MUSCULOSKELETAL

• Musculoskeletal system

  The body's bones, muscles, and joints

  
• Musculoskeletal system


  • Controlled and innervated by the nervous system
  • Overall purpose is to provide structure and movement for body parts
• Functions of skeletal system

  • Support
  • Protection
  • Movement
  • Storage
  • Blood cell formation
• A total of 206 bones make up the axial skeleton (head and trunk) and the appendicular skeleton (extremities, shoulders, and hips)

  
• Bone marrow

  • Red bone marrow produces blood cells and hemoglobin
  • Yellow bone marrow contains fat and connective tissue
• Types of muscles

  • Skeletal
  • Smooth
  • Cardiac
• Skeletal muscles

  • 650 skeletal (voluntary) muscles, which are under conscious control

  
• Skeletal muscle movements

  • Abduction
  • Adduction
  • Circumduction
  • Inversion
  • Eversion
  • Extension
  • Flexion
  • Pronation
  • Supination
  • Protraction
  • Retraction
  • Rotation
  • Internal rotation
  • External rotation

  
• Joint


  The place where two or more bones meet
• Types of joints

  • Synarthrosis (immovable)
  • Amphiarthrosis (slightly movable)
  • Diarthrosis or synovial (freely movable)
• Synovial joints

  • Surface covered with cartilage
  • Joint cavity covered with tough fibrous capsule
  • Cavity lined with synovial membrane and filled with synovial fluid
• Joints of the body

  • Ball and socket joint
  • Pivot joint
  • Hinge joint
• Cartilage


  Acts as a cushion between bones at a joint and protects the bones
• Ligaments

  Connect bone to bone, limit or enhance movement, provide joint stability, enhance joint strength
• Tendons

  Attach muscles to bones, enable bones to move when muscle contract

  
• Assessment of musculoskeletal system

  • Health history-taking
  • Inspect and palpate joints
  • Assess range of motion
  • Assess muscle strength

  
• General health history

  • Present health status
  • Past health history
  • Family history
  • Personal and psychological history
• Common reported problems

  • Pain
  • Problems with movement
  • Problems with daily activities
• Many musculoskeletal injuries are emergencies, so the PQRST is convenient to use
• General considerations

  • The patient should be undressed and gowned as needed
  • Some portions of the examination may not be appropriate depending on the clinical situation
  • When taking a history for an acute problem, always inquire about the mechanism of injury, loss of function, onset of swelling (<24 hours) and initial treatment
  • When taking a history for a chronic problem, always inquire about past injuries, past treatments, effect on function and current symptoms
  • Always begin with inspection, palpation, and range of motion, regardless of the region you are examining
  • A complete evaluation will include a focused neurologic exam of the affected area
• Regional considerations

  • Remember that the clavicle is part of the shoulder
  • The patella is much easier to examine if the leg is extended and relaxed
  • Be sure to palpate over the spinous process of each vertebrae
  • It is always helpful to observe the patient standing and walking
  • Always consider referred pain
  • Pain with, or limitation of, rotation is often the first sign of hip disease
• 5 P's of musculoskeletal injury

  • Pain
  • Paresthesia
  • Paralysis
  • Pallor
  • Pulse
• Assessment technique

  • Inspect skeleton and extremities
  • Inspect muscles
  • Palpate bones and joints
  • Observe range of motion of each joint and adjacent muscles
  • Test muscle strength and compare sides

  
• Muscle tone


  Describes muscular resistance to passive stretching
• Grading muscle strength

  • 5/5 Normal
  • 4/5 Good
  • 3/5 Fair
  • 2/5 Poor
  • 1/5 Trace
  • 0/5 Zero
• Equipment

  • Tape measure
  • Goniometer (optional)
  • Skin marking pen (optional)