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Musculoskeletal Definitions
  • Synovial joints: freely movable because they have bones that are seperated from each other enclosed in a joint cavity
  • cartilage: cushions the bones and gives a smooth surface.
  • Ligaments: fibrous bands running directly from one bone to another
  • Tendons: strong fibrous cords which connect muscle to bone
  • Bursa: an snclosed sac filled with viscous synovial flluid
Range of motion terms
  • Flexion/extension
  • abduction/adduction
  • pronation/supination
  • circumduction
  • inversion/eversion
  • protraction/retraction
  • elevation/depression
Musculoskeletal subjective data
  • Joints: pain stiffness, swelling, heat, limited ROM
  • Muscles: pain, cramps, weakness
  • Bones: pain, deformity, trauma
  • Functional assessments: ADLs
  • Self-care behaviors and occupational hazards
Musculoskeletal subjective data significance
  • joint pain in the morning is a cardinal sign of osteoarthritis
  • Heat and swelling in joints is possible infection (ostemmyelitis)
  • aching muscles are often related to a viral infection
  • Bone deformity can be from cancer or trauma
  • self care behaviors include the use of helmets and seatbelts
  • Occupational hazards could be repetitive motion injuries
Musculoskeletal objective data
  • inspection: look for swelling, deformity, changes in color
  • palpation: look at each joint for temperature, bony articulation, and tenderness
What are some common fractures in the hand/wrist?
  • buckle fracture: common in the wrist, with radius and ulna breaking
  • Boxers fracture: broken neck of the 4th or 5th metacarpal from punching something
Assessing ROM in head/neck
  • TMJ: place tips of f ingers in front of the pt's ears and ask them to open and close their mouth. You should not feel popping or clicking
  • C-spine: assess flexion/extension, lateral bending, and rotation
Flexion Extension injuries of the neck
  • diziness
  • neck stiffness
  • shoulder pain
  • memory loss
  • whiplash
  • flexion is worse than extension
ROM assessment of shoulders
  • compare size and symmetry bilaterally
  • palpate both shoulders noting and muscular spasm or atrophy
  • check forward flexion,
  • internal rotation,
  • abduction/adduction,
  • and external rotation
ROM assessment of elbow
  • inspect the contours while flexed and extended
  • palpate the elbow when flexed and feel the epicondyles for heat and tenderness (tennis elbow). fat pads should not feel boggy
  • check pronation and supination
What is nurse maids elbow?

  • partial dislocation of the elbow

  • common in children 1-4

Hand and wrist assessment
  • Inspect hands and wrists: Heberden's nodules (nodules at the distal interphalangeal joints, common in osteoarthritis) Bouchard's nodules (nodules at the distal interphalangeal joints, osteoarthrits and RA)
  • Check ROM at the wrist, open and close fingers
  • Phalen's test: hands back to back while flexing wrists at 90 degrees, positive test is associated with carpal tunnel syndrome
  • Tinel's sign: percussion of the median nerve- can produce a burning or tingling in carpal tunnel s yndrome
Deformities of the hands
  • Swan-neck deformity: flexion of the distal interphalangeal joints and hyperextension of the proximal interphalangeal joints, often seen with RA
  • Boutonniere deformity: extension of the metacarpophalangeal and distal interphalangeal joints and flexion of the proximal interphalangeal joint.
Assessment of hips
  • Inspect and palpate the hip joint
  • raise each lef with the knee extended
  • keen to chest and flex the leg upwards
  • adduction and abduction
  • external and internal rotation
  • limited ROM is indicitive of hip disease
Assessment of the spine
  • Inspection: look at pt's back for generalized deformities, convex or concave, kyphosis, lordosis
  • ROM: flexion, extension, rotation
Assessment of knees and feet
  • Knee: have pt supine or legs dangling for inspection, look at skin
  • compare one knee to the other
  • palpate the patella for crepitus, pain, or any bony irregularities
  • feet: assess dorsiflexion, plantar felxion, eversion, and inversion
Knee injuries
  • Torn ACL: happens when upper and lower legs twist in opposite directions, more common in females due to increased levels of relaxin
Lower extremity disorders
  • legg-calve-perthes disease: avascular necrosis in proximal femoral epiphysis
  • Rickettsia: knock knees, d/t scurvy (vit C deficiency)
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