Assessment of the Musculoskeletal System (PowerPoint)

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					Assessment of the
Sara H. Mitchell, Ph.D., RN,
The impact of diseases of the
musculoskeletal system
Composition of the
Musculoskeletal System
   The skeleton proper (bones & joints)

   Skeletal muscles

   Tendons

   Ligaments
Nutrition & Musculoskeletal
   Fluoride       Aluminum

   Magnesium      Copper

   Zinc           Iron

                   Manganese
   Iodine
Assessment of the musculoskeletal
   History-taking
   Inspect & Palpate joints
   Assess range of motion
   Assess muscle strength
       2
       3
       4
       5
Joint motion - a review of terms
   Flexion              Inversion
   Extension            Eversion
   Dorsiflexion         Internal rotation
   Plantar flexion      External rotation
   Adduction            Pronation
   Abduction            Suppination
Measuring Range of Motion
   If any limitation or
    increase in ROM is
    noted, use a
    ___________ to
    measure the angles
Cervical Spine Assessment
                  Abnormal findings
Upper Extremity Assessment
   Abnormal findings:
ROM of wrist & hand
                    Flexion –

                    Extension –

                    Hyperextension –

                    Ulnar deviation –

                    Radial deviation –
Spinal Assessment
                  Abnormal findings:
Torso Range of Motion
                  Abnormalities:
Lower Extremity ROM
   Hip flexion with knee
    straight –
   Hip flexion with knee
   Internal & External
    rotation :
   Abduction :
   Adduction :
Range of Motion of the Knee
                Flexion-extension – 1350

                Hyperextension - 100
   Used to test for joint effusion
   If there is an effusion present a palpated tap
    will be present and the transmitted impulse
    will be felt by the fingers on either side of the
        Ankle Range of Motion
   Dorsiflexion – 20o
   Plantar Flexion – 500
   Inversion of hind foot – 50
   Eversion of hind foot - 50
Alterations of Musculoskeletal
   Musculoskeletal        Disorders of joints
    Injuries                n
    s                      i
    s                     Disorders of skeletal
   Disorders of bone       muscle
                             s
                             m
                             m
    b                       I
Primary symptoms of
musculoskeletal disease
Phalen’s test
   Ask the person to
    hold both hands back
    to back while flexing
    the wrists 90 degrees.
    Acute flexion of the
    wrist for 60 seconds
    produces numbness
    and burning in a
    person with carpal
    tunel syndrome
Tinel’s Sign
                  In carpal tunnel
                   syndrome, percussion
                   of the median nerve
                   produces burning and
                   tingling along its
                   distribution, which is a
                   positive Tinel’s sign
The musculoskeletal system of
the young
   C

   E

   B

   S
Musculoskeletal assessment in
the pediatric patient
     O             Limp

     L

     G              I

     G              S

     S
_____________ Maneuver for
Congenital Dislocated Hip
   With a dislocated hip, the
    head of the femur is not
    cupped in the acetabulum
    but rests posterior to it.

   Hip instability feels like a
    clunk as the head of the
    femur pos into place. This
    is a positive
Lower Extremity Findings in
                     ______________:
                      “bowlegged” stance is
                      normal through the first
                      two years of life.
                      Resolves with growth and
                     ____________: knock-
                      kneed stance occurs
                      normally between 2 and
                      3½ years of age

   Dislocation of the
    hip functionally
    shortens and
    weakens hip and
    pelvis muscles.

   When a child stands
    on the dislocated
    hip, the opposite
    side of the pelvis
               _________ scoliosis
                is flexible. It is
                apparent with
                standing and
                disappears with
                forward standing.
               ____________
                scoliosis is fixed. The
                curvature shows both
                on standing and on
                bending forward
The Musculoskeletal system of
the elderly
 Muscle atrophy         Osteoarthritis
 Osteoporosis           Reduced range of
 Kyphosis                motion
 Decreased              Degenerative
  intervertebral disc     changes
 Joint stiffness
Degenerative Joint Disease of
                      Osteoarthritis is
                       characterized by hard,
                       nontender nodules, 203
                       mm or more. These
                       osteophytes (bony over-
                       growths) of the distal
                       interphalangeal joints are
                       called ____________
                       nodes and those of the
                       proximal interphalangeal
                       joints are called
                       _______________ nodes
   Risk Factors
   Classification
   Diagnosis
   Prevention
   Treatment

                       Areas of yellow indicate
                       bone loss from osteoporosis
The Musculoskeletal system of
the elderly (continued)
   “Musculoskeletal problems have the most
    significant impact on the aged population.
    More than 1 billion dollars is spent
    annually by Medicare for hospitalization of
    elderly patients with these conditions.
    This represents 20% of all Medicare
Reaching a conclusion
 Based on history & physical examination
  does there appear to be a musculoskeletal
  disease or impairment?
 Do the history and finding suggest a
  primary musculoskeletal concern or signs
  & symptoms of a systemic disease?
 What is the differential diagnosis?
 What additional tests (labs, diagnostic
  studies) are indicated?
Differential diagnoses - what is
the primary problem
 Fracture
 Sprain
 Dislocation or subluxation
 Joint or muscle inflammation
 Age specific abnormality
 Systemic illness (examples)
     neuropathy
     myopathy
     connective   tissue disease
Test for musculoskeletal
   Bone function      Joint function
                           a
                           a
                           M
    r                     a
    a                 Muscular function
    b                   S________,
    b                     U
                           EMG
                           f
                           m
 “Diseases  of the musculoskeletal
 system rank first among disease
 conditions that alter the quality of
 life…the cost of which exceeds 60
 billion dollars annually…”

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