Musculoskeletal Chapters 22 & 40

What is being assessed for in a musculoskeletal assessment?
function for ADLs and to screen for any abnormalities
Describe a screening musculoskeletal examination.
∙ inspect and palpate joints
∙ observe ROM
∙ age-specific screening
** this is usually what is done for most people
Describe the complete musculoskeletal examination.
used for people with an articular disease, a history of musculoskeletal symptoms, or any problems with ADLs
What should be initially surveyed?
∙ posture
∙ gait and mobility
∙ balance
∙ coordination
What needs to be inspected for?
∙ size, color, and contour of extremities
∙ symmetry and normal function
∙ swelling, masses, or deformities
** swelling is present if there is joint irritation
What needs to be palpated?
palpate each point including the skin for temp, its, muscles, bony articulations, and areas of a joint capsule
** note ant heat, tenderness, swelling, or masses
What is the difference in passive ROM and active ROM?
∙ passive ROM: helping the patient complete the ROM if a limitation is noted
∙ active ROM: the patient completing ROM themselves
What is the most significant sign of joint disease?
limitation in ROM
Describe muscle testing.
it tests the strength of the prime-mover muscle groups for each joint
∙ have the patient repeat ROM and ask them to flex and hold as you apply opposing force
** muscle strength should be equal and bilateral
Describe the muscle testing grading scale.
∙ Grade 5: full ROM against gravity, full resistance, 100% normal, normal assessment
∙ Grade 4: full ROM against gravity, some resistance, 75% normal, good assessment
∙ Grade 3: full ROM with gravity, 50% normal, fair assessment
∙ Grade 2: full ROM with gravity eliminated (passive ROM), 25% normal, fair assessment
∙ Grade 1: slight contraction, 10% normal, trace assessment
∙ Grade 0: no contraction, 0% normal, zero assessment
Review Risk for Fall scales on canvas.
What is an acute assessment focused on?
∙ identifying the specific problem
∙ alleviating pain
∙ preventing complication
What do you look for in an acute assessment?
∙ alignment of limbs, joints, and the spine
∙ symmetry of the size, shape, position, and movement of extremities
∙ soft-tissue injury and bleeding
What are some expected examinations in a pregnant woman?
∙ progressive lordosis
∙ kyphosis toward the third trimester
∙ slumped shoulders
∙ protuberant abdomen
∙ waddling gait
What is the maneuver to check if an infants legs for dislocation dysplasia?
the Ortolani maneuver should be performed at every doctor visit until the infant reaches 1 year old
∙ it feels like a clunk if it the hip is not in place
∙ it should feel smooth and has no sound
What is common among adolescents?
∙ kyphosis from poor posture
∙ scoliosis
What is common among the aging adult?
∙ kyphosis
∙ slight flexion of the hips and knees
Describe performing an assessment for ADLs on an aging adult.
∙ walking with shoes on
∙ climb up stairs
∙ walk down stairs
∙ pick up an object off the floor
∙ rise up from sitting
∙ rise up from lying in bed
** review on page 616 Jarvis
What are some common abnormalities?
∙ limited ROM
∙ pain
∙ swelling, warmth, and redness
∙ contractures
∙ crepitation
∙ muscle atrophy
What are some cultural considerations?
∙ African American adults and Hispanic woman have DECREASED risk for fracture than whites
∙ Greater bone mass and bone mineral density among black men than white men
∙ White woman bone mineral density peak earlier causing a rapid decline in bone density, therefore increasing the risk of fracture
∙ weight-bearing physical activity is imperative during reproductive and middle adult years will slow decline of bone mineral density
What are the most common risk factors for musculoskeletal issues?
∙ diet
∙ exercise
∙ lifestyle
∙ medical options
∙ supplements
Define isometric contraction.
muscle tension is increased without changing its length, there is no associated joint motion
Define isotonic contraction.
muscle is shortened without a change in its tension, a joint is moved as a result
Define flaccid.
limp, without muscle tone
Define spastic.
having greater-than-normal muscle tone
Define atonic.
without tone, denervated muscle that atrophies
What is a prime mover?
muscle that causes a particular movement
What is an antagonist?
it must relax to allow the prime mover to contract
Describe neuromuscular checks.
∙ assess patients with musculoskeletal disorders
∙ assess due to the risk of tissue and nerve damage
∙ CMS: circulation, motion, and sensation
What is compartment syndrome?
∙ pressure within muscle compartment so severe microcirculation diminishes
∙ can lead to muscle and nerve anoxia and necrosis
∙ function can be lost if anoxic more than 6 hours
What are the 6 P's of a neuromuscular assessment?
∙ pain: always assess below the injury
∙ pallor
∙ paresthesia
∙ paralysis
∙ pulselessness: below the injury site
∙ poikilothermia: change in temp. of extremity
What are the 3 spine deformities?
∙ kyphosis
∙ lordosis
∙ scoliosis
Research Rheumatoid Arthritis- Ulnar Deviation and "Swan-Neck" Deformity
Describe the diagnostic tests.
∙ Radiographs: determines bone density, texture, erosion, and changes
∙ CT: shows detailed cross-sections
∙ MRI: can look at torn ligaments, muscles, and cartilage
∙ Arthrography: used to identify any unexplained joint pain
∙ Bone densitometry: used to evaluate bone mineral density
∙ Bone scan: used to detect bone cancers and diseases
∙ Arthroscopy: direct visualization of a joint through fiberoptic endoscope along with treatment of tears, defects, and disease processes
∙ Arthrocentesis: obtain synovial fluid for examination or to relieve pain due to effusion
∙ Electromyography: done to evaluate muscle weakness, pain, and disability by testing the electrical potential of muscles and nerves leading to them
∙ Biopsy: excision of tissue to determine the structure and composition of bone, bone marrow, and synovium (NM: educate, monitor for edema, bleeding, pain, hematoma, infection, apply ice to prevent swelling and bleeding, administer antibiotics & analgesics as prescribes, report signs of complications)
Describe lab studies that can be conducted.
∙ Calcium: produced by the parathyroid
∙ Phosphorus: reversed with calcium (if one is elevated the other is down)
∙ Acid phosphate
∙ Alkaline phosphate
∙ Thyroid studies, calcitonin, PTH, and vit. D (vit. D helps the absorption of calcium) (calcitonin produced in the thyroid regulates the production of calcium)
∙ Creatinine kinase
∙ Serum osteocalcin
∙ urine calcium