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

 C7 & T1 prominent base of neck  Inferior angle of scapula in line with T7 & T8  Highest point iliac crest at L4  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

 Size & contour of joint  Color, swelling, masses, deformity

Palpation

 Each joint  Temperature  Muscles  Bony articulations joint capsule  Tenderness, 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 2-3x. 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