, fibula and talus

When do you perform McMurray's test? How do you do it and what are the normal and abnormal findings?

To test any tear in the meniscus of the knee see you tube video for demo https://www.youtube.com/watch?v=fkt1TOn1UfI Pt fells nothing=Negative Pt feels pain=Postive (should also hear a Pop)

Who is most at risk for developing gout?

men over 40

When testing strength of muscles, what is 0/5?

no contraction

What type of joint is limited to rotation?

pivot ex. radio-ulnar joint, (pronation and supination)

What is Osteoporosis?

-decrease in skeletal bone mass -weakened bone state increases risk for stress fractures -found especially in wrists, hips, and vertebrae -occurs primarily in postmenopausal white women, also associated with lower height and weight, lack of weight bearing exercise, and lack of estrogen in women (menopause)

What are the major functions of the musculoskeletal system?

1-helps with ADL's 2-movement(coordination involves muscle and brain) 3-protects vital organs 4-bone marrow produce RBCs and storage of essential minerals

What is the physical assessment order of the MS?

1-inspection 2-palpation 3-ROM 4-muscle testing

What attaches a muscle to bone?

tendon

Heberden and Bouchard nodes are hard and nontender and are associated with: A-Osteoarthritis B-Rheumatoid arthritis C-Dupuytren contracture D-Meacarpophalangeal bursitis

A-Osteoarthritis

Heberden and Bouchard nodes are hard and nontender and are associated with: A-Osteoarthritis B-Rheumatoid arthritis C-Dupuytren contracture D-Metacarpophalangeal bursitis

A-Osteoarthritis Heberden-distal interphalangeal joints Bouchard-proximal interphalangeal joints

Crepitation is an audible sound that is produced by A-roughened articular surfaces moving over each other B-tendons or ligaments that slop over bones during motion C-joints that are stretched when placed in hyperflexion D-flexion and extension of an inflamed bursa

A-roughened articular surfaces moving over each other

What is bursa?

An enclosed sac filled with viscous synovial fluid, much like a joint. Located in areas of potential friction and help muscles and tendon glide smoothly over bone. Ex. subacromial bursa of the shoulder and prepatellar bursa of the knee

When assessing an infant, the examiner completes Ortolani maneuver by: A-lifting the newborn 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 lengths of the clavicles

B-gently lifting and abducting the infants flexed knees while palpating the greater trochanter with the fingers

What is a nonsynovial joint?

Bones are united by fibrous tissue or cartilage and are immovable or only slightly movable. i.e. skull and vertebrae

Know Different types of muscle movements

Flexion-crease angle, bending a limb at a joint extension-straightening limb at a joint abduction and adduction pronation and supination circumduction-arm circle around shoulder inversion-sole of foot moving inward eversion-sole of foot moving outward at ankle Protraction-stick out, forward and parallel to the ground (push your chin forward) Retraction-move backward and parallel to the ground elevation-raising a body part(shrug shoulders) depression-lowering a body part rotate-moving along axis line(turning head to each shoulder "no")

What happens to the MS in pregnant women?

Lumbar lordosis-the bending inward of the spine Hormones(estrogen, relaxin, and corticosteroids) increase the mobility of the joints

What is Boutonniere's Deformity?

The knuckle looks as if it is being pushed through a buttonhole. Includes flexion of the proximal interphalangeal joint with compensatory hyperextension of distal interphalangeal joint. Occurs in chronic RA

Where is the glenohumeral joint?

The articulatinon of the humerous and the glenoid fossa of the scapula, it is a ball and socket joint. The rotator cuff or shoulder joint

What is a joint?

The functional unit of the MS system because they permit the mobility needed for activities of daily living.

How do you palpate the ischial uberosity?

The ischial tuberosity lies under the gluteus maximus muscle and is palpable when the hip is flexed. Palapte by flexing the hip.

When testing strength of muscles, what is 1/5?

slight contraction

What type of joint enables upright posture and flexibility?

spine

An imaginary line connecting the highest point on each iliac crest would cross the __________ vertebra.

Fourth lumbar

What is a synovial joint?

Freely movable joints. They have bones that are separated from one another and enclosed in a joint cavity. This cavity is filled with a lubricant or synovial fluid.

When testing muscle strength, what is 5/5?

Full ROM against gravity and full resistance

When testing muscle strength, what is 4/5?

Full ROM against gravity with some resistance

When testing muscle strength, what is 3/5?

Full ROM with gravity

When testing strength of muscles, what is 2/5?

Full ROM with gravity eliminated Full Passive ROM

What type of joint has motion limited to flexion and extension?

Hinge ex. elbow, knee, ankle, (tibiotalar joint)

When would you use a goniometer?

If you suspect abnormalities/limitations in ROM. It is used to measure exact angles.

What can Bulge sign and ballotment of Patella indicate regarding the knee joint?

Bulge-small fluid (4-8cc) around knee joint Ballotment-large fluid around knee joint

What are some developmental consideration in the aging adult?

-loss of bone matrix(resorption) more rapidly than new growth (deposition) -Postural changes -more pronounced bony prominences -absolute loss of muscle mass -osteoporosis is the result of the net effect of gradual loss of bone density -decreased height (long bones do not shorten, but the decreased height is due to shortening of the vertebral column which is caused by loss of water content and thinning of the intervertebral disks and decrease in the height of individual vertebrae from osteroporosis) -kyphosis

Which ethnic group has the lowest incidence of osteoporosis? Whites African Americans Asians American Indians

African Americans

Bouchard's nodes vs. Heberden's nodes

Both are new formation of small bone deposits on the joint associated with Osteoarthritis; will see bony, hard, non-tender nodes around joint. Bouchard's-on middle joint of the fingers Herden's-near fingerips

The divisions of spinal vertebrae include: A-cervical, thoracic scaphoid, sacral, and clavicular B-scapular, clavicular, lumbar, scaphoid, fasiculi C-Cervical, thoracic, lumbar, sacral, coccygeal D-cervical, lumbar, iliac, synovial, capsular

C-Cervical, thoracic, lumbar, sacral, coccygeal 7 cercial 12 thoracic 5 lumbar 5 sacral 3-4 coccygeal

During 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

What is an intervertebral disk and what is in the center of it?

Elastic fibrocartilaginous plates with nucleus pulposus in the center filled with soft, semifluid, mucloid material. They cushion the spine like shock absorber and help it move. i.e. A herniated disk is when the nucleus pulposus ruptures which compresses the spinal nerves causing pain

The knee joint is a articulation of what 3 bones?

Femur, Tibia, and patella

What are ligaments?

Fibrous bands running directly from one bone to another bone that strengthens the joint and help prevent movement in undesirable directions. (Are you down with LBB?)

What is cartilage?

In synovial joints a layer of _______ covers the surface of opposing bones. It's avascular; it receives nourishment from synovial fluid that circulates during joint movement. It's a very stable connective tissue with slow cell turnover. It is tough, firm yet flexible. It cushions the bones and gives a smooth surface to facilitate movement.

How do you palpate the temporomandibular joint?

In the depression anterior to the tragus of the ear.

What has happened to the SM of a 3 month fetus?

It has formed a "scale model" of the skeleton that is made up of cartilage.

What is LaSegue's Test?

Leg raising test to check for sciatica pain. In supine position passively elevate the leg 30-70 degrees. It should not produce pain. If someone complains of pain in the calf, ankle, or foot it is a Positive sign for sciatica. *The pain could be due to herniated nucleus pulposus.*

What is the difference between osteoarthritis and rheumatoid arthritis?

Osteoarthritis is NON-INFLAMMATORY and involves the deterioration of articular cartilages and subchondral bone and formation of new bone at joint surfaces. Rheumatiod arthritis is INFLAMMATORY - inflammation of synovial membrane, leading to thickening and then fibrosis, which limits motion and finally to bony ankylosis

What are signs and symptoms of gout?

Redness, swelling, heat and extreme tenderness (usually in the big toe)

During a subjective assessment the patient complains that pain is worse in the morning but gets better when she moves more. What could this be?

Rheumatoid arthritis. Movement increases most joint pain, except with RA

What type of joint permits jaw function for speaking and chewing; allows 3 motions?

TMJ-temporomandibular joint 1-hinge action to open and close the jaw 2-gliding actin for protrusion and retraction 3-gliding side to side movement of the lower jaw

When do your bones stop growing?

around 20