Musculoskeletal System Chapter 22 Elsevier items and derived

Musculoskeletal System Chapter 22 Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Chapter 22: Musculoskeletal System Structure and Function Subjective Data—Health History Questions Objective Data—The Physical Exam Abnormal Findings Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -2

Chapter 22: Musculoskeletal System Structure and Function Joints Ø Nonsynovial or synovial joints Ø Cartilage Ø Ligament Ø Bursa Muscles Ø Fasciculi Ø Tendon Ø Skeletal muscle movements Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -3

Chapter 22: Musculoskeletal System Synovial Joint Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -4

Chapter 22: Musculoskeletal System Skeletal Muscle Movements Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -5

Chapter 22: Musculoskeletal System Skeletal Muscle Movements (cont. ) Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -6

Chapter 22: Musculoskeletal System Structure and Function (cont. ) Temporomandibular joint Spine Ø Vertebrae Ø Landmarks of the spine Ø Intervertebral disks Shoulder Ø Glenohumeral joint Ø Rotator cuff Ø Subacromial bursa Ø Acromion process Ø Greater tubercle of the humerus Ø Coracoid process Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -7

Chapter 22: Musculoskeletal System Landmarks of the Spine Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -8

Chapter 22: Musculoskeletal System Shoulder Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -9

Chapter 22: Musculoskeletal System Structure and Function (cont. ) Elbow Ø Medial and lateral epicondyles Ø Olecranon process of ulna Wrist and carpals Ø Radiocarpal joint Ø Midcarpal joint Ø Metacarpophalangeal joints Ø Interphalangeal joints Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -10

Chapter 22: Musculoskeletal System Right Elbow Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -11

Chapter 22: Musculoskeletal System Bones of the Hand Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -12

Chapter 22: Musculoskeletal System Structure and Function (cont. ) Hip Acetabulum and head of femur Ø Anterior superior iliac spine Ø Ischial tuberosity Ø Ø Greater trochanter of femur Ankle and foot Tibiotalar joint Ø Medial and lateral malleolus Ø Metatarsals Ø Knee Femur, tibia, and patella Ø Suprapatellar pouch Ø Ø Ø Medial and lateral menisci Cruciate ligaments Prepatellar bursa Quadriceps muscle Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -13

Chapter 22: Musculoskeletal System Hip Joint Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -14

Chapter 22: Musculoskeletal System Landmarks of the Knee Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -15

Chapter 22: Musculoskeletal System Ankle and Foot Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -16

Chapter 22: Musculoskeletal System Subjective Data— Health History Questions Joints Pain Ø Stiffness Ø Swelling, heat, and redness Ø Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -17

Chapter 22: Musculoskeletal System Subjective Data— Health History Questions (cont. ) Muscles Pain (cramps) Ø Weakness Ø Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -18

Chapter 22: Musculoskeletal System Subjective Data— Health History Questions (cont. ) Bones Pain Ø Deformity Ø Trauma (fractures, sprains, dislocations) Ø Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -19

Chapter 22: Musculoskeletal System Subjective Data— Health History Questions (cont. ) Functional assessment (activities of daily living) Self-care behaviors Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -20

Chapter 22: Musculoskeletal System Objective Data—The Physical Exam Preparation Ø Ø Screening musculoskeletal examination Complete musculoskeletal examination Order of the examination Ø Inspection • Size and contour of joint • Skin and tissues over joint Ø Palpation • Skin temperature • Muscles, bony articulations, Equipment needed area of joint capsule Ø Tape measure Ø Range of motion Ø Goniometer, to measure joint angles Ø Muscle testing Ø Skin marking pen • Apply opposing force • Grading muscle strength Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -21

Chapter 22: Musculoskeletal System Objective Data—The Physical Exam (cont. ) Temporomandibular joint Inspect joint area Palpate as person opens mouth Motion and expected range Ø Open mouth maximally Ø Protrude lower jaw and move side to side Ø Stick out lower jaw Palpate muscles of mastication Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -22

Chapter 22: Musculoskeletal System Objective Data—The Physical Exam (cont. ) Cervical spine Inspect alignment of head and neck Palpate spinous processes and muscles Motion and expected range Ø Chin to chest Ø Lift chin Ø Each ear to shoulder Ø Turn chin to each shoulder Shoulders Inspect joint Palpate shoulders and axilla Motion and expected range Ø Arms forward and up Ø Arms behind back and hands up Ø Arms to sides and up over head Ø Touch hands behind head Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -23

Chapter 22: Musculoskeletal System Objective Data—The Physical Exam (cont. ) Elbow Wrist and Hand Inspect joint in flexed and extended positions Palpate joint and bony prominences Motion and expected range Inspect joints on dorsal and palmar sides Palpate each joint Motion and expected range Ø Bend hand up, down Ø Bend and straighten elbow Ø Bend fingers up, down Ø Pronate and supinate hand Ø Turn hands out, in Ø Spread fingers, make fist Ø Touch thumb to each finger Phalen’s test Tinel’s sign Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -24

Chapter 22: Musculoskeletal System Objective Data—The Physical Exam (cont. ) Hip Knee Inspect as person stands Inspect joint and muscle Palpate with person supine Palpate Motion and expected range Bulge sign Ø Raise leg Ballottement of patella Ø Knee to chest Ø Flex knee and hip; swing foot out, in Motion and expected range Ø Ø Ø Bend knee Swing leg laterally, medially Ø Extend knee Stand swing leg back Ø Check knee during ambulation Mc. Murray’s test Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -25

Chapter 22: Musculoskeletal System Objective Data—The Physical Exam (cont. ) Ankle and foot Inspect with person sitting, standing, and walking Palpate joints Spine Inspect while person stands Palpate spinous processes Motion and expected range Ø Point toes down, up Ø Turn soles out, in Ø Flex and straighten toes Ø Bend sideways, backward Ø Twist shoulders to each side Straight leg raising Measure leg length discrepancy Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -26

Chapter 22: Musculoskeletal System Sample Charting Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -27

Chapter 22: Musculoskeletal System Abnormal Findings Abnormalities Affecting Multiple Joints Inflammatory conditions Ø Rheumatoid arthritis Ø Ankylosing spondylitis Degenerative conditions Ø Osteoarthritis (degenerative joint disease) Ø Osteoporosis Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -28

Chapter 22: Musculoskeletal System Abnormal Findings Abnormalities of the Shoulder Atrophy Dislocated shoulder Joint effusion Tear of the rotator cuff Frozen shoulder—adhesive capsulitis Subacromial bursitis Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -29

Chapter 22: Musculoskeletal System Abnormal Findings Abnormalities of the Elbow Olecranon bursitis Gouty arthritis Subcutaneous nodules Epicondylitis—tennis elbow Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -30

Chapter 22: Musculoskeletal System Abnormal Findings Abnormalities of the Wrist and Hand Ganglion cyst Colles’ fracture Carpal tunnel syndrome Ankylosis Dupuytren’s contracture Swan-neck and boutonniere deformities Ulnar deviation or drift Degenerative joint disease or osteoarthritis Acute rheumatoid arthritis Syndactyly Polydactyly Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -31

Chapter 22: Musculoskeletal System Abnormal Findings Abnormalities of the Knee Abnormalities of the Ankle and Foot Mild synovitis Achilles tenosynovitis Prepatellar bursitis Chronic/acute gout Swelling of menisci Osgood-Schlatter disease Callus Plantar wart Ingrown toenail Chondromalacia patellae Hallux vagus with bunion and hammer toes Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -32

Chapter 22: Musculoskeletal System Abnormal Findings (cont. ) Abnormalities of the Spine Scoliosis Herniated nucleus pulposus Common Congenital or Pediatric Abnormalities Congenital dislocated hip Talipes equinovarus (clubfoot) Spina bifida Coxa plana (Legg-CalvéPerthes syndrome) Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -33

Chapter 22: Musculoskeletal System Ankylosis is… A. B. C. D. one or more bones in a joint being out of position partial dislocation of a joint shortening of a muscle leading to limited range of motion of joint stiffness or fixation of a joint Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -34

Chapter 22: Musculoskeletal System Why would the examiner ask a high school athlete “what do you do when you get hurt? ” A. B. C. D. Because so many young athletes are injured that it is important to plan ahead. Because many athletes are reticent to report injuries because they think it will limit their playing time. Because it is important for young athletes to understand the risks involved in playing sports. Because it is important for the athlete to report an injury to a clinician, rather than a coach, who may not take the injury seriously. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 22 -35