Musculoskeletal System

Transcription

1 Musculoskeletal System N1037 Anatomy and Physiology Bones 206 bones Axial skeleton Appendicular skeleton Anatomy and Physiology Bones (cont d) Structure Diaphysis Epiphysis Medullary cavity (continues) 1

2 Anatomy and Physiology Muscles 600+ muscles Types Cardiac Smooth Skeletal Involuntary vs. voluntary (continues) Anatomy and Physiology Tendons Attach muscle to bone Strong connective tissue Cartilage Avascular dense connective tissue Covers ends of opposing bones Ligaments Connect bone to bone at the joint level Encases the joint capsule Bursae Fluid-filled sacs Cushions btwn 2 surfaces (continues) 2

3 Anatomy and Physiology Joints Union between two bones Permit some movement of bones 3 Types of Skeletal Joints Synarthroses (immovable) Amphiarthroses (slightly movable) Diarthroses (synovial- freely movable) (continues) Anatomy and Physiology Types of joints Hinge Pivot Saddle Condyloid Ball and socket Gliding Synovial Joints 3

4 A & P Synovial Joint Descriptive Terms for Joint ROM Flexion Extension Hyperextension Adduction Abduction Internal rotation External rotation Circumduction Supination Pronation Opposition Eversion Inversion Descriptive Terms for Joint ROM Dorsiflexion Plantar flexion Elevation Depression Protraction Retraction Gliding 4

5 Health History Age Early adulthood Mid to late adulthood Gender Female Male Race Caucasian African American Common Chief Complaints Pain Weakness Limited movement Stiffness Deformity 5

6 Characteristics of Chief Complaint Location Quantity, quality Associated manifestations Aggravating factors Alleviating factors Setting Timing Medical History Musculoskeletal specific Joint disorders Bone or skeletal disorders Neuromuscular disorders Nonmusculoskeletal specific Infections Blood disorders Peripheral vascular disorders Surgical History Arthroscopy Arthroplasty Discectomy or laminectomy Internal fixation External fixation Amputation Reattachment of a limb 6

7 Health History Common medications Anti-inflammatory inflammatory agents Analgesics: narcotic or non-narcotic narcotic Muscle relaxants Steroids Calcium supplements Communicable diseases Injuries and accidents Special needs Amputation Use of assistive devices Hemiplegia,, paraplegia, quadriplegia Health History Childhood illnesses Poliomyelitis Juvenile arthritis Family history Rheumatoid arthritis Osteoporosis Paget s s disease Social history Alcohol or tobacco use Work environment: role of repetitious movements Home environment: physical layout and barriers Health History Hobbies and leisure activities Sports Use of weights and exercise machines Aerobic activities Health maintenance activities Sleep Diet Intake of calcium, nutritional supplements Exercise Weight-bearing, nonweight-bearing, aerobic 7

8 Safety Tips to Reduce Fall Risk Avoid Scatter or throw rugs Floors with a slippery surface Dim lighting Ill-fitting shoes Clutter Cords on the floor Assessment Equipment Tape measure and felt tip marker Goniometer Sphygmomanometer (continues) Assessment General approach Ensure patient comfort Compare nonaffected to affected Proceed in cephalocaudal order 8

9 General Assessment Overall appearance Posture Gait and mobility Gait patterns Transfer ability Weight bearing Normal findings Height and weight are appropriate Ambulates independently No structural defects Shoulders and hips are level Head and torso are upright Stable gait General Assessment Gait disturbance pg 590 due to limited mobility associated with degenerative joint disease, rheumatoid arthritis, Paget s s or Parkinson s s disease Severe kyphosis Pathological fracture 9

10 Inspection of Muscle Inspect muscle size and shape Joint contour and periarticular tissue Normal findings Symmetrical muscle contour No involuntary muscle movements Bilateral limb measurements are within 1 31 cm of each other Joints are flat when extended, and smooth or rounded during flexion No joint enlargement or deformity (continues) Inspection of Muscle Hypertrophy Atrophy Involuntary muscle movements p 593 Limb circumference Jt dislocation(total) Jt subluxation (partial) Palpation Muscle tone Palpate muscles during voluntary movement Palpate while performing passive Rom Palpate movement against resistance or gravity N= muscles are smooth, light resistance to passive stretch Hypotonicity (flaccidity) Spasticity ( Spasticity ( muscle muscle tension on passive stretching) 10

11 Joints Palpation Palpate all joints using light pressure Palpate from periphery inward to the center of the joint N= no tnederness,, warmth, pain or nodules Bone enlargements= (pg 597) Tenderness= infection, capsule pressure Localized warmth = jt inflammation Palpation Range of motion Note limitations Muscle strength Compare bilaterally Note involuntary movments N= able to perform full ROM Hemiparesis (hemiplegia) Special Techniques for Assessing Joints Temporomandibular Cervical spine Shoulders Elbows Wrists and hands (continues) 11

12 Special Techniques for Assessing Joints Hips Knees Ankles and feet Spine Special Techniques for Assessing Joints Temporomandibular Assessing TMJ Pushing out lower jaw.moving moving jaw side to side 12

13 Assessing for Hypo Calemia & Tetanus Infection Chvostek s Sign N= no change in facial expression when temple is stimulated +ve chvostek s Sign is ipsilateral muslce spasm of mouth and cheek (mus( spasm in uoward direction towards cheek) Indicates hypocalsemia, tetanus infection Special Techniques for Assessing Joints Cervical spine Stand behind pt inspect spine Palpate spinous processes Stand in front of pt Assess ROM of cervical spine Chin to chest Look up at ceiling Move ear to shoulder Turn head against resistence 13

14 Special Techniques for Assessing Joints Shoulders Inspect size, shape, symmetry Palpate musles Palpate acromion Assess ROM Assess CN XI (shrug against resistence) 14

15 Special Techniques for Assessing Joints Elbows Support forearm Flex & extend elbow Supination Pronation Assess strength against resistance push & pull ROM Of Elbow Special Techniques for Assessing Joints Wrists and hands Palpate muscles Palpate joints Assess Rom Assess strength Hand Grasp & squeeze Finger strength against resistance 15

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17 Bouchards Nodes Polydactyly Ganglion cyst Abnormal Findings Ulnar deviation flexion Ankylosis Special Assessments Grip strength roll BP cuff into ball and inflate cuff to 20mmHg ask pt to squeeze the infklated cuff note increase in mmhg assess other hand N= usually can achieve 150mHg below 150mmHg due to stroke, myasthenia gravis, MS, rheumatoid arthritis 17

18 Special Assessments Tinel s sign flex arm & palms facing upbriskly tap center of wrist ask pt to describe sensation repeat on other wrist N= no burning or tingling in hand, thumb, or fingers +ve Tinel sign = presence of tingling, burningin hand, thumb, middle or index fingers when median nerve tapped due to compression of median nerve Special Assessments Phalen s sign ask pt to sit flex at elbow and place backs of hands together flex wrist at 90 for at least 1 minute ask pt to describe sensation N= no sensation +ve Phalen test = numbness and paresthesia in the palmar aspect of hand and in fingers which disappears when hands return to normal position caused by carpel tunnel syndrome Special Assessments - Hips Trendelenburg test ask pt to stand with one foot on floor & the other flexed off floor observe symmetry of the iliac crest repeat on other leg N= the iliac crest of the side opposite the wt bearing leg elevates slightly Abnormal Finding: +ve Trendelenburg Test = iliac crest of the non-wt bearing leg drops because of weak gluteus meduis muscle indicative hip dislocation 18

19 Hips Assess Rom of Hips: hip flexion with knee straight hip flexion with knee flexed internal and external rotation abduction adduction Hips Hyperextension flexion against opposing force abduction with opposing force Knees Assess Joint grasp anterior thigh above patella gradually move hand down the suprapatella pouch Assess ROM flexion & extension against resistence Assess Alignment 19

20 Special Assessments - Knees Bulge sign assessment for fluid firmly milk upwards on medial aspect of knee to displace fluid press or tap the lateral aspect of the knee observe the hollow on the medial side of knee for fluid buldge N= no fluid = -ve bulge sign +ve bulge sign = fluid presence Special Assessments - Knees Patellar ballottement performed to detect large effusions firmly grasp the thigh just above the patella with thumb on one side and 4 fingers on the other side and compress with the other hand push the patella back towards the femur feel for a click N= no palpable click Abnormal findings: a palpable click indication fluid present Assessing for Meniscal Tears Apley s grinding sign place pt in prone position manually flex the affected knee to 90 push down on the foot while rotating the lower leg inward and outward assess for limited knee movement or audible clicks during knee joint movement N= No audible clicks heard during joint movement +ve apley s sign = limited movement of knee (locking of knee joint )& audible click indicates torn meniscal cartilage within the knee joint 20

21 Assessing for Meniscal Tears McMurray s s sign place pt supine manually flex knee & hip using hand that is holding the foot internally rotate the leg while applying resistance to the medial aspect of the knee joint (assess medial meniscus) move the knee to position of full extension...note if tolerated d by pt manually flex the knee & hip again using hand that is holding the foot externally rotate the leg while applying resistance to the lateral aspect of the knee joint (assess lateral meniscus) assess for audible click of knee joint N= no click, pt tolerates extension of leg pt is unable to extend leg when audible click is present = +ve+ McMurrays sign indicating torn meniscus Assessing the Cruciating Ligaments Drawer test place pt in supine position with foot flat on table sit on pt R foot place thumbs on tibia attempt to move the tibia forward (anterior drawer test) and backwards (posterior drawer test) N= no movemnt of tibia move tibia forward > 6mm or to move it backwards indicates instability of anterior cruciating ligament of knee Ankles & Feet Inspect & palpate Assess for ROM assess strength 21

22 Ankles & Feet Hallux Valgus (p623) Hammertoe callus Special Assessments Talar tilt test- assesses for ankle sprain have pt sit with feet hanging freely place your hands around heel so that your thumbs are inferior to the malleoli passively evert & invert the ankle note movement, compare affected & unaffected ankle N= equal talar tilt & ROM in both ankles Abnormal findings: Injured ankle has> talar tilt = tear of calcaneofibular ligament Spine Ask pt to stand inspect & palpate spine assess ROM lateral bending hyperextension rotation 22

23 Spine scoliosis kyphosis lordosis list Assessing for Scoliosis Have pt stand upright & straight stand behind the pt draw imaginary line down center of back inspect and palpate progression of spinous processes ask pt to bend forward from waist N= imaginary line remains straight while moving from standing to bent over position Abnormal Finding: moderate to severe deviation of spine due to scoliosis Special Assessments - Spine Straight leg raising test (Las( Lasègue s test) assesses for herniated disc position pt supine raise leg to the anglke at which low back pain occurs while leg is raised dorsiflex foot repeat on other leg N= no low back pain with lifting of extended leg nor with dorsiflexion of foot +ve straight leg raising test indicates irritation in lumbosacral nerve roots pain at <40 dt herniated disc in lumbosacral area 23

24 Crutches Use of Assistive Devices Cane Walker Brace, splint, immobilizer Cast Gerontological Variations Decrease in bone density Weaker bones, increased risk of osteoporosis Muscle atrophy Decreased muscle strength Decreased overall body mass Increase in fat content Deterioration of articulating cartilage Vertebral inflexibility Thoracic kyphosis 24