muscoloskeletal system. musculoskeletal system consists of: bones muscles joints cartilage
TRANSCRIPT
function
Support to stand erectMovementProtect inner vital organsHemopoiesis – Bone marrow produces
white & red bld cells and plateletsReservoir for storage of minerals & energy
– Ca. & Phosphorus in the bones.
Joints
2 or more bones connectingMobility Nonsynovial = immovable, skull suturesSynovial = movableSynovial 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 weightContract & produce movementSkeletal muscle is voluntaryComposed of Bundles of muscle fibers or
fasciculiMuscle is attached to bones via tendons
Skeletal muscles produce the following movements
Flexion – bendingExtension – straighteningAbduction – away from midlineAdduction – toward midlinePronation – palm downSupination – palm upCircumduction - circular
Skeletal muscles produce the following movements
Inversion – sole inwardEversion – sole outwardRotation – head around central axisProtraction –forward movement parallel to
ground (chin)Retraction – backward parallel movementDepression/elevation – Shoulders up &
down
Temporomandibular Joint (TMJ)
Articulation of temporal & mandibleDepression anterior to tragus of earJaw function for chewing & speakingMovements
– Hinge – open/close– Gliding – protrusion/retraction– Gliding- side to side
Spine
33 VertebraeSpinous process posterior midline7 Cervical12 Thoracic5 Lumbar5 Sacral3 – 4 Coccygeal
C7 & T1 prominent base of neck Inferior angle of scapula in line with T7 & T8Highest point iliac crest at L4Curves 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 & femurBall & socket joint Weight bearing functionLandmarks ( IM injections)
– Anterior, superior iliac crest– Ischial tuberosity (↓ gluteus maximus, flex
hip)– Greater trochanter of femur
Knee
Femur, tibia & patellaLargest jointHinged joint & largest synovial membrane2 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 = osteoporosisPostural changes↓ height due to shortening of the vertebral
column
Objective AssessmentPhysical Exam Musculoskeletal
Purpose – To assess function for ADL’s – Screen for abnormalities
Screening Exams
InspectionPalpationROM with movement active or passive if
apparent limitations Age Specific
Muscle Testing
Repeat movements for Active ROMClient flexes & holds against opposing
force= bilaterally, resists opposing force
Grade muscle strength (pg. 616)
Values 0- 5Grade 5= Normal –Full ROM against
gravity, full resistance
TMJ
Swelling, tenderness, crepitationCrepitation = 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
FlexionExtension Internal rotation External rotationAbductionAdductionCircumduction 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
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
HyperextensionPalmar flexionFlexion of fingersAbduction for fingers Opposition Ulnar deviation, Radial deviation
Muscle Strength for Wrist and Hands
Flex wrist against palm resistancePhalen’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 jointsROM
Knee
Supine with legs extended ( knees can be flexed or dangling for inspection)
Swelling = ? Soft tissue or ↑ fld in the jointBulge 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