prepared by: dr. h.el sharkawy to review the general anatomy of musculoskeletal system. to know...
TRANSCRIPT
Musculoskeletal System
Prepared by:Dr. H.EL Sharkawy
To review the general anatomy of musculoskeletal system .
To know how to assess musculoskeletal system .
To know the common posture deformities & its rehabilitation .
Objectives
The Skeletal System
· Parts of the skeletal system· Bones (skeleton)· Joints· Cartilages· Ligaments (bone to bone)(tendon=bone to
muscle)
· Divided into two divisions· Axial skeleton- skull, spinal column· Appendicular skeleton – limbs and girdle
SkinMusclesBonesTendonsLigamentsCartilage
Musculoskeletal Structures
Holds all structures together Barrier function Protects underlying structures Subcutaneous tissue
◦ Fat◦ Fascia
Musculoskeletal Structures - Skin
Composed of specialized cells with ability to contract
Voluntary (Skeletal)◦ Conscious control◦ Allows mobility
Smooth (Bronchi, GI tract, blood vessels)◦ Controlled by ANS◦ Able to alter inner lumen diameter
Cardiac◦ Contracts rhythmically on its own
Musculoskeletal Structures -Muscle
Can only contract Skeletal muscle causes movement by
shortening resulting in pulling on bones through cord like bands
Musculoskeletal Structures -Muscle
Tendons◦ Bands of connective tissue binding muscles
to bones Cartilage
◦ Connective tissue covering the epiphysis◦ Surface for articulation
Ligaments◦ Connective tissue supporting joints◦ Attach bone ends to each other
Musculoskeletal Structures
Functions of Bones
· Support of the body
· Protection of soft organs
· Movement due to attached skeletal muscles
· Storage of minerals and fats
· Blood cell formation
Bones of the Human Body
· The skeleton has 206 bones· Two basic types of bone tissue
· Compact bone· Homogeneous
· Spongy bone· Small needle-like
pieces of bone· Many open spaces
Figure 5.2b
Classification of Bones on the Basis of Shape
Figure 5.1
Types of Bone Cells
Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings
· Osteocytes· Mature bone cells
· Osteoblasts· Bone-forming cells
· Osteoclasts· Bone-destroying cells· Break down bone matrix for remodeling and release
of calcium· Bone remodeling is a process by both osteoblasts
and osteoclasts
The Axial Skeleton
Slide 5.20a
Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings
· Forms the longitudinal part of the body· Divided into three parts
· Skull· Vertebral Column· Rib Cage
The Vertebral Column
· Vertebrae separated by intervertebral discs made of cartilage
· The spine has a normal S curvature
· Each vertebrae is given a name according to its location
A joint, or articulation, is the place where two bones come together.
Fibrous- Immovable:connect bones, no movement. (skull and pelvis).
Cartilaginous- slightly movable, bones are attached by cartilage, a little movement (spine or ribs).
Synovial- freely movable, much more movement than cartilaginous joints. Cavities between bones are filled with synovial fluid. This fluid helps lubricate and protect the bones.
Joints
Occur in 70-80% of all multi-trauma patients Blunt or Penetrating Upper extremity rarely life-threatening
◦ may result in long-term impairment Lower extremity associated with more severe
injuries◦ possibility of significant blood loss◦ femur, pelvic injuries may pose life-threat
Incidence/Mortality/Morbidity
Problem is not just the bone injury◦ Other injuries caused by the injured bone
Soft tissue Vascular Nervous system Decreased function
Incidence/Mortality/Morbidity
Sports Training Seat Belt use Child Safety Seat use Airbag use Gun Safety and Education Motorcycle education and protective
equipment Fall prevention Can you think of others?
Prevention Strategies
Look for asymmetry between sides Swelling Deformities Atrophy Erythema
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Inspection of Specific Area
Have patient range the joints Watch for decreased or increased movement
of the joint compared to the other side. Watch for pain with movement Listen for crepitus or “popping” Watch for abnormal movements
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Range of Motion (Active)
Next range the joints passively, comparing the end points to the active
Again note any decreased or increased movement
Pain with the movement Crepitus or “popping”
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Range of Motion (Passive)
When palpating a structure, you need to know the anatomy of that structure
Palpate for swelling Palpate for warmth Palpate each area of the structure in turn
evaluating for pain, and abnormalities as compared to the other side
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Palpation
Check the following comparing one side to the other:◦ Grade strength (0-5)◦ Grade reflexes (0-4)◦ Sensory exam( Types ) .
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Muscular and Neurological
Health History
Subjective Data -Chief Complaints – pain, altered sensation, limited motion
Family history, personal history, dietary history, socioeconomic status
Medications (steroids); Current health problems – obesity
Objective Data - Physical Exam Objective Data - Diagnostic Tests Special Assessment Techniques
◦ Ballottement◦ Bulge Sign◦ Phalen◦ Tinel’s
MusculoskeletalAssessment
History of injury? Any previous back or neck pain? Any positions of comfort? Family history? Previous illnesses, surgeries, or severe
injuries? Hx of other conditions (connective tissue
diseases such as Marfan’s Syndrome)?
Patient History
Footwear? Patient age? Growth spurt? In females, related to menarche/menses? In males, related to voice change Deformity progressive or stationary?
Patient History
Neurologic symptoms? Nature, extent, type, and duration of pain? Exacerbating activities or positions? Difficulty breathing? Previous treatment? Did it help?
Patient History
◦ Mental Status◦ General inspection◦ Head and neck: temporomandibular joint; crepitus◦ Height, weight, nutritional status, skin, spine –
lordosis, scoliosis, posture, joint function, upper and lower extremities
◦ Posture, gait, ROM ex., deep tendon reflexes, bone integrity, muscle strength and tone, neurovascular, MS injuries
Physical Exam
X-ray- determine density of the bone. Arthrogram- visualization of joint structure & movement. Diskogram- visualization of intervertebral disk abnormalitiy. Sinogram- visualizes course of sinus & tissues involved. CT- to identify soft tissue & bone abnormalities, and various
MS trauma. MRI- to view soft tissue- useful in the dx. Of ligament
tears, osteomyelitis, disk disease. Bone and Muscle Biopsy Ultrasonography
Musculoskeletal System Diagnostic tests
Body type◦ Ectomorph◦ Mesomorph◦ Endomorph
Observation
Assessment of Posture
Definition of posture Postural development Common spinal deformities HIPS
Overview
◦ Defined: “The position of the body at a given point in time.”
(Starkey) “A set of muscle contractions that place the body
in the necessary location from which a movement is performed.” (Enoka)
“The situation or disposition of the several parts of the body with respect to each other for a particular purpose.” (Webster)
What is posture?
What is good posture? Ideal posture serves as a
reference point. Ideal posture…
◦ Distributes gravitational stress for balanced muscle function.
◦ Allows joints to move in their mid range to minimize stress on ligaments and articular surfaces.
◦ Effective for the individual’s activities of daily living.
◦ Allows the individual to avoid injury.
Factors affecting posture◦ Bony contours◦ Laxity of ligamentous structures
Fascial & musculotendinous tightness
◦ Muscle tonus◦ Pelvic angle◦ Joint position & mobility
Postural Development
Good Spinal Posture
Any position that deviates from “good posture”◦ Static
Standing Sitting Sleeping
◦ Dynamic Running Throwing, etc.
What is bad posture?
Shoulder/Scapula◦ FSP Forward shoulder
posture ◦ Winging Scapula
Head and C-Spine◦ FHP(Forward Hip
posture
Commonly Seen Postural Deviations
History
Inspection
Palpation
Special (Functional) Tests
HIPS
Identify factors that influence posture
◦ Overuse◦ Neurological
Problems◦ Pain◦ Lack of awareness◦ Ms weakness/
Imbalance
Relevant History
◦ Hypermobile Jts◦ Hypomobile Jts◦ ST Flexibility◦ Bony Abnormality◦ Leg Length Disc.
◦ Use of a plumb line Anatomical reference 3 views
Lateral (sagittal plane movements)
Anterior (frontal/ transverse plane movements)
Posterior (frontal/ transverse plane movements)
Inspection
Look for:◦ @ ankle?◦ @ knee?◦ @ hip?◦ @ shoulder?◦ @ neck?◦ @ head?
Lateral View
Anterior view◦ Head straight on
shoulders◦ Shoulders level◦ Clavicles/AC joints◦ Sternum & ribs◦ Waist angles & arm
positions◦ Carrying angles◦ Iliac crests◦ ASIS◦ Patellae◦ Knees◦ Fibular heads
◦ Malleoli level◦ Arches◦ Foot rotation◦ Bowing of bones◦ Diastematomyelia (hairy
patches)◦ Pigmented lesions
Café au lait spots
Anterior view
Look for:◦ @ heel?◦ @ pelvis?◦ @ lumbar spine?◦ @ scapulae?◦ @ neck?◦ @ head?
Posterior View
In assessment position (i.e., standing), palpate:◦ Laterally
ASIS vs. PSIS◦ Anteriorly
Patellae Iliac Crests ASIS heights Lateral Malleolar heights Fibular Head heights Shoulder heights
Palpation
Posteriorly PSIS positions Spinal alignment Scapular positions
Slump Test Romberg Tandem walking Others designed to:
◦ Rule out bony restrictions
◦ Rule out soft tissue restrictions
◦ Assess muscular length ROM Resting muscle length
Functional Tests
Video Analysis 3D Motion Analysis REBA Rapid Entire
BodyAssessment (REBA)Posture assesment.
Sway Measurement Tools( posture sway measurment) .◦ Force Plate◦ Biodex Stability System◦ NeuroCom
Other Technology
Postural development Common spinal deformities Patient history Observation Examination
Overview
Correct posture◦ “Position in which
minimum stress is placed on each joint.” (Magee)
Faulty posture◦ Any position that increases
stress on joints
Postural Development
Birth› Entire spine concave
forward (flexed)› “Primary curves”
Thoracic spine Sacrum
Developmental (usually around 3 mos.)› Secondary curves› Cervical spine› Lumbar spine
Postural Development
Causes of poor posture› Positional factors
social factors . Muscle
imbalances/contractures Pain Respiratory conditions
› Typically can be managed conservatively through ex & education.
Postural Development
Causes of poor posture◦ Structural factors
Congential anomalies Developmental problems Trauma Disease
◦ Not typically easily managed .
Postural Development