Knowledge and Process
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| What is the MSK made up of | bones - 206
joints - nonsynovial, synovial, cartilage, ligaments, bursa
muscles - fasciculi (bundles of muscle fibres), tendon
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| What is the function of the MSK? | support (posture and positioning)
movement
protection (encases and protects inner vital organs)
hematopoiesis (RBC production)resevoir of essential minerals
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| What are the different types of joints | non synovial - fibrous, cartilaginous
synovial
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| what is a fibrous joint? ex? | joints connecting bones without any movement
bones of the skull
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| what is a cartilaginous joint? ex? | joint where bones are connected by cartilage - allow only limited movement
spine, ribs, pelvis
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| what is a synovial joint? ex? | joints with bursa containing synovial fluid which lubricates and allows free movement (supported and facilitated by cartilage, ligaments, tendons and muscles)
knee, shoulder, elbow, wrist, knee, ankle
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| what is a ginglymus? ex? | hinge joint
flexion and extension only
elbow, knee, ankle, interphalangeal joints of hand
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| What is a condyloid? ex? | write and carpal joints
permit movement in tow different planes
wrist - radiocarpal (flexion/extension) side to side deviation
midcarpal - flexion/ extension, some rotation
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| what is a ball and socket ex? | allow movement on several axis
flexion, extension, abduction, adduction, rotation and circumduction
shoulder girth, hip
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| What is an anthrodial? ex? | gliding/plane join
permits gliding or sliding movements
clavicle
metatarsals
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| what is a cylindrical joint? ex? | pivot joint
allows rotation, pronation, supination
cervical spine, forearm
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| what is the temporal mandibular joint (TMJ)? | ginglymus and anthrodial joint at jaw
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| what accounts for 40-50% of body weight | muscles
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| what is skeletal muscle composed of | muscle fibers (faciculi)
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| how to muscles attach to bone? | tendons
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| extension/flexion | bending movement that decreases the angle between two parts
bending movement that increases the angle between body parts
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| abduction/adduction | motion that moves a structure away from or towards the center of the body (midline)
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| circumduction | concical movemnt of a body part (ball and socket joint)
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| internal / external rotation | rotation of body parts towards the axis of the body or away from the center of the body
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| pronation/supination | rotation of the forearm where it goes from palm up to down and vice versa
rotation of the foot big toes out and in
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| protraction/ retraction | moving forward and moving back
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| depression/ elevation | moving up and down
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| opposition/ reposition | grasping with the thumb and releasing an object
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| inversion/eversion | sole of the foot towards or away from the midline of the body
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| ulnar deviation/ radial deviation | adduction of the wrist, abduction of the wrist
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| what are developmental considerations in infants and children for the MSK | epiphyseal plates vs epiphyseal line
spinal curvature C to s to ss
developmental dysplasia of hip
growing pains
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| what are developmental considerations in pregnant women for the MSK | increased joint mobility
lordosis (big butt)
spinal curvature
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| what are developmental considerations in pregnant women for the MSK | osteoporosis
decreased height (thinning of intervertebral discs)
influence of exercise on skeletal mass
kyphosis
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| what is the leading cause of pain, disability, and health care utilization in canada | arthritis
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| who is at greater risk for arthritis | aging women with lower education and lower income levels
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| what are osteoarthritis risk factors | job, nutrition, female, age, smoking
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| rickets | vit D, calcium or phosphate deficiency
softening/ weakening of the bone
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| osteoporosis | porous bones, calcium deficiency
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| what are endocrine disorders associated with MSK | carpal tunnel: pregnancy, hypothyroidism, diabetes, acromegaly
joint problems: hyperthyroidism, hyperparathyroidism
muscle atrophy: adrenocorticoid insufficiency
bone disorders: glucocorticoid excess
hyperparathyroidism
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| what are neuromusclar diseases associated with MSK disorders | CVA - stroke
parkinson's
MS
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| hyperthyroidism/ hyperpituitarism in MSK system | auto immune disorder
increased risk of disorders of skeletal system
slow bone growth resulting in short limbs
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| excess GH from anterior pituitary in MSK system | depends on onset, if it was before or after the epiphyseal plate closure at puberty
acromegaly (after)
gigantism (before)
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| what should you watch for to notice endocrine disorders that impact the MSK system in children | delayed tooth development
delayed puberty
hoarse voice/ cry (if infant)
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| congenital hip dysplasia | misalignment of the hip joint - head of femur does not sit properly in the acetabulum
bilateral or unilateral
present at birth
higher risk with multiple births due to crowing in utero
trendelenburg sign
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| talipes equinovarus | when a baby's foot is stuck in inversion/ eversion
congenital defect often picked up by nurses
best results if treated early on with better resolution
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| trendelenburg sign | when a child stands on affected side, shifting occurs to instability (positive)
pelvis line drop, lean toward affected side
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| Legge-calve-perthe disease | coxa plana
aseptic necrosis of femoral head
hip or referred knee pain
may be mistaken for growing pains
progressive flattening of femoral head
limp
tx: non weight bearing abduction brace until bone grows and heals. may need hip replacement
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| muscular dystrophy | causes progressive muscle degeneration
always affects symmetrical muscle groups
may have mild mental imipairment
gower's sign
die early from obesity and cardiopulmonary disorders
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| Gower's sign | when child rises from floor there is a lack of lower body strength so the child gets up in a climbing fashion
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| scoliosis | lateral curvature of the spine
may interfere with lung expansion
congenital
secondary to neuromuscular conditions
idiopathic - most common in girls
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| Juvenile rheumatoid arthritis | idiopathric
girls aged 1-3 or 8-10
chroinc inflammation of joints and tissues - joint effusion
eventual erosion, destruction and fibrosis of articular cartilage
adhesions
results in loss of function (ankylosis)
can be single or multiple joints
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| ankylosis | loss of function in joints
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| joint effusion | chronic inflammation of jionts and tissues
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| adhesion | band of scar like tissue that forms between two surfaces inside the body causing them to stick together
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| bone cancers | osteosarcoma
Ewing's sarcoma
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| osteosarcoma | important to treat early because it can metastasize
more common in adolescent boys
often in long bones - 6th leading cause of cancer in children under 15
S&S - pain, swelling, limp, pathologic fractures
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| ewing's sarcoma | translocation of Genes 11 and 12
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| Hemophilia | bleeding that doesn't clot
bleeding in the knees, elbows, or other joints
no obvious injury
initial tightness in the joint with no real pain or any visible signs of bleeding. then joint becomes swollen, hot to touch and painful to bend
treat quickly
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| what are the different types of fractures | complete - bones break completely
comminuted - complete separation with little pieces broken off
compound - through skin (risk of infection)
greenstick - not complete
S&S pain, swelling, redness, bruising, abnormal position, inability to move
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| osteomyelitis | infection of bone from
open fracture through blood stream
usually bacterial (staph aurous), at risk for pathological fractures
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| Rating scale for Muscle Strength complete ROM against gravity and full resistance | 5/5
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| Rating scale for Muscle Strength complete ROM against gravity and moderate resistance | 4/5
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| Rating scale for Muscle Strength complete ROM against gravity | 3/5
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| Rating scale for Muscle Strength complete ROM with joint supported; cannot perform ROM against gravity | 2/5
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| Rating scale for Muscle Strength muscle contraction detectable, but not movement of the joint | 1/5
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| Rating scale for Muscle Strength no visible muscle contraction | 0/5
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| SEADS (muscle) | swelling/ strength
erythema (reddness)
atrophy
deformity
skin changes
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| atony | lack of residual tension in muscle tone
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| hypotonicity (muscle tone) | diminished tone of skeletal muscles
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| spasticity | hypertonic, so the muscles are stiff and movements awkward
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| spasm | sudden violent involuntary contraction of a muscle
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| fasciculation | involuntary twitching of muscle fibres
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| tremors | involuntary contraction of muscles
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| what is the shape of the spine in adults | double s
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| what are the movements of the spine? | flexion, extension, abduction, rotation
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| to what degree can the thoracic and lumbar spine move flexion extension hyperextension lateral flexion rotation | 90
0
30
35
30
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| What are the movements of the shoulder | abduction, adduction, circumduction, rotation, flexion, extension
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| what are common abnormalities of the shoulder | atrophy
dislocated shoulder
joint effusion
tear of the rotator cuff
frozen shoulder (adhesive capsulitis)
subacromial cursitis
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| subacromial bursitis | inflammation of the bursa in the shoulder that causes upper extremity muscle weakness
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| what are the movements of the hand | flexion, extension, rotation, side to side deviation
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| phalen's test | test for carpal tunnel
putting back of hands together
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| Tinel's sign | lightly percussing nerves in hand
(+) tingling sensation and pain
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| to what degree can the wrist/ hand move? flexion extension hyperextension radial deviation ulnar deviation | 90
0
70
20
55
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| ganglyion cyst | non cancerous lumps that develop along the tendons or joints of ones wrists or hands
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| carpal tunnel syndrome | median entrapment neuropathy that cuases paresthesia, pain, numbness and other symptoms in the distribution of the median nerve due to is compression at the wrist in the carpal tunnel
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| colles' fracture | fracture of the distal radium in the forearm with dorsal and radial displacement of the wrist and hand (landing on wrist with hand up
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| Dupuytren's contracture | fixed flexion contracture of the hand due to palmar fibromatosis
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| swan-neck and boutonniere deformities | hyperextension of the proximal interphalangela (PIP) joint and flexion of the distal interphalangela (DIP) joint
presents the flexion of the PIP and hyperextension of the DIP
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| ulnar deviation/ drift | swelling of metacarpophalangeal joints causes the fingers to become displaced, tending towards the little finger
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| degenerative joint disease or osteoarthritis | mechanical abnormalities involving degradation of joints
joint pain, tenderness, stiffness, locking and sometimes an effusion
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| acute rheumatoid arthritis | chronic inflammatory disorder that typically affects the joints in your hands and feet
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| syndactyly | condition where two or more digits are fused together
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| polydactyl | having an abnormal number of digits
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| what movements can the elbow make | flexion and extension
pronation and supination - radioulnar joints
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| to what degree can the elbow move flexion extension pronation supination | 150-160
0
90
90
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| olecranon bursitis | inflammation and swelling behind the elbow
student's elbow
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| subcutaneous nodules | slightly elevated lesions on or in the skin
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| lateral epicondylitis | outer part of the elbow becomes sore and tender caused by overuse of arm, forearm and hand muscles that results in elbow pain
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| To what degree can the hip move flexion extension hyperextension\abduction adduction internal rotation external rotation | 90; 120 with knee flexed
0
15
45
30
40
45
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| what is a fss, bruising, swellingractured hip | inability to move after fall
inability to weight bare weight
severe pain in hip/ groin
stiffne
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| sinovitis | inflammation of the synovial membrane
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| what is the expected degree of movement in the knee flexion extension hyperextension | 130
0
15
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| prepatellar bursitis | carpet layer's knee - swelling of the bursa in the patellar
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| swelling of menisci | tear in the cartilage in the middle of the knee that causes swelling
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| post-polio muscle atrophy | affects polio survivors that causes muscle death
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| chrondromalacia patella | overuse, injury and other factors that lead to damage to the cartilage under thte kneecap
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| what are the expected degrees of movement in the ankle and foot dorsifelxion plantar flexion inversion eversion | 20
45
30
20
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| achilles tenosynovitis | inflammatory condition of the sheath of the achilles tendon (paratenonitis)
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| Tophi | deposit of monosodium urate crystals in people with longstanding high levels of uric acid in the blood
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| hallux valgus with bunion and hammer toes | deformity in the foot, deformity of the big toe where it curves in towards the middle of the foot and the bone protrudes out on the outside (bunion)
hammer toe is when the toes look contracted
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| ingrown toenail | when the toenails grows into the nail fold
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| plantar wart | wart caused by HPV occuring on the sole
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| ankylosing spondylitis | inflammatory disease the can cause some of the vertebrae in your spine to fuse together
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| osteoarthritis vs rheumatoid | oste: most common, overuse, wear and tear
rheu: autoimmune disease, snynovial joints - ankylosis
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| osteoporosis | porous, spongy, weak bones
risk: menopausal women, smoking, increased alcohol intake, decreased calcium, sedentary lifestyle
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| bulge sign knee | fluid wave presents medially
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| ballottement of the patella | palpable click as patella strikes teh trochlea
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| mcmurray test | click hear or palpated on above maneuvers
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| what test should you use for: carpal tunnel | phalen's test
Tinel's test
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| what test should you use for: rotator cuff | arm drop test - patient can not hold arm at 90 degrees
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| what test should you use for: lumbar spine disc herniation | straight leg raising (lasegue test)
pain with leg raise
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| what test should you use for: knee ligaments | mcmurray's test
drawer sign
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| what test should you use for: effusion | bulge test
ballottement
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| What are the 4 quadrants of the breast | upper outer; upper inner; lower outer lower inner
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| gynecomastia | benign enlargement of breast tissue in males
usually occurs during puberty
temporary
usually only in one breast
impact is related to body image
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| what are abnormal findings in a breast exam | dimpling
nipple retraction
edema - peau d'orange
deviation in nipple pointing
fixation
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| what is fixation of the breast | asymmetry, distortion, or decreased mobility of the breast
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| what are abnormal findings in a breast exam during lactation | plugged duct
breast abscess
mastitis
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| what are the axillary nodes | central
pectoral
subscapular
lateral
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| what are developmental considerations for adolescents (Rectum, Anus, reproductive structures) | puberty
asymmetry/ tenderness
thelarche and menarche
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| thelarche | onset of secondary breast development usually occuring at the beginning of puberty
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| menarche | first menstrual cycle
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| what are developmental considerations for pregnant women | breast changes/ early sign of pregnancy
colostrum (first milk)/ lactation
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| what is the developmental considerations for older women (Rectum, Anus, reproductive structures) | menopause and atrophy of glandular tissue
replaced by fibrous connective tissue
decrease in size and elasticity
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| what are the developmental considerations for males (Rectum, Anus, reproductive structures) | gynecomastia - enlargement of the male breast tissue
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| what are causes of a breast lump | benign breast disease - fibroscystic breast disease
cancer
fibroadenoma
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| Gail Model | calculate individual risk for breast cancer
calculates 5 year and lifetime cumulative lifetime risk
takes into account age, family history, age at menarche, age at first live birth
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| what are different forms of breast cancer screening | self breast exam
clinical breast examination
mammography
breast cancer gene test
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| sensitivity | ability to test to correctly identify those patiens with the disease (false negatives)
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| Specificity | ability of the test to correctly identify those patients without the disease (false positive)
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| what are abnormal findings in urinary | urethritis (urethral discharge and dysuria)
STIs
renal calculi (kidney stone)
bladder stones (vesico calculus/cystolith)
urethral stricture
acute urinary retention
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| abnormal characteristics of urine | cloudy, pale yellow, dark amber, bright yellow, orange, pink or red, tea, dark grey, blue
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| adnexa | appendages of an organ
ex fallopian tubes, ovaries, ligaments and supporting tissues
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| squamocolumnar junction | area in the cervix where squamous vaginal tissue meet columnar epithelial uterine tissue and is a common site for neoplastic changes
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| rectouterine pouch (cul-de-sac of Douglas) | indicative of a ruptured follicle, ovarian cyst or ectopic pregnancy
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| goodell's sign | It is a significant softening of the vaginal portion of the cervix from increased vascularization. This vascularization is a result of hypertrophy and engorgement of the vessels below the growing uterus.
4-6 weeks
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| Chadwick's sign | bluish discoloration of the cervix, vagina, and labia resulting from increased blood flow.
6-8 weeks
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| Hegar's sign | isthmus of uterus softens
6-8 weeks
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| mucus plug | A jellylike plug that seals off the cervix and is expelled before delivery
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| sanguineous or leukorrhea (mucoid discharge) | thick whitish or yellow vaginal discharge that may be normal around puberty
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| Pedersen speculum |
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| Pediculosis | crab lice
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| hepes simplex virus | type 2 (herpes genitalis)
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| syphilitic chancre | firm, painless, non-itchy skin ulcerations
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| what are abnormal findings on the external genitalia | crab lice, Herpes, Syphilis, contact dermatitis, HPV, abscess of Bartholin's gland, urethritis, urethral caruncle, tumors of vulva
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| what are abnormal findings on the pelvic musculature | cystocele - herniation of the bladder through a weakened pelvic wall into the vagina (Kegel)
rectocele - herniation of the rectal tissue into the vagina
uterine prolapse
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| what are common causes of vulvovaginal inflammations | atrophic vaginitis
candidiasis (moniliasis)
trichomoniasis
bacterial vaginosis
chlamydia
Gonorrhea
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| what are common conditions of uterine enlargment | pregnancy,
myomas (leiomyomas, uterine fibroids)
carcinoma of endometrium
endometriosis
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| what are abnormal findings (adnexal enlargement) | fallopian tube
acute salpingitis; pelvic inflammatory disease
ectopic pregnancy
fluctuant ovarian mass ovarian cyst
solid ovarian mass ovarian cancer
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| what are abnormal findings in the scrotum | cryptorchidism
testicular tortion
epididymitis
varicocele
diffuse tumour
hydrocele
scrotal hernia
orchitis
scrotal edema
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| what are the different types of inguinal and femoral hernias | indirect - failure of embryonic closure of teh deep inguinal ring after the testicle has passed through
direct - protrusion through a weakened area in the transversalis fascia near the medial inguinal fossa
femoral
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| what are abnormal findings in the prostate gland | benign prostatic hypertrophy (BPH)
prostatitis
carcinoma
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| what are abnormal findings of the anal region | pilonidal cyst or sinus
anorectal fistula
fissure
hemorrhoids
rectal prolapse
pruitus ani
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| what are abnormal findings of the rectum | abscess
rectal polyp
fecal impaction
carcinoma
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| what are the arteries in the arm | ulnar
radial
brachial
axiallary
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| what are the arteries in the leg | femoral
popliteal
dorsalis pedis
posterior tibial
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| what are the 2 peripheral artery diseases | occlusions
aneurysms
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| what is an occlusion | caused by atherosclerosis or ateriosclerosis (diabetes)
chronic buildup of fatty streaks, fibroid plagues, calcification of vessel wall, trombus formation
reduces blood flow (oxygen and nutrients)
may results in aterial (ischemic ulcer)
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| what is an aneurysm | sac formed by dilation in artery wall; most common in aorta
vessel wall weakened by atherosclerosis
ballloon-like enlargement from effect of blood pressure
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| what is the venous system made up of | venins, venules, perforators (connecting veins)
- have thinner walls than arteries
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| what are key components of venous flow | pressure gradient caused by breathing
contraction ofskeletal muscles
intraluminal valves
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| what are the veins in the arm? | basilic
cephalic
median antebrachial
median cubital
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| what are the deep veins in the ary subclavianarm | ulnar
radial
brachial
axiallary
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| what are the deep veins in the leg | femoral
popliteal
tibial
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| what are the superficial veins in the leg | great saphenous
small saphenous
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| what is peripheral venous disease | interruption in venous flow
acute or chronic
obstruction, incompetence, trauma
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| what are examples of peripheral venous disease | varicose veins
deep vein thrombosis
thrombophlebitis
venous (stasis) ulcer
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| what is lymphedema | interruption of lymphatic flow due to
scarring (sergery, trauma)
removal of lymph nodes
radiation therapy
chronic infection
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| what organs are related to lymphatic systems | spleen, tonsils, thymus gland
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| what are cardiovascular risk factors | smoking
hyperchlesterolemia
diet high in saturated fats
sedentary lifestyle
hypertension
diabetes
obesity
genetics
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| what are pre-existing diseases that attribute to CVD | peripheral artery disease
venous disease
lymphatic disorders
medications
surgery
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| what type of pain is this deep usually in calf or lower intermittent claudication (cramp) chronic, aggrivated by activity, walking and elevation of limb pain relieved with rest cool pale limbs/ feet/ toes ulcers on toes, heels | aterial
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| what type of pain is this? arterial/ venous intermittent claudication (cramp) | arterial
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| what type of pain is this? arterial/ venous chronic, aggravated by activity, walking (stairs and distance), and elevation of limb | arterial
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| what type of pain is this? arterial/ venous pain relieved with rest, if not (dangling - indicates severe disease) | arterial
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| what type of pain is this? arterial/ venous risk factors: aging, genetic predisposition, hx of HTX, smoking diabetes, hypercholestermia, obesity vascular disease | arterial
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| what type of pain is this? arterial/ venous pain: calf and lower leg | venous
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| what type of pain is this? arterial/ venous aching tired, feeling heavy or full | venous
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| what type of pain is this? arterial/ venous chronic , increases at end of day | venous
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| what type of pain is this? arterial/ venous exacerbated by prolonged standing or sitting | venous
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| what type of pain is this? arterial/ venous relieved by elevation of limbs, lying or walking | venous
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| what type of pain is this? arterial/ venous associated with varicosities, edema, weeping ulcers (often on lower legs | venous
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| what type of pain is this? arterial/ venous risk factors: work environment, pregnancy, prolonged bedrest, trauma, trhbophebitis | venous
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| how do you quantify edema? | 1+ 2mm 2+ 4mm 3+ 6mm 4+ 8mm
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| deep vein thrombosis | acute blood clot in deep vein (usually leg) immediate intervention to start anticoagulants is necessary
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| pulmonary embolism | acute, life threatening emergency blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body
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| compartment syndrome | acute , life threatening condition of the limbs which occurs after an injury, when there is insufficient blood supply to muscles and nerves
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| what are the 6 Ps of acute assessment for the death of distal tissues | pain, pallor, pulselessness, poikilothermia/polar senstation, paresthesia, paralysis
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| poikilothermia | cold to touch
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| paresthesia | burning, tingling, or numbness
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| what are developmental considerations in infants and children (cardio vascualar and peripheral) | transient acrocyanosis and skin mottling
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| what are developmental considereations in pregnant women(cardio vascualar and peripheral) | varicose veins, growing uterus obstructs drainage of iliac vein and inferior vena cava, dependent edema
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| what are developmental considerations in older adults (cardio vascualar and peripheral) | dosalis pedis, posterior tibial pulses more difficult to find, trophic changes associated with arterial insufficiency, arteriosclerosis, atherosclerosis, increased risk of DVT
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| arteriorsclerosis | thickening, hardening and loss of elasticity of the walls of arteries
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| atherosclerosis | thickening of the artery wall as a result of the accumulation of calcium and fatty materials (cholesterol and triglyceride)
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| ankle-brachial index | ratio of the blood pressure in the lower legs to the blood pressure in the arms
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| modified allen test | can you make the hand turn white
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| manual compression test for varicosities | compress vein, feel for wave – no wave felt competent valves, wave felt incompetent valves
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| what are peripheral vascular diseases in the arms | raynaud’s phenomenon, lymphedema
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| what are abnormal heart rhythms | bradycardia, tachycardia, sinus arrhythmia, av blocks, BBB, ectopic beats, Afib, Vfib
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| what are developmental considerations in cardio for infants and children | foramen ovale, ductus arteriosus, murmurs more common in first days, normal heart rates, position of heart in chest, innocent heart murmurs
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| what are developmental considerations in pregnant women (cardio) | increase in BV, increase in SV and CO, heart sound changes
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| diaphoresis | excessive sweating
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| what are murmurs caused by valvular defects | midsystolic ejection murmurs, pansystolic regurgitant murmurs, diastolic rumbles of atrioventricular valves, early diastolic murmurs
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| paresis | weakness of involuntary movement or impaired movement
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| paralysis | loss of motor function as a result of a lesion
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| dysmetria | inability to control range of motion muscles
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| paraesthesia | abnormal sensation, such as burning, tingling
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| dysarthria | difficulty forming words
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| dysphasia | difficulty with language comprehension or expression
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| midsystolic ejection murmurs | aortic senosis, pulmonic stenosis
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| pansystolic regurgitant murmurs | mitral regurgitation, tricuspid regurgitation
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| diastolic rumbles of atrioventricular valves | mitral stenosis, tricuspid stenosis
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| early diastolic murmurs | aortic regurgitation, pulmonic regurgitation
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| list the congenital heart defects | patent ductus arteriosus, atrial septal defect, ventricular septal defect, tetralogy of fallot, coarctation of the aorta
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