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 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 Muscles Pain Stiffness Swelling, heat, redness Pain, cramps weakness

Subjective Data Bones Functional Assessment ( ADL’s ) 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 Palpation Head & neck alignment Spine Spinous processes, Trapezius, Paravertebral muscles ROM, flexion, extension, hyperextension, lateral flexion, rotation, circumduction Repeat applying opposing force

Shoulders Inspect Palpate Bilateral comparison 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 Palpate 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