support, movement, protection, production, and storage

5 functions of the bones joints and muscles

cortical bone

dense bone that forms the outer shell

trabecular bone

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

ostepblasts

build new bone

osteoclasts

break down bone tissue

osteocytes

mature bone cells that maintain the bone matrix

bone remodeling

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

PTH calcitonin and vitamin D

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

osteoporosis

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

synarthrosis

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

amphiarthrosis

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

diarthrosis

freely movable joint (shoulder, elbow)

synovial

cavity filled with lubricant freely movable

uniaxial joints

includes hinge and pivot joints

hinge

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

pivot

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

biaxial joints

includes saddle and condyloid joints

saddle

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

condyloid

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

multiaxial joints

includes ball and socket and gliding joints

ball and socket joint

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

gliding joint

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

tendons

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

cartilage

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

ligaments

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

bursa

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

myofibrils

make up the skeletal muscle fibers

sarcomeres

repeating units of myofibrils that are the functional units of contraction

sliding filament theory

explains how muscles contract

myosin heads bind to actin filaments and pull them inward shortening the sarcomere

muscle contraction

ATP

required for muscle contraction; triggered by calcium ion release

calcium ions

released from the sarcoplasmic reticulum

excitation contraction coupling

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

Type I Slow Twitch

fatigue-resistant, used for endurance

Type II Fast Twitch

generate more force, used for short bursts of power

sarcopenia

muscle mass and strength decline with age

strength testing, reflexes, and electromyography

three things used to evaluate muscle function

joints

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

muscles

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

skeletal

health history gait change limping numbness tingling crepitus recent fractures

how the injury occurred and how the patient self treated

two important factors during MS health assessment

Onset, Location, Duration, Characteristics, Alleviating/Aggravating Factors, Radiation, Timing, Severity

history of present illness factors

illness, trauma, deformity, immunosuppression, DM, PVD, med use (NSAIDS)

past medical history factors important during MS assessment

RA, osteoporosis, Gout, Paget's, Dupuytren's contracture, SLE, Marfan's syndrome, scoliosis

relevant family medical history for MS assessment

ETOH and tobacco use (risk of osteoporosis), work environment, home environment, hobbies/activities

relevant social history for MS assessment

obesity, poor nutrition, low calcium intake, medication history, chronic illness, age, and gender

7 risk factors for musculoskeletal problems

compare side to side, size, contour, swelling, redness, deformities

MS inspection includes:

dislocation subluxation contracture and ankylosis

four deformities of MS system

subluxation

partial dislocation

ankylosis

fusion of bones across a joint

ROM

palpation part of MS assessment

active ROM

done by patient refusal or inability suggesting significant injury

passive ROM

done by examiner with patient relaxed and supporting injured area

isometric

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

heat, tenderness, swelling, masses

four signs to look for during palpation of MS system

crepitus

grating seen with arthritis

palpable fluid, visible bulging, doughy/boggy, and crepitus

four abnormalities to observe in MS assessment

muscle testing grading

done with patient flexing and holding against resistance

5 full range of motion/full 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

4 full ROM/ some resistance

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

3 full ROM with gravity

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

2

full range of motion gravity removed

1

slight contraction 10%

0

no contraction 0%

3 or less

muscle strength grade that indicates disability

strain

injury in the muscle tears or pulls that heals faster

sprain

injury of the ligament that heals slowest

joint, ligament bursa

pain with passive ROM

muscle and tendon

pain with active ROM

detection of congenital deformities and enormous changes during infancy

focus of infant MS assessment

upper extremity abnormalities

abnormalities in older children rare outside of injury

lower extremity and spinal

issues to look for in older child MS assessment

grade 1

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

grade 2

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

antalgic gait

gait with definite limp

grade 3

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

osteoarthritis, rheumatoid arthritis, osteoporosis and fibromyalgia

four common MS issues

osteoporosis

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

44 million Americans

osteoporosis prevalence

55% of people 50+

percentage and age of osteoporosis prevalence

10 million, 8 million, 2 million

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

44 million

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

$19 billion

estimated national direct care expenditures for osteoporotic fractures

fibromyalgia

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

shoulder

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

Hawkins

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

Neer 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

Gerbers liftoff 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

empty can 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

painful arc

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

drop arm test

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

Hawkins, Neer, Gerbers liftoff, empty can, painful arc, and drop arm

six shoulder special tests

clavicle

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

elbow

includes medial epicondyle, lateral epicondyle, flexors, and extensors

valgus and varus stress test and book test

two special tests for elbow

bursitis

known as big red elbow

epicondylitis

muscle mass inflamed as it attaches to the bone

golfer's elbow

epicondylitis on medial elbow

tennis elbow

epicondylitis on lateral elbow

book/polk test lateral

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

book/polk test medial

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

nursemaids elbow

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

hand

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

neuromuscular assessment of hand

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.

Phalens and tinels tests

special tests of hand

ulnar deviation

fingers outward

ankylosis

wrist extreme flexion

dupuytrens contracture

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%

swan neck and Boutonnière

deformities seen with RA

ganglion of wrist

Heberden's and Bouchard's

DIP and PIP seen with OA

carpal tunnel syndrome

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

phalens

test most specific for carpal tunnel syndrome

polydactyly

extra fingers

syndactyly

webbed fingers

hip/spine

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