Muscoloskeletal System

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

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

Objective AssessmentPhysical 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 • Head & neck alignment • Spine • Palpation • Spinous processes, Trapezius, Paravertebral muscles • ROM, flexion, extension, hyperextension, lateral flexion, rotation, circumduction • Repeat applying opposing force

Shoulders • Inspect • Bilateral comparison • Palpate • 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 • 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

Muscoloskeletal System