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PA Musculoskeletal
| Question | Answer |
|---|---|
| joint (articulation) | place of union of 2 or more bones, functional units of M.S. system because they permit mobility |
| nonsynovial joints (synarthosis) | bones united by fibrous tissue or cartilage and are immovable (sutures) or only slightly movable (vertebrae) |
| synovial joints (diarthrosis) | freely movable joints because bones are separated from each other and enclosed in a joint cavity filled with synovial fluid (allows sliding) |
| catrilage | covers surface layer of opposing bones, cushions bones and gives smooth surface to facilitate movement. Avascular (nourishment from synovial fluid), slow cell turnover, tough, firm consistency, but is flexible |
| ligaments | fibrous bands running from bone to bone, strengthens the joint and helps prevent movement in undesirable directions |
| bursa | enclosed sac filled with synovial fluid located in areas of potential friction (shoulder, knee) and help muscles and tendons glide moothly over bone |
| fasciculi | bundles of muscle fibers that make up skeletal muscles |
| tendon | attached bone to muscle |
| flexion | bending of limb at joint |
| Extension | straightening limb at joint |
| o Abduction | moving limb away from midline |
| o Adduction | moving limb toward the midline |
| o Pronation | turning forearm so palm is down |
| o Supination | turning forearm so palm is up |
| o Circumduction | moving arm in circle around shoulder |
| o Inversion | moving sole of foot inward at ankle |
| o Eversion | moving sole of foot outward at ankle |
| o Rotation | moving head |
| o Protraction | moving body part forward and parallel to ground |
| o Retraction | moving body part backward and parallel to ground |
| o Elevation | raising a body part |
| o Depression | lowering a body part |
| screening examination- M.S. | o inspection and palpation of joints integrated with each body region and observation of ROM |
| Ortolani Maneuver | with infant supine, flex knees, holding your thumbs togehter on inner mid thighs and fingers on hips touching greater trochanters. Adduct legs with thumbs touching, then abduct until legs touch table. Should be smooth and have no sound |
| inspection of joints | not size and contour, inspect skin and tissues over joints for color, swelling, and any masses or deformity |
| palpation of joints | note skin temperature, muscles, bony articulations, tenderness, swelling, or masses which signal inflammation |
| Range of motion | ask for active voluntary ROM while stabilizing the body area proximal to that being moved |
| muscle testins | test strength of prime mover muscle groups for each joint, ask person to flex and hold as you apply opposing force. Should be equal bilaterally and should resist opposing force |
| cervical spine exam | inspect alignment of head and neck, palpate spinous processed, sternocleidomastoid, trapezius, and paravertebral muscles , ROM described in degrees |
| shoulder exam | inspect and compare, check size and contour, check for abnormal swelling, have patient point out pain with opposite hand, palpate both shoulders, noting any muscle spasm or atrophy, swelling, heat, or tenderness, test ROM (note crepitation) |
| shoulder ROM | forward flexion 180, hyperextension 50, internal rotation 90, external rotation 90, abduction 180, adduction 50 |
| elbow exam | inspect size, contour in flexed and extended positions, look for deformity, redness, swelling, palpate extensor surface of elbow, olecranon process, and medial/lateral epicondyles of humerus, palpate olecranon bursa for heat, swelling,tenderness, nodules |
| elbow ROM | flexion of 150-160 degrees, extension 0. pronation and supination- 90 degrees |
| elbow strength test | stabilize person's arm with one hand, have person flex elbow against your resistance applied just proximal to wrist. Ask person to extend elbow agaisnt your resistance |
| wrist and hand exam | inspect on dorsal and palmar surfaces (wrist is normally in slight extension), look for lesions, deformities, swelling,tenderness. Muscles should be fll, with rounded mounds under thumb and pinky. Palpate all joints |
| wrist and hand ROM | hyperextension 70, palmar flexion 90. Metacarpophalangeal flexion 90/hyperextension 30, ulnar deviation 50-60, radial deviation 20, abduction of fingers 20 |
| Phalen test | test for carpal tunnel, ask person to hold both hands back to back while flexing the wrists at 90 degrees. Acute flexion of wrist for 60 seconds produces no symptoms in normal hand |
| Tinel sign | direct percussion of the location of the median nerve at the wrist produces no symptoms in normal hand |
| Hip exam | inspect joint when sitting, note symmetry of iliac crests, gluteal folds, and equal buttocks. Smooth even gait reflects equal leg length and functional hip motion. Palpate hip joints in supine position- should feel stable/symmetric, no tenderness/crepitus |
| hip ROM | flexion 90, flexion w/ knee bent 120, internal rotation 40, external 45, abduction 40-45, adduction 20-30, hyperextension 15 |
| knee exam | inspect alignment, shape, contour, patellar burse/suprapatellar pouch, quads for atrophy, palpate in supine , start 10 cm above patella.Should feel solid, smooth, no warmth/tender/thickening/nodules, plpate tibiofem. joint/infrapatellar fat pad/patella |
| knee ROM | flexion of 130-150, extension 0, hyperextension 15 in some |
| ankle and foot exam | inspect while sitting, standing and walking, weight bearing should be in middle of foot, support ankle by grasping heel with fingers while palpating with thumbs. joint spaces should feel smooth and depressed with no swelling, tenderness.Palpate toes |
| ankle and foot ROM | plantar flexion 45, dorsiflexion 20, eversion 20, inversion 30 |
| # cervical vertebrae | 7 |
| # thoracic vertebrae | 12 |
| # lumbar vertebrae | 5 |
| # sacral vertebrae | 5 |
| # coccygeal vertebrae | 3-4 |
| inspection of spine from back | note whether its straight, follow imaginary line down spinous processes, note horizontal positions for shoulders, scapulae, iliac crests, and gluteal folds and equal spaces between arm and lateral thorax |
| inspection of spine from side | note normal convex thoracic curve and concave lumbar curve |
| kyphosis | enhanced thoracic curvature (common in aging people) |
| lordosis | pronounced lumbar curvature (common in obese and pregnant) |
| spine ROM | bend forward, touch toes- 75-90, lateral bending 35, hyperextension 30, rotation of 30 degrees bilaterally |
| rheumatoid arthritic | chronic systemic inflammatory disease of joints/connective tissue. Inflammation of synovial membrane=thickening, fibrosis, bony ankylosis. heat, redness, swelling, painful motion, fatigue, weakness, weight loss, low grade fever, fusiform swelling |
| osteoporosis | decrease in skeletal bone mass when rate of bone resorption >bone formation. Increases risk for stress fractures. Occurs primarily in postmenopausal white women. Associated w/smaller ht. and wt., younger at menopause, lack of activity, lack of estrogen |
| osteoarthritis | noninflammatory, localized progressive disorder involving deterioration of articular cartilages and subchondral bone/formation of new bone impaired. Affected joints have stiffness, swelling, hard bony protuberances, pain and limitation w/motion, |
| heberden nodes | hard, non tender nodules 2-3 mm or more; bony overgrowths of the distal interphalangeal joints |
| genu varum | bow-legged |
| genu valgum | knock knees |
| epicondylitis | tennis elbow;pain at lateral epicondyle of humerus, radiates down extensor surface of forearm. Pain can be located with one finger, resisting extension of hand will increase pain. Occurs w/activities combining excessive supination and pronation of forearm |
| carpal tunnel syndrome | caused by chronic repetitive motion, occurs between 30-60 yrs of age and 5x more common in women than men. S/S pain, burning and numbness, positive Phalen and Tinel tests, atrophy of thenar muscles |
| osgood schlatter disease | painful swelling of tibial tubercle (just below knee), probably from repeated stress on patellar tendon. Occurs in puberty and mostly in males. Occurs with weightbearing exercise. Usually self limiting and resolves |
| scoliosis | lateral curvature of thoracic and lumbar segments of the spine, usually with some rotation of involved vertebrae |
Created by:
alexadianna
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