Musculoskeletal System

• Musculoskeletal complaints and disorders are the leading causes of health care visits
• The musculoskeletal system can be examined at the same time as the neurologic system
• In this chapter, the anatomy and physiology and the examination for each joint are combined
• Articular structures(JASSIJ)


  • joint capsule
  • articular cartilage
  • synovium
  • synovial fluid
  • intra-articular ligaments
  • juxta-articular bone

  
• Extra-articular structures

  • periarticular ligaments
  • tendons
  • bursae
  • muscle
  • fascia
  • bone
  • nerve
  • overlying skin
• Ligaments

  Rope-like bundles of collagen fibrils; connect bone to bone
• Tendons

  Collagen fibers connecting muscle to bone
• Cartilage


  Another type of collagen matrix; facilitates smooth painless movement of the joint
• Bursae


  Pouches of synovial fluid; cushion movement of tendons and muscles over bone/other joint structures
• Types of Joint Articulation

  • Synovial joints
  • Cartilaginous Joints
  • Fibrous joints
• Synovial joints


  • Freely movable
  • Covered by articular cartilage
  • Synovial cavity
  • Joint capsule

  
• Cartilaginous Joints


  • Slightly movable
  • Fibrocartilaginous discs
  • Nucleus pulposus

  
• Fibrous joints


  • Intervening layers of fibrous tissue or cartilage hold bones together
  • Almost in direct contact
  • No appreciable movements

  
• The leading cause of complaints in health care visits are related to musculoskeletal complaints
• Common or concerning symptoms

  • Joint pain
  • Joint pain associated with systemic symptoms, such as fever, chills, rash, weakness, and weight loss
  • Low back pain
  • Neck pain
  • Bone pain
  • Muscle pain or cramps
  • Muscle weakness
• Myalgias


  Muscle pain
• Arthralgias


  Joint pain
• Important areas of examination for each of the major joints


  • Inspect joint symmetry, alignment, bony deformities
  • Inspect and palpate surrounding tissues for skin changes, nodules, muscle atrophy, crepitus
  • Range of motion maneuvers to test joint function and stability
  • Assess for signs of inflammation, swelling, warmth, tenderness, redness
  • Assess muscle strength

  
• Systematic examination


  • Inspection and palpation of bones and joints
  • Assessment of range of motion and muscle strength
• Equipment for examining the joints

  • Tape measure
  • Goniometer
  • Skin marking pen
• Tips for a successful examination

  • Look for symmetry
  • Use inspection and palpation to assess surrounding tissues
  • Test range of motion and maneuvers
  • Test muscle strength
• Signs of inflammation


  • Swelling
  • Warmth
  • Tenderness
  • Redness
• Muscle tone


  • Slight residual tension that remains when normal muscle with intact nerve supply is relaxed voluntarily
  • Assess with passive stretch
  • Hypotonia? Flaccidity?
  • Spasticity? Rigidity?
• Muscle strength


  • Allow for variables: age, sex, muscular training
  • Dominant side usually slightly stronger
  • Active resistance testing
  • Paresis, paralysis, or plegia?
• Trauma that results in stretching or tearing of ligaments is referred to as a sprain
• The temporomandibular joint allows for threefold range of motion
• The shoulder is referred to as the shoulder girdle due to its complex interconnected structure of four joints, three large bones, and three principal muscle groups
• Shoulder joints


  • Glenohumeral joint
  • Sternoclavicular joint
  • Acromioclavicular joint

  
• Shoulder muscle groups


  • Scapulohumeral group
  • Axioscapular group
  • Axiohumeral group
• Additional shoulder structures


  • Articular capsule
  • Long head of the biceps tendon
  • Subacromial bursa

  
• Shoulder flexion


  1. Raise your arms in front of you and overhead

  2. Principle muscles: Anterior deltoid, pectoralis major, coracobrachialis, biceps brachii
• Shoulder hyperextension


  1. Raise your arms behind you

  2. Principle muscles: Latissimus dorsi, teres major, posterior deltoid, triceps brachii
• Shoulder abduction


  1. Raise your arms out to the side and overhead

  2. Principle muscles: Supraspinatus, middle deltoid, serratus anterior
• Shoulder adduction


  1. Lower your arms to your sides, then bring them across your body

  2. Principle muscles: pectoralis major, coracobrachialis, latissimus dorsi, teres major, subscapularis
• Shoulder internal rotation


  1. Place one hand behind your back and touch your shoulder blade

  2. Principle muscles: subscapularis, anterior deltoid, pectoralis major, teres major, latissimus dorsi
• Shoulder external rotation


  1. Raise your arm to shoulder level, bend your elbow, and rotate your arm outward

  2. Principle muscles: infraspinatus, teres minor
• Shoulder movement: Abduction


  Raise your arms out to the side and overhead
• Principle muscles for shoulder abduction


  • Supraspinatus, middle deltoid, serratus anterior
• Shoulder movement: Adduction


  Lower your arms to your sides, then bring them across your body
• Principle muscles for shoulder adduction

  • pectoralis major, coracobrachialis, latissimus dorsi, teres major, subscapularis