SAS 20

• The students will study and read Chapter 18 of their book about this lesson: Examination of Joints: Anatomy and Physiology and Physical Examination.
• Important areas of examination for each of the major joints include inspection for joint symmetry, alignment, bony deformities; inspection and palpation of surrounding tissues for skin changes, nodules, muscle atrophy, crepitus; range of motion and maneuvers to test joint function and stability, and integrity of ligaments, tendons, bursae, especially if pain or trauma; and assessment of inflammation or arthritis, especially swelling, warmth, tenderness, redness.
• During inspection, look for symmetry of involvement in acute involvement of only one joint suggests trauma, septic arthritis, gout.
• Use inspection and palpation to assess the surrounding tissues, noting skin changes, subcutaneous nodules, and muscle atrophy.
• Note any crepitus, an audible or palpable crunching during movement of tendons or ligaments over bone.
• Subcutaneous nodules in rheumatoid arthritis or rheumatic fever; effusions in trauma; crepitus over inflamed joints, in osteoarthritis, or in inflamed tendon sheaths.
• Test range of motion and maneuvers to demonstrate limitations in range of motion or joint instability from excess mobility of joint ligaments, called ligamentous laxity.
• When the forearm is midway between pronation and supination, extension at the wrist can be tested with gravity eliminated.
• Boutonniere deformity and Bouchard’s nodes are finger abnormalities seen in patients who have osteoarthritis or degenerative joint disease.
• If the muscles are too weak to overcome resistance, test them against gravity alone or with gravity eliminated.
• A muscle is strongest when shortest, and weakest when longest.
• Tenderness or warmth above a thickened synovium is indicative of arthritis.
• Quadriplegia can occur due to injury to the cervical spine.
• A barely detectable flicker or trace of contraction from the muscle must be graded as 0.
• If the patient fails to move the body part, watch or feel for weak muscular contraction.
• Rheumatoid arthritis causes the “swan neck” deformity, characterized by hyperextension of the proximal interphalangeal joints with fixed flexion of the distal interphalangeal joints.
• Gouty arthritis usually has high uric acid serum levels in the blood.
• Rheumatoid arthritis is caused by an unknown factor.
• When the forearm rests in a pronated position, dorsiflexion at the wrist can be tested against gravity alone.
• When assessing for the muscle strength of a post-stroke patient, the nurse must note paralysis in the right half of the body as paraplegia.
• Decreased range of motion in arthritis, inflammation of tissues around a joint, fibrosis in or around a joint, or bony fixation (an ankylosis).
• Test muscle strength to aid in the assessment of joint function, especially alert to signs of inflammation and arthritis.
• Swelling in the joint can involve the synovial membrane, which can feel boggy or doughy; the joint fluid within the joint space; or soft-tissue structures such as bursae, tendons, and tendon sheaths.
• Other causes of muscular atrophy include motor neuron diseases, any disease that affects the peripheral motor system projecting from the spinal cord, rheumatoid arthritis, and protein-calorie malnutrition.
• When looking for atrophy, pay particular attention to the hands, shoulders, and thighs, checking the thenar and hypothenar eminences and the spaces between the metacarpals, where the dorsal interosseous muscles lie.
• When a normal muscle with an intact nerve supply is relaxed voluntarily, it maintains a slight residual tension known as muscle tone, which can be assessed by feeling the muscle’s resistance to passive stretch.
• Hemiparesis refers to weakness of one half of the body; hemiplegia to paralysis of one half of the body.
• Hypertrophy is an increase in bulk with proportionate strength, while increased bulk with diminished strength is called pseudohypertrophy, seen in the Duchenne form of muscular dystrophy.
• To assess muscle tone in the legs, support the patient’s thigh with one hand, grasp the foot with the other, and flex and extend the patient’s knee and ankle on each side.
• People vary widely in their strength, and the assessment should allow for such variables as age, sex, and muscular training.
• Muscular atrophy refers to a loss of muscle bulk, or wasting, resulting from diseases of the peripheral nervous system such as diabetic neuropathy, and diseases of the muscles themselves.
• Paraplegia means paralysis of the legs; quadriplegia, paralysis of all four limbs.
• Decreased resistance suggests disease of the peripheral nervous system, cerebellar disease, or the acute stages of spinal cord injury.
• Impaired strength is called weakness, or paresis, and absence of strength is called paralysis, or plegia.
• Muscle bulk can be assessed by inspecting the size and contours of muscles, looking for atrophy, and checking for fasciculations.
• If resistance is increased, determine whether it varies as you move the limb or whether it persists throughout the range of movement and in both directions, for example, during both flexion and extension.