Musculoskeletal: 13 s Concept Overview Motion: Mechanisms…  Musculoskeletal: 13 sConcept OverviewMotion:Mechanisms that facilitate and impair mobility.Interrelated concepts include:Oxygenation of blood to tissues.Intracranial regulation by brain, spinal cord, and peripheral nerves.Pain from motion can limit movement.Nutrition must be adequate.Excessive weight can damage joints.Elimination—Risk of constipation due to limited mobility.Anatomy & Physiology 101Bones:Support and protection for soft tissues and organsMuscles:Muscle fibers that attach to bones to facilitate movement.Muscles attach to bone, ligament, tendon, or fasciaJoints: Place of union of two or more bones; hold bones together while allowing movement.Ligaments:Strong, dense, flexible bands of connective tissue that hold bones together.Allow for safe movement of bones.Tendons: Strong, non-elastic cords of collagen that attach muscles to bones.Support bone movement in response to muscle contraction.Directional TerminologyProximal: Nearer to the trunk of the body.Distal: Farther from the trunk of the body.Superior: Toward the head.Inferior: Lower on the body, farther from the head.Medial: Toward the midline.Lateral: Away from the midline.Directional TerminologyDistalSites located away from a specific area, most often the center of the body.The hand is distal to the shoulder: The thumb is distal to the wrist. Distal is the opposite of proximal.ProximalNearer to the center (trunk of the body) or to the point of attachment to the body. If another reference point is given, such as the heart, the proximal point of another organ or extremity is the point closest to the heart, central rather than peripheral. Musculoskeletal Subjective DataJoints:pain, stiffness, swelling, heat, redness, limitation of movementKnee: joint if injuredMuscles:pain (cramps) or weaknessBones:Pain, deformity, trauma (fractures, sprains, or dislocation)Functional assessment Activities of Daily Living (ADLs)Musculoskeletal – Muscles, Bones & JointsCompleteness of assessment depends on needs/problems of clientOrder of Examination:Inspection, Palpation, & ROMMuscles Assessment:StrengthToneSize / Development SymmetryMusculoskeletal Tests & Supplies Tests               *Moves all extremitiesUE___     LE___Hand GripPatellar Reflex*Lower Extremity Strength (hips, quads, calves)*Upper Extremity Strength (perform two tests)Balance, GaitFine Motor movementSuppliesHand SanitizerPercussion hammerMuscle Strength & ToneTone should be relaxed w/slight flexion Atony/atonic muscleLack of muscle tone, flaccidSpastic/hypertonicityHyper muscle toneCheck Movement / Strength of musclesCompare sides Inspection & Palpation: Compare for SymmetrySizeatrophy vs hypertrophyDeformitiesTendernessSwellingNodulesCrepitusAlignment and symmetryBowlegKnock-kneeJoints & BonesJoints Range of Motion (ROM), flexibility Tenderness, pain, swelling, redness, Thickening, crepitation, nodulesBonesNormal formDeformitiesAbnormal spine curvaturesPostural abnormalitiesTemporomandibular Joint (TMJ) Inspection and palpation Audible and palpable snap or click occurs in many healthy people as mouth opens.Palpate contracted temporalis and masseter muscles as person clenches teeth.Compare right and left sides for size, firmness, and strength.Ask person to move jaw forward and laterally against your resistance, and to open mouth against your resistance.This tests integrity of cranial nerve V (trigeminal nerve).Observe for swelling, limitation of motion and/or reported pain. Shoulder Inspect and compare both shoulders posteriorly and anteriorly. Do not attempt if you suspect neck trauma. Shoulder pain, ask him or her to point to spot with hand of unaffected side.Shoulder pain may be from local causes or may be referred pain which could be potentially serious.Pain from a local cause is reproducible during the examination by palpation or motion.While standing in front of person, palpate both shoulders, noting any muscular spasm or atrophy, swelling, heat, or tenderness.Use a methodical method to assess muscle strength and ROM. Shoulder shrug also tests integrity of cranial nerve XI, spinal accessory nerve.Wrist and Hand Inspect hands and wrists on dorsal and palmar sides.Note position, contour, and shape; normally no swelling or redness, deformity, or nodules are present.Palpate each joint in wrist and hands.Perform ROM and assess muscle strength.Use stabilizing technique to support extremity during muscle testing. Perform testing to determine presence of Carpal Tunnel Syndrome. Phalen test—acute flexion of wrist produces numbness and burning if +Tinel sign test—percussion of median nerve produces burning and tingling if +SpinePerson should be standing, draped in gown open at back.Inspect and note if spine is straight.From side, note normal convex thoracic curve and concave lumbar curve.Range of MotionTest joint movementFlexionExtensionHyperextensionAbduction / adductionPronation / supinationTremors & Twitches Tremor is an involuntary trembling of a limb or body part3 Types of TremorsIntentionRestingFasciculationMuscle AbnormalitiesMuscle Tone   FlacciditySpasticityRigidityCogwheel rigidityMuscle MovementParalysisFasciculationsTicMyoclonusChoreaAthetosisSeizure disorderTremorRest tremorIntention tremorCommon Problems and Conditions:OsteoporosisLoss of bone density and decreased bone strength results in osteoporosis.Causes: Age; Decline of estrogen and relationship to calcium deficit, and lack of exercise.Clinical findings:Osteoporosis occurs without signs or symptomsPatients may not know until they realize loss of height, have spontaneous fracture from brittle bones, or develop kyphosis (convex curvature of thoracic spine).Common Problems and Conditions: Joints—GoutGout:Increase in serum uric acid due to increased production, or decreased excretion of uric acid and urate salts.Uric acids not only accumulate commonly in great toe & other joints such as wrists, hands, ankles, and knees.Clinical findings: Erythema and edema of joints that are very painful to move and limit range of motion.Tophi, a sign of gout, are round, pea-like deposits of uric acid in ear cartilage, or large, irregularly shaped deposits in subcutaneous tissue or other joints. Kidney stones from uric acid crystals can cause manifestations of flank pain, and costovertebral.Health Science Science Nursing NURB 231

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