Chapter 18 Musculoskeletal System Copyright 2002 Delmar A

Chapter 18 Musculoskeletal System Copyright 2002, Delmar, A division of Thomson Learning

Competencies l l l Elicit a health history from a patient with a musculoskeletal chief complaint. Perform inspection and palpation of the musculoskeletal system. Describe the range of motion movements of the major joints. (continues) Copyright 2002, Delmar, A division of Thomson Learning

Competencies l l l Measure range of joint motion with a goniometer. Assess muscle strength of the arms and legs using the muscle strength grading scale. Document the findings of the musculoskeletal assessment. Copyright 2002, Delmar, A division of Thomson Learning

Descriptive Terms for Joint ROM l l l Flexion Extension Hyperextension Adduction Abduction Internal rotation (continues) Copyright 2002, Delmar, A division of Thomson Learning

Descriptive Terms for Joint ROM l l l l External rotation Circumduction Supination Pronation Opposition Eversion Inversion (continues) Copyright 2002, Delmar, A division of Thomson Learning

Descriptive Terms for Joint ROM l l l l Dorsiflexion Plantar flexion Elevation Depression Protraction Retraction Gliding Copyright 2002, Delmar, A division of Thomson Learning

Health History: Patient Profile l Age £ £ l Gender £ £ l Early adult Mid to late adult Female Male Race £ £ Caucasian African American Copyright 2002, Delmar, A division of Thomson Learning

Common Chief Complaints l l l Pain Weakness Limited movement Stiffness Deformity Copyright 2002, Delmar, A division of Thomson Learning

Characteristics of Chief Complaint l l l l Location Quantity Quality Associated manifestations Aggravating factors Alleviating factors Setting Timing Copyright 2002, Delmar, A division of Thomson Learning

Medical History l Musculoskeletal specific Joint disorders £ Bone or skeletal disorders £ Neuromuscular disorders £ l Nonmusculoskeletal specific Infections £ Blood disorders £ Peripheral vascular disorders £ Copyright 2002, Delmar, A division of Thomson Learning

Surgical History l l l l Arthroscopy Arthroplasty Diskectomy or Laminectomy Internal fixation External fixation Amputation Reattachment of a limb Copyright 2002, Delmar, A division of Thomson Learning

Health History l Common medications Anti-inflammatory agents £ Analgesics: narcotic or non-narcotic £ Muscle relaxants £ Steroids £ Calcium supplements £ l Communicable diseases (continues) Copyright 2002, Delmar, A division of Thomson Learning

Health History l l Injuries/accidents Special needs Amputation £ Use of assistive devices £ Hemiplegia, quadriplegia, paraplegia £ l Childhood illnesses Polio £ Juvenile arthritis £ (continues) Copyright 2002, Delmar, A division of Thomson Learning

Health History l Family history £ £ £ l Rheumatoid arthritis Paget’s disease Osteoporosis Social history £ £ £ Alcohol or tobacco use Work environment: role of repetitious movements Home environment: physical layout/barriers (continues) Copyright 2002, Delmar, A division of Thomson Learning

Health History l Hobbies/leisure activities Contact activities £ Weight-bearing activities £ Nonweight-bearing activities £ (continues) Copyright 2002, Delmar, A division of Thomson Learning

Health History l Health maintenance activities Sleep £ Diet £ £ Intake of calcium, nutritional supplements Exercise Weight-bearing, nonweight-bearing, aerobic Use of safety devices £ Health checkups £ Copyright 2002, Delmar, A division of Thomson Learning

Safety Tips to Decrease Fall Risk l Avoid the following Scatter or throw rugs £ Slick floors £ Dim lighting £ Clutter £ Cords on the floor £ Ill-fitting shoes £ Stairways without banisters £ Copyright 2002, Delmar, A division of Thomson Learning

Assessment l Equipment Goniometer £ Tape measure and felt tip marker £ Sphygmomanometer £ l General approach Patient comfort £ Compare nonaffected to affected £ Proceed in cephalocaudal order £ Copyright 2002, Delmar, A division of Thomson Learning

General Assessment l l l Overall appearance Posture Gait and mobility Weight-bearing status £ Gait patterns £ Transfer ability £ (continues) Copyright 2002, Delmar, A division of Thomson Learning

General Assessment l Normal findings Height and weight are proportionate £ Full ROM £ Ambulate independently £ No structural defects £ Shoulders and hips are level £ Head and torso are upright £ Stable gait £ Copyright 2002, Delmar, A division of Thomson Learning

Inspection l Muscle size and shape Hypertrophy £ Atrophy £ Involuntary muscle movements £ Limb circumference £ l Joint contour and periarticular tissue (continues) Copyright 2002, Delmar, A division of Thomson Learning

Inspection l Normal findings Symmetrical muscle contour £ No involuntary muscle movements £ Bilateral limb circumference is within 1– 3 cm of each other £ Joints are flat when extended, and smooth/rounded during flexion £ No joint enlargement or deformity £ Copyright 2002, Delmar, A division of Thomson Learning

Palpation l Muscle tone Measure £ Movement against resistance or gravity £ l Joints £ l Range of motion £ l Special techniques Goniometer Muscle strength £ Scale Copyright 2002, Delmar, A division of Thomson Learning

Special Techniques for Assessing Joints l l l l Temporomandibular Cervical spine Shoulders Elbows Wrist and hands Knees Ankles and feet Spine Copyright 2002, Delmar, A division of Thomson Learning

Special Assessments l l l Chvostek’s sign Drop arm test Trousseau’s sign Grip strength Tinel’s sign Phalen’s sign (continues) Copyright 2002, Delmar, A division of Thomson Learning

Special Assessments l l l Tredelenburg test Measuring limb length Patrick’s test Bulge sign Patellar ballottement Apley’s sign (continues) Copyright 2002, Delmar, A division of Thomson Learning

Special Assessments l l l l Mc. Murray’s sign Drawer test Lachman’s test Varus stress test Valgum stress test Thompson test Milgram test Copyright 2002, Delmar, A division of Thomson Learning

Use of Assistive Devices l l l Crutches Cane Walker Brace, splint, immobilizer Cast Copyright 2002, Delmar, A division of Thomson Learning

Normal Findings l l l l Normal muscle tone No crepitus or masses Joints without pain, tenderness, or swelling Full ROM Normal muscle strength Muscle strength is equal bilaterally No lordosis, kyphosis, or scoliosis Copyright 2002, Delmar, A division of Thomson Learning

Gerontological Variations l l l l Bone density decreases Weaker bones, increased risk for osteoporosis Muscle atrophy Decreased muscle strength Deterioration of articulating cartilage Vertebral inflexibility Thoracic kyphosis Copyright 2002, Delmar, A division of Thomson Learning