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PA Musculoskeletal

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