musculuskeletal system

• Musculoskeletal system


  Composed of bones, muscles and joints

  
• Bones


  • Provide structure
  • Give protection
  • Serve as levers
  • Store calcium
  • Produce blood cells
• Structure of the Bones


  • 206 bones
  • Axial and appendicular skeleton
  • Compact and spongy bones
  • Osteoblasts, osteoclasts

  
• Bones


  • 206
  • Axial (head and trunk)
  • Appendicular (extremities, shoulders, hips)

  
• Bones


  • Composed of oseous tissue
  • Divided into compact and spongy
  • Formed by osteoblasts
  • Broken down by osteoclasts

  
• Bones


  • Contain red marrow and yellow marrow

  
• Skeletal muscles


  • Assist with posture
  • Produce body heat
  • Allow the body to move
• Types of muscles


  • Skeletal (650 voluntary)
  • Smooth
  • Cardiac

  
• Skeletal muscle movements


  • Abduction
  • Adduction
  • Inversion
  • Eversion
  • Extension
• Abduction


  Moving away from midline of the body
• Adduction


  Moving toward midline of the body
• Inversion


  Moving inward
• Eversion


  Moving outward
• Extension


  Straightening the extremity
• Joints


  • Place where 2 or more bones meet
  • Classified as fibrous, cartilagenous, synovial
• Structure of the Joints


  • Fibrous
  • Cartilaginous
  • Synovial
  • Ligaments
  • Bursae

  
• Collecting Objective Data


  • Preparing the client
  • Tape measure
  • Goniometer
  • Skin marking pencil
• Technique for Musculoskeletal Assessment


  • Inspection
  • Palpation
  • Test for ROM (Active, Passive)
  • Test for muscle strength

  
• Passive range-of-motion (ROM) exercise


  Exercise in which another person moves each of the client's joints through their complete range of movement, maximally stretching all muscle groups within each plane over each joint
• Active range-of-motion exercises


  Isotonic exercises in which the client independently moves each joint in the body through its complete range of movement, maximally stretching all muscle groups within each plane, over the joint
• Muscle Strength Rating


  • 5 - Active motion against full resistance (Normal)
  • 4 - Active motion against some resistance (Slight weakness)
  • 3 - Active motion against gravity (Average weakness)
  • 2 - Passive ROM (gravity removed & assisted by examiner) (Poor ROM)
  • 1 - Slight flicker of contraction (Severe weakness)
  • 0 - No muscular contraction (Paralysis)
• Physical Assessment


  • Observe gait and posture
  • Inspect size of muscles, joint muscles and extremities for size symmetry and color
  • Palpate joints, muscles and extremities for tenderness, edema, heat, nodules and crepitus
  • Test muscle strength and ROM of joints
  • Compare bilateral findings of joints and muscles

  
• Cervical, thoracic, and lumbar spine assessment


  • Observe the cervical, thoracic, lumbar curves
  • Palpate the spinous processes and paravertebral muscles for tenderness or pain
• Musculoskeletal Assessment - Gait


  • Base of support
  • Weight bearing activity
  • Foot position
  • Stride and length and cadence and stride
  • Arm swing
  • Posture

  
• Evenly distributed weight, client able to stand on heels and toes, toes point straight ahead, equal on both sides, posture erect

  
• Temporomandibular joint assessment


  • Inspect and palpate the TMJ
  • Move the jaw from side to side
  • Protrude and retract the jaw
  • Ask the client to open the mouth and move the jaw laterally against resistance
  • Ask the client to clench the teeth, feel the temporal and masseter muscles to test the integrity of trigeminal nerve (v)
• Sternoclavicular joint assessment


  • Inspect and palpate for midline location, color, swelling, and masses
  • Palpate for tenderness
• Cervical, thoracic and lumbar spine assessment


  • Observe cervical,thoracic and lumbar curves from the side and behind
  • Observe for symmetry, noting differences in height of shoulders, iliac crests and buttock creases
  • Test ROM of the cervical, thoracic, lumbar spine
  • Test for back and leg pain
  • Measure leg length
• Cervical and lumbar spines are concave, thoracic spine is convex, spine is straight
• Non tender spinous process, well-develop, firm smooth, non tender paravertebral muscles, no muscle spasm
• Cervical spine ROM test


  • Flexion (45 degrees)
  • Hyperextension (45 degrees)
  • Lateral bending (40 degrees)
  • Rotation (70 degrees)
• Thoracic and lumbar spine ROM test


  • Forward bend (75-90 degrees)
  • Lateral bend (35 degrees)
• Performing the straight leg test to test for back and leg pain
• Measure leg length
• Shoulders, arms, and elbows assessment


  • Inspect for symmetry, color, swelling, masses
  • Palpate for tenderness
  • Test ROM (forward, backward, overhead, elbows flexed behind back)
• Extent of shoulder ROM: forward flexion 180°, hyperextension 50°, adduction 50°, abduction 180°, external and internal rotation 90°

  
• Elbows assessment


  • Inspect for size, shape, deformities, redness, or swelling
  • Test ROM (flexion, extension, pronation, supination)
• Elbows are symmetric, without deformities, redness or swelling, non tender, without nodules
• Wrists assessment


  • Inspect for size, shape, symmetry, color and swelling
  • Palpate for tenderness and nodules
  • Palpate the anatomic snuffbox
• Musculoskeletal Assessment


  • Inspect and palpate elbows
  • Test ROM
  • Inspect and palpate wrists
  • Palpate anatomic snuffbox
  • Inspect and palpate hands and fingers
  • Test ROM of hands and fingers
  • Inspect and palpate hips
  • Test ROM of hips
  • Inspect and palpate knees
  • Test for swelling in knees
  • Test ROM of knees
  • Inspect and palpate ankles and feet
  • Test ROM of ankles and feet