Muscoloskeletal System Musculoskeletal System Consists of Bones Muscles

Muscoloskeletal System

Musculoskeletal System Consists of: ¬Bones ¬Muscles ¬Joints ¬cartilage

function ¬Support to stand erect ¬Movement ¬Protect inner vital organs ¬Hemopoiesis – Bone marrow produces white & red bld cells and platelets ¬Reservoir for storage of minerals & energy – Ca. & Phosphorus in the bones.

Bones ¬ 206 ¬Bones & cartilage are types of Connective tissue ¬Bone is hard and rigid and dense

Joints ¬ 2 or more bones connecting ¬Mobility ¬Nonsynovial = immovable, skull sutures ¬Synovial = movable ¬Synovial joints – ends of bones are covered with cartilage & enclosed in a joint cavity filled with synovial fld.

¬Ligaments are fibrous bands – connect one bone to another. Strengthen joint & prevent movement in the wrong direction ¬Bursa – enclosed sac filled with synovial fld. & are located in areas of potential friction = shoulder, knee. Help muscles & tendons glide over bone.

Muscles ¬ 40 – 50 % body weight ¬Contract & produce movement ¬Skeletal muscle is voluntary ¬Composed of Bundles of muscle fibers or fasciculi ¬Muscle is attached to bones via tendons

Skeletal muscles produce the following movements ¬Flexion – bending ¬Extension – straightening ¬Abduction – away from midline ¬Adduction – toward midline ¬Pronation – palm down ¬Supination – palm up ¬Circumduction - circular

Skeletal muscles produce the following movements ¬Inversion – sole inward ¬Eversion – sole outward ¬Rotation – head around central axis ¬Protraction –forward movement parallel to ground (chin) ¬Retraction – backward parallel movement ¬Depression/elevation – Shoulders up & down

Temporomandibular Joint (TMJ) ¬Articulation of temporal & mandible ¬Depression anterior to tragus of ear ¬Jaw function for chewing & speaking ¬Movements – Hinge – open/close – Gliding – protrusion/retraction – Gliding- side to side

Spine ¬ 33 Vertebrae ¬Spinous process posterior midline ¬ 7 Cervical ¬ 12 Thoracic ¬ 5 Lumbar ¬ 5 Sacral ¬ 3 – 4 Coccygeal

¬ C 7 & T 1 prominent base of neck ¬ Inferior angle of scapula in line with T 7 & T 8 ¬ Highest point iliac crest at L 4 ¬ Curves Double S – lateral view – cervical & lumbar are concave; (inward) – Thoracic & sacrococcygeal are convex ¬ Intervertebral discs cushion the spine = shock absorber

Shoulder ¬Articulation of humerus & glenoid fossa of scapula ¬Ball & socket – enclosed by rotator cuff (4 muscles and tendons) ¬Acromion process – bump at top of shoulder

Elbow ¬Articulation humerus, radius, & ulna ¬Landmarks are the Medial & lateral epicondyles of the humerus & large olecranon process of the ulna in between ¬Sensitive ulnar nerve

Wrists and Carpals ¬Wrist –articulation of radius & carpal bones ¬Permits flexion, extension & side to side deviation ¬Metacarpophalangeal & interphalangeal joints – permit finger flexion and extension

Hip ¬Acetabulum & femur ¬Ball & socket joint ¬Weight bearing function ¬Landmarks ( IM injections) – Anterior, superior iliac crest – Ischial tuberosity (↓ gluteus maximus, flex hip) – Greater trochanter of femur

Knee ¬Femur, tibia & patella ¬Largest joint ¬Hinged joint & largest synovial membrane ¬ 2 cartilages – medial & lateral menisci cushion the tibia & femur

Ankle & Foot ¬Ankle joint is the articulation of Tibia, fibula & talus ¬Hinged joint – Dorsiflexion – Plantar flexion ¬Landmarks – Medial & lateral malleolus

Aging adult ¬Loss of bone density = osteoporosis ¬Postural changes ¬↓ height due to shortening of the vertebral column

Subjective Data ¬Joints – Pain – Stiffness – Swelling, heat, redness ¬Muscles – Pain, cramps – weakness

Subjective Data ¬Bones – Pain – Deformity – Trauma ¬Functional Assessment ( ADL’s ) ¬Self – care behaviors

Objective Assessment Physical Exam Musculoskeletal ¬Purpose – To assess function for ADL’s – Screen for abnormalities

Screening Exams ¬Inspection ¬Palpation ¬ROM with movement active or passive if apparent limitations ¬Age Specific

Important to : ¬Client comfort ¬Systemic approach ¬Support joints ¬Bilateral exam

Equipment ¬Tape measure ¬Goniometer ¬Skin marking pen

Inspection ü Size & contour of joint ü Color, swelling, masses, deformity

Palpation ü Each joint üTemperature üMuscles üBony articulations joint capsule üTenderness, swelling, masses

ROM ¬Active ROM ¬Limitation – try passive motion ¬ or in ROM, use a goniometer to measure angles

Muscle Testing ¬Repeat movements for Active ROM ¬Client flexes & holds against opposing force ¬= bilaterally, resists opposing force

Grade muscle strength (pg. 616) ¬Values 0 - 5 ¬Grade 5= Normal –Full ROM against gravity, full resistance

TMJ ¬Swelling, tenderness, crepitation ¬Crepitation = audible & palpable crunching or grating with movement

Cervical Spine ¬ Inspection – Head & neck alignment – Spine ¬ Palpation – Spinous processes, Trapezius, Paravertebral muscles – ROM, flexion, extension, hyperextension, lateral flexion, rotation, circumduction – Repeat applying opposing force

Shoulders ¬Inspect – Bilateral comparison ¬Palpate – Bilaterally for muscle spasms, atrophy, swelling, heat, tenderness – Clavicle to acromioclavicular joint, scapula, greater tubercle of humerus, subacromal bursa, biceps groove & anterior aspect glenohumeral joint

Test for Shoulder ROM ¬ Flexion ¬ Extension ¬ Internal rotation ¬ External rotation ¬ Abduction ¬ Adduction ¬ Circumduction Test for strength; shrug shoulders, flex forward, up & abduct against resistance

Elbow ¬ Inspect – Size & contour with flexion, extension – Deformity, redness, swelling – Olecranon bursa ¬ Palpate – Flexed 70 degrees • Olecranon process, medial & lateral epicondyles of humerus • Olecronon bursa for heat, swelling, tenderness, nodules

ROM of Elbow ¬Flexion ¬Extension ¬ pronation ¬supination

Muscle Strength of Elbow ¬Flex elbow – then extend against resistance applied just proximal to the wrist

Wrist and Hand ¬Inspect – Palmar & dorsal surface • Position, contour and shape – Swelling, redness, deformity or nodules

Wrist and Hand ¬Palpate – Wrist and hand joints – Support hand, use both thumbs to palpate – Metacarpophanlangeal joints – Use thumb and index finger in a pinching motion to palpate interphalangeal joints

ROM of Wrists and Hands ¬Hyperextension ¬Palmar flexion ¬Flexion of fingers ¬Abduction for fingers ¬Opposition ¬Ulnar deviation, Radial deviation

Muscle Strength for Wrist and Hands ¬Flex wrist against palm resistance ¬Phalen’s test – both hands flexed & back to back for 60 secs. Normally no symp. Carpel tunnel syndrome will give a + result of numbness & burning ¬Tinel’s Sign – direct percussion @ median nerve of wrist. In carpel tunnel + result = burning & tingling

Hip ¬Inspect hip joint with spine when client is standing ¬Client is supine, palpate the hip joints ¬ROM

Knee ¬Supine with legs extended ( knees can be flexed or dangling for inspection) ¬Swelling = ? Soft tissue or ↑ fld in the joint ¬Bulge Sign – stroke up medial aspect 2 -3 x. Tap lateral aspect. Watch for a bulge in the medial hollow. ¬Ballottement of the Patella – lger amt of flds

Ankle & foot ¬Inspect while nonweight- bearing, then standing & walking ¬ROM ¬Muscle strength

Spine ¬Standing ¬Inspect ¬Palpate spinous processes ¬ROM of spine is checked by asking to touch toes

Leg measurement ¬True leg length = measure b/t fixed points, the anterior iliac spine cross the medial side of the knee to the medial malleolus