Bates' Guide to Physical Examination and History Taking: Musculoskeletal Assessment Flashcards

5 functions of the bones joints and muscles

dense bone that forms the outer shell

sponge bone found at the ends of long bones and in vertebrae

build new bone

break down bone tissue

mature bone cells that maintain the bone matrix

helps repair micro-damage and adapt to new loads in response to stress and hormonal signals bone reforms

hormones that play key roles in regulating calcium levels and bone turnover

balance between bone resorption and formation is disrupted leading to fragile bones

non-synovial immovable joint (growth plate, between distal ends of radius and ulna, root to tooth to mandible)

non-synovial slightly movable joint (vertebrae, symphysis pubis)

freely movable joint (shoulder, elbow)

cavity filled with lubricant freely movable

includes hinge and pivot joints

joint- angular movement in 1 axis and 1 plane (elbow finger knee)

joint- rotary movement, a ring rotates around (radioulnar, 1st and 2nd cervical vertebrae)

includes saddle and condyloid joints

articulating surface of 1 bone is convex and surface of 2nd bone is concave (thumb)

angular motion on 2 planes without axial rotation (wrist between distal radius and carpels)

includes ball and socket and gliding joints

joint- round end of bone into cuplike cavity (shoulder hip)

joint- sliding motion (vertebrae, tarsal bones of ankle)

strong connective tissue, outer cover of muscle belly, attaches muscle to bone

avascular, dense, connective tissue covers end of opposing bones withstands increased pressure and tension

strong fibrous connective tissue, connect bones to each other at joint level and encase capsule, support purposeful joint movement and prevent wrong movement

enclosed sac filled with viscous fluid located in areas of potential friction act as cushion between surfaces

make up the skeletal muscle fibers

repeating units of myofibrils that are the functional units of contraction

explains how muscles contract

muscle contraction

required for muscle contraction; triggered by calcium ion release

released from the sarcoplasmic reticulum

begins with a nerve impulse travels down the motor neuron and results in muscle contraction

fatigue-resistant, used for endurance

generate more force, used for short bursts of power

muscle mass and strength decline with age

three things used to evaluate muscle function

health history stiffness redness swelling pain with motion complaints of pain that coincide with climate change

health history weakness fatigue aching wasting associated factors related to exercise or sudden movement

health history gait change limping numbness tingling crepitus recent fractures

two important factors during MS health assessment

history of present illness factors

past medical history factors important during MS assessment

relevant family medical history for MS assessment

relevant social history for MS assessment

7 risk factors for musculoskeletal problems

MS inspection includes:

four deformities of MS system

partial dislocation

fusion of bones across a joint

palpation part of MS assessment

done by patient refusal or inability suggesting significant injury

done by examiner with patient relaxed and supporting injured area

contracts muscles at injured area without moving bones, noting any visible defects

four signs to look for during palpation of MS system

grating seen with arthritis

four abnormalities to observe in MS assessment

done with patient flexing and holding against resistance

patient has full ability to demonstrate full range of motion of the joint with the examiner applying full pull or force in the opposite direciton

patient has full ability to demonstrate full range of motion of the joint with the examiner applying less opposite pull or force in the opposite direction

there is no resistance applied by the examiner but the patient is able to have full ROM against normal gravity

full range of motion gravity removed

slight contraction 10%

no contraction 0%

muscle strength grade that indicates disability

injury in the muscle tears or pulls that heals faster

injury of the ligament that heals slowest

pain with passive ROM

pain with active ROM

focus of infant MS assessment

abnormalities in older children rare outside of injury

issues to look for in older child MS assessment

strain with no specific event; pain and stiffness after activity; pain is vague not one specific spot, no pain with rest; nearly full strength

strain pain with several steps, muscle spasm; relatively small area of pain; strength significantly decreased to resisted contraction with pain; definite limp

gait with definite limp

strain with sudden intense pain (like someone hit me with a rock); point of pain in area of tear in tendon or muscle belly; strength- can't develop tension in muscle unit; gait- can't use muscle to ambulate

four common MS issues

risk factors include being a caucasian or asian woman, small thin frame, positive family history close relatives, early or surgically induced menopause, chronic illnesses, amenorrhea, low life-time calcium intake, anorexia, impaired GI absorption, immobilization or sedentary lifestyle, smoking and alcohol use, low testosterone in men, use of certain medications

osteoporosis prevalence

percentage and age of osteoporosis prevalence

amount of individuals, women, and men estimated to already have osteoporosis

amount of people estimated to have low bone mass putting them at risk for osteoporosis

estimated national direct care expenditures for osteoporotic fractures

chronic pain disorder with debilitating symptoms such as muscle tendon and joint pain as well as fatigue; symptoms overlap with other disease; unknown etiology but linked to anxiety depression stress conditions infections and viruses

includes glenohumeral joint, acromion process, clavicle, acromioclavicular joint, greater tubercle, coracoid process; muscles are deltoid, trapezius, biceps, rotator cuff, supraspinatus, infraspinatus, trees minor, subscapularis

subacromial impingement; forward abduct sagittal plane patient's arm at 90 degrees with elbow bent internally; rotate arm internally; pain with internal rotation is positive test

impingement bursitis; stabilize the scapula and internally rotate patient's arm and raise straight rotated arm; pain anywhere along upward trajectory is positive test

supscapularis muscle/tendon, bursitis; patient standing and clinician behind, external rotate arm placing dorsal of hand to small of back instructing patient to lift the hand off the back while applying resistance against the patient; if patient cannot resist, lift hand, or compensate with elbow or shoulder extension is positive test

supraspinatus muscle/tendon assessment; help rule out likelihood of bursitis; patient straight arm elevated 90 degrees in sagittal plane and rotate fully internally pronation of forearm with thumb down as if pouring liquid from a can with clinician applying resistance; pain or weakness with resistance is a positive test

subacromial impingement syndrome, bursitis; with straight arm patient abducts arm along coronal plane then adduct back; pain between 60-120 degrees in either direction that remits after 120 degrees or below 60 is positive

full thickness of rotator cuff tear of supraspinatus/infraspinatus; clinician passively abducts patient's straight arm to 90 degrees in coronal plane with full external rotation then releases arm, instructing patient to hold then slowly lower the arm; if patient suddenly drops arm or there is weakness or pain is a positive test

six shoulder special tests

at risk for fracture in infants; found in 2.9% of term infants often on the right side; often silent and noticed after a few weeks by palpable callous

includes medial epicondyle, lateral epicondyle, flexors, and extensors

two special tests for elbow

known as big red elbow

muscle mass inflamed as it attaches to the bone

epicondylitis on medial elbow

epicondylitis on lateral elbow

patient grasps item with palm facing floor with arm pronated and attempt to lift; pain is positive test

patient grasps item with palm facing up with arm supinated and attempts to lift (bicep curl); pain is a positive test

found in toddlers; subluxation of radial head d/t tugging injury

includes radiocarpel joint, carpals, metacarpophalangeal joint, phalanges, interphalanges (proximal and distal)

Sensation intact to light touch and two-point discrimination in median, ulnar, and radial nerve distributions. Capillary refill <2 seconds; radial and ulnar pulses palpable.

special tests of hand

fingers outward

wrist extreme flexion

contractures of fingers contracting inward towards the thumbs; usually appears at 40-60 years; occurs more often and more severe in males or Northern European origin; associated with alcohol and epilepsy medications, diabetes; autosomal dominant in some cases; most often in ring and little fingers; bilateral 45%

deformities seen with RA

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DIP and PIP seen with OA

presents with numbness tingling weakness sleepless nights and pain up and down arm; caused by repetitive use, endocrine (DM), pregnancy, thyroid, anoxia; diagnosed with tingles and phalanx positive tests

test most specific for carpal tunnel syndrome

extra fingers

webbed fingers

includes paraspinals, quadrates lumborum, psoas, gluteals, piriformis, hamstrings