MTAR

• Structures of the musculoskeletal system

  • Bones
  • Muscles
• Axial skeleton


  Anything that is in the middle
• Appendicular skeleton


  Anything that is in the peripheral or sides

  
• Types of joints


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


  Immovable, example: sutures of the skull
• Cartilaginous joints


  Slightly movable, example: intervertebral discs
• Synovial joints


  Contain a space between the bones filled with synovial fluid, a lubricant that promotes sliding movement of the ends of the bones, contain bursae (small sacs filled with synovial fluid that cushions the joint), examples: suprapatellar bursa, prepatellar bursa, infrapatellar bursa
• Tendons


  Connect bones to muscles
• Major joints of the body


  • Temporomandibular joint (TMJ)
  • Sternoclavicular joint (SCJ)
  • Elbow
  • Shoulder
  • Wrist / fingers / thumb
  • Vertebrae
  • Hip
  • Knees
  • Ankles / feet

  
• Skeletal muscle movements

  • Abduction (away from the midline)
  • Adduction (moving towards the midline)
  • Circumduction (circular motion)
  • Inversion (moving inwards)
  • Eversion (moving outwards)
  • Extension (straightening of the extremity of the joint and increasing the angle of the joint)
  • Hyperextension (bending of the joint greater than 180 degrees)
  • Flexion (bending of the extremity of the joint and decreasing the angle of the joint)
  • Dorsiflexion (toes point upward to the ankle)
  • Plantarflexion (toes point downward away from the ankle)
  • Pronation (facing downward)
  • Supination (facing upward)
  • Protraction (forward movement of the jaw)
  • Retraction (backward movement of the jaw)
  • Rotation (internal and external rotation, turning of the bone on its own axis)
• Aspects of nursing health history for musculoskeletal system


  • Physical activities (ADLs)
  • Nutrition
  • Pain, stiffness, and limitation of movement
  • History of present concern
  • Personal health history
  • Family history
  • Lifestyle and health practices
• COLDSPA


  Characteristics of pain that can indicate condition: Aching pain - arthritis, Dull/deep pain - bone pain, Sharp pain - fracture
• Lifestyle and health practices to assess


  • Activities or exercises
  • Current medications (diuretics, steroids, statins)
  • Smoking history
  • Alcohol and caffeine intake
  • Diet (calcium containing products and calcium supplements)
  • Sunlight exposure
  • Occupation
  • Use of special footwear or assistive devices
  • Difficulty performing ADLs
  • Bone density screening results
• Equipment for musculoskeletal assessment


  • Tape measure
  • Goniometer (used to assess degree of joint movement)
  • Skin marking pencil
• Steps in musculoskeletal assessment


  • Observation/inspection (size, shape, symmetry, color)
  • Palpation (swelling, tenderness, warmth, nodules)
  • Test muscle strength and range of motion
  • Compare bilateral findings
  • Perform special tests
• Types of gait


  • Waddling gait
  • Steppage gait
  • Propulsive (shuffling) gait
  • Scissors gait
  • Spastic gait
• Gait


  The pattern of movement of the limbs of animals, including humans, during locomotion over a solid substrate
• Aspects of gait assessment


  • Inspection (base of support, weight-bearing stability, foot position, stride and length of cadence, arm swing, posture)
  • Nudge test (assess risk of falling backwards)
• Temporomandibular joint (TMJ)


  The articulation between the temporal bone and mandible

  
• Assessing TMJ


  1. Put middle and index fingers on front of ear

  2. Ask client to open mouth

  3. Ask client to move jaw laterally

  4. Observe for findings

  
• Assessing range of motion of TMJ

  1. Move jaw against lateral resistance (side-to-side and backward/forward)

  2. Ask client to clench teeth and feel for muscle contraction
• Sternoclavicular joint (SCJ)


  The joint where the clavicle meets the sternum
• Assessing SCJ


  1. Inspect (location, color, swelling, masses)

  2. Palpate (swelling, tenderness, warmth, nodules)
• Normal and abnormal findings for SCJ


  • Normal: No visible bony growth, tenderness, swelling, or redness
  • Abnormal: Swelling, tenderness, asymmetry

  
• Assessing cervical, thoracic, and lumbar spine


  1. Inspect curvature from side view (observe for concavity/convexity, flexion, hyperextension, bending, lateral rotation)

  2. Inspect from back view (observe for symmetry, differences in height of shoulders, iliac crests, buttock creases)

  3. Palpate for tenderness/pain on spinous processes and paraspinal muscles

  
• Normal and abnormal spinal curvatures


  • Normal: Cervical and lumbar concave, thoracic convex, straight back view
  • Abnormal: Herniated disc/ankylosing spondylitis (flattened lumbar), scoliosis (lateral curvature), lordosis (exaggerated lumbar), kyphosis (exaggerated thoracic), unequal leg height

  
• Cervical spine range of motion test


  Ask client to flex, hyperextend, laterally bend, and laterally rotate cervical spine, repeat with resistance
• Cervical strain


  Most common cause of neck pain, from wrong sleeping position, heavy suitcase, motor vehicle accident
• Thoracic and lumbar spine range of motion test


  Ask client to touch toes (flexion), perform lateral flexion or rotation, note symmetry
• Straight leg test (Lasegue test)


  Test done on patients with back pain radiating to legs, to check for herniated discs

  
• Measuring leg length


  1. True leg length (ASIS to medial malleolus)

  2. Apparent leg length (umbilicus to medial malleolus)
• Assessing the shoulders


  1. Inspect (size, shape, symmetry, color)

  2. Palpate (swelling, tenderness, warmth) anterior structures (clavicle, acromioclavicular joint, subacromial area, biceps) and posterior structures (glenohumeral joint, coracoid process, trapezius, scapula)

  
• Normal and abnormal findings for shoulders


  • Normal: Symmetrical, round, well-developed muscles, no pain/tenderness
  • Abnormal: Muscle atrophy (decrease in size and wasting of muscle tissue)
• The shoulder is a ball and socket joint where the humerus, scapula, and glenohumeral cavity connect

  
• Coracoid process


  Also known as the "lighthouse of the shoulder"
• SHOULDER AND ARMS


  • ASSESSING THE SHOULDERS
  • MUSCULOSKELETAL SYSTEM
  • ELBOWS
  • WRIST, FINGERS, AND THUMB
  • HANDS AND FINGERS
  • HIPS
  • KNEES
  • ANKLES AND FEET

  
• Inspect the shoulders


  1. Size

  2. Shape

  3. Symmetry

  4. Color
• Palpate the shoulders


  1. Swelling

  2. Tenderness

  3. Warmth

  4. Clavicle

  5. Acromio-clavicular joint

  6. Sub-acromial area and biceps

  7. Glenohumeral joint

  8. Coracoid process

  9. Trapezius

  10. Scapula

  
• Normal findings of the shoulders
• Abnormal findings on the shoulders