1. Muscoloskeletal System

2. Musculoskeletal System Consists of:
Bones
Muscles
Joints
cartilage

3. 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.

4. Bones 206 Bones & cartilage are types of Connective tissue
Bone is hard and rigid and dense

5. 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.

6. 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.

7. 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

8. 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

9. 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

11. 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

12. Spine 33 Vertebrae Spinous process posterior midline 7 Cervical
12 Thoracic
5 Lumbar
5 Sacral
3 – 4 Coccygeal

13. 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

14. 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

15. 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

16. Wrists and Carpals Wrist –articulation of radius & carpal bones
Permits flexion, extension & side to side deviation
Metacarpophalangeal & interphalangeal joints – permit finger flexion and extension

17. 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

18. Knee Femur, tibia & patella Largest joint
Hinged joint & largest synovial membrane
2 cartilages – medial & lateral menisci cushion the tibia & femur

19. Ankle & Foot Ankle joint is the articulation of Tibia, fibula & talus
Hinged joint
Dorsiflexion
Plantar flexion
Landmarks
Medial & lateral malleolus

20. Aging adult Loss of bone density = osteoporosis Postural changes
↓ height due to shortening of the vertebral column

21. Subjective Data Joints Muscles Pain Stiffness Swelling, heat, redness
Pain, cramps
weakness

22. Subjective Data Bones Functional Assessment ( ADL’s )
Pain
Deformity
Trauma
Functional Assessment ( ADL’s )
Self – care behaviors

23. Objective Assessment Physical Exam Musculoskeletal
Purpose
To assess function for ADL’s
Screen for abnormalities

24. Screening Exams Inspection Palpation
ROM with movement active or passive if apparent limitations
Age Specific

25. Important to : Client comfort Systemic approach Support joints
Bilateral exam

26. Equipment
Tape measure
Goniometer
Skin marking pen

27. Inspection
Size & contour of joint
Color, swelling, masses, deformity

28. Palpation Each joint Temperature Muscles
Bony articulations joint capsule
Tenderness, swelling, masses

29. ROM Active ROM Limitation – try passive motion
or in ROM, use a goniometer to measure angles

30. Muscle Testing Repeat movements for Active ROM
Client flexes & holds against opposing force
= bilaterally, resists opposing force

31. Grade muscle strength (pg. 616)
Values 0- 5
Grade 5= Normal –Full ROM against gravity, full resistance

33. TMJ Swelling, tenderness, crepitation
Crepitation = audible & palpable crunching or grating with movement

34. 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

35. 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

36. Test for Shoulder ROM Flexion Extension Internal rotation
External rotation
Abduction
Adduction
Circumduction
Test for strength; shrug shoulders, flex forward, up & abduct against resistance

37. 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

38. ROM of Elbow
Flexion
Extension
pronation
supination

39. Muscle Strength of Elbow
Flex elbow – then extend against resistance applied just proximal to the wrist

40. Wrist and Hand Inspect Palmar & dorsal surface
Position, contour and shape
Swelling, redness, deformity or nodules

41. 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

42. ROM of Wrists and Hands Hyperextension Palmar flexion
Flexion of fingers
Abduction for fingers
Opposition
Ulnar deviation, Radial deviation

43. 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 median nerve of wrist. In carpel tunnel + result = burning & tingling

44. Hip Inspect hip joint with spine when client is standing
Client is supine, palpate the hip joints
ROM

45. 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

46. Ankle & foot Inspect while nonweight- bearing, then standing & walking
ROM
Muscle strength

47. Spine Standing Inspect Palpate spinous processes
ROM of spine is checked by asking to touch toes

48. 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