Chapter 40 Assessment of Musculoskeletal Function Copyright 2014

Question What is atrophy? A. Shrinkage-like decrease in the size of the muscle B.

Answer A. Shrinkage-like decrease in the size of the muscle. Atrophy is shrinkage-like decrease

Functions of the Musculoskeletal System • Protection of vital organs • Mobility and movement

Structure • 206 bones in the body – Long bones – Short bones –

Structure of a Long Bone; Composition of Compact Bone Copyright © 2014 Wolters Kluwer

Bone Cells • Osteoblasts – Function in bone formation • Osteocytes – Mature bone

Bone Formation and Maintenance • Osteogenesis: process of bone formation – Ossification: the process

Bone Healing • Hematoma and inflammation • Angiogenesis and cartilage formation • Cartilage calcification

Question Is the following statement true or false? Epiphysis is the bone-forming cell. Copyright

Answer False Epiphysis is the end of a long bone. Osteoblast is a boneforming

Joints (Articulation): Junction of Two or More Bones • Synarthrosis: immovable joints • Amphiarthrosis:

Hinge Joint of the Knee Copyright © 2014 Wolters Kluwer Health | Lippincott Williams

Muscles • Attached to bones and other structures by tendons • Encased in a

Muscle Maintenance • Muscle tone • Muscle actions • Exercise, disuse, and repair Copyright

Question Is the following statement true or false? Bone is in a constant state

Answer True Bone is in a constant state of turnover. Copyright © 2014 Wolters

Assessment of the Musculoskeletal System • Include data related to function ability; ADLs, IADLS,

Normal Spine and Three Abnormalities Copyright © 2014 Wolters Kluwer Health | Lippincott Williams

Detecting Fluid in the Knee Copyright © 2014 Wolters Kluwer Health | Lippincott Williams

Rheumatoid Arthritis—Ulnar Deviation and “Swan-Neck” Deformity Copyright © 2014 Wolters Kluwer Health | Lippincott

Diagnostic Evaluation • Radiographs • Arthroscopy • Computed tomography • Arthrocentesis • MRI •

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Which statement is false about magnetic resonance imaging? A. Credit cards with magnetic

Answer C. Transdermal patches that have a thin layer of aluminized back must be

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Question What is atrophy? A. Shrinkage-like decrease in the size of the muscle B. Fluid-filled sac found in connective tissue C. Rhythmic contraction of muscle D. Grating or crackling sound or sensation Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer A. Shrinkage-like decrease in the size of the muscle. Atrophy is shrinkage-like decrease in the size of the muscle. Bursa is a fluid-filled sac found in connective tissue. Clonus is rhythmic contraction of muscle. Crepitus is a grating or crackling sound or sensation. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Functions of the Musculoskeletal System • Protection of vital organs • Mobility and movement • Facilitate return of blood to the heart • Production of blood cells (hematopoiesis) • Reservoir for immature blood cells • Reservoir for vital minerals Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Bone Cells • Osteoblasts – Function in bone formation • Osteocytes – Mature bone cells that function in bone maintenance – Located in the lacunae • Osteoclasts – Multinuclear cells function in destroying, resorbing, and remodeling bone – Located in Howship’s lacunae Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Bone Formation and Maintenance • Osteogenesis: process of bone formation – Ossification: the process of formation of the bone matrix and deposition of minerals • Bone is in constant state of turnover • Regulating factors – Stress and weight bearing – Vitamin D – Parathyroid hormone and calcitonin – Blood supply • Role of calcium Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Bone Healing • Hematoma and inflammation • Angiogenesis and cartilage formation • Cartilage calcification • Cartilage removal • Bone formation • Remodeling Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Joints (Articulation): Junction of Two or More Bones • Synarthrosis: immovable joints • Amphiarthrosis: allow limited movement • Diarthrosis: freely movable – Ball and socket – Hinge – Saddle – Pivot – Gliding Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Muscles • Attached to bones and other structures by tendons • Encased in a fibrous tissue—fascia • Contraction of muscle causes movement • Sarcomere: the contractile unit of skeletal muscle that contains actin and myosin • Muscle cell fibers react to electrical stimulation • Contraction uses energy in the form of ATP • Anaerobic pathways using glucose metabolized from stored glycogen provide energy for more strenuous muscle activity Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Assessment of the Musculoskeletal System • Include data related to function ability; ADLs, IADLS, and ability to perform various activities; note any problems related to mobility • Health history: family history, general health maintenance, nutrition, occupation, learning needs, socioeconomic factors, and medications (include OTC) • Assessment of pain and altered sensations • Physical assessment: posture, gait, bone integrity, joint function, muscle strength and size, skin, neurovascular status Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Diagnostic Evaluation • Radiographs • Arthroscopy • Computed tomography • Arthrocentesis • MRI • Electromyography • Arthrography • Biopsy • Bone densitometry • Laboratory studies • Bone scan Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Which statement is false about magnetic resonance imaging? A. Credit cards with magnetic strips may be erased. B. Nonremovable cochlear implant devices can become inoperable. C. Transdermal patches that have a thin layer of aluminized back must be covered with gauze. D. Jewelry and hair clips must be removed before the MRI is performed. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer C. Transdermal patches that have a thin layer of aluminized back must be covered with gauze. True statements are credit cards with magnetic strips may be erased. Nonremovable cochlear implant devices can become inoperable. Jewelry and hair clips must be removed before the MRI is performed. Transdermal patches that have a thin layer of aluminized back must be covered with gauze is false. Transdermal patches that have a thin layer of aluminized back must be removed before the MRI is performed because they can cause burns. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins