NurseReview.Org - Muscoloskeletal System

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Information about NurseReview.Org - Muscoloskeletal System

Published on April 30, 2008

Author: nclexvideos

Source: slideshare.net

Description

http://NurseReview.Org Muscoloskeletal System

Muscoloskeletal System

Musculoskeletal System Consists of: Bones Muscles Joints cartilage

Bones

Muscles

Joints

cartilage

function Support to stand erect Movement Protect inner vital organs Hemopoiesis – Bone marrow produces white & red bld cells and platelets Reservoir for storage of minerals & energy – Ca. & Phosphorus in the bones.

Support to stand erect

Movement

Protect inner vital organs

Hemopoiesis – Bone marrow produces white & red bld cells and platelets

Reservoir for storage of minerals & energy – Ca. & Phosphorus in the bones.

Bones 206 Bones & cartilage are types of Connective tissue Bone is hard and rigid and dense

206

Bones & cartilage are types of Connective tissue

Bone is hard and rigid and dense

Joints 2 or more bones connecting Mobility Nonsynovial = immovable, skull sutures Synovial = movable Synovial joints – ends of bones are covered with cartilage & enclosed in a joint cavity filled with synovial fld.

2 or more bones connecting

Mobility

Nonsynovial = immovable, skull sutures

Synovial = movable

Synovial joints – ends of bones are covered with cartilage & enclosed in a joint cavity filled with synovial fld.

Ligaments are fibrous bands – connect one bone to another. Strengthen joint & prevent movement in the wrong direction Bursa – enclosed sac filled with synovial fld.& are located in areas of potential friction = shoulder, knee. Help muscles & tendons glide over bone.

Ligaments are fibrous bands – connect one bone to another. Strengthen joint & prevent movement in the wrong direction

Bursa – enclosed sac filled with synovial fld.& are located in areas of potential friction = shoulder, knee. Help muscles & tendons glide over bone.

Muscles 40 – 50 % body weight Contract & produce movement Skeletal muscle is voluntary Composed of Bundles of muscle fibers or fasciculi Muscle is attached to bones via tendons

40 – 50 % body weight

Contract & produce movement

Skeletal muscle is voluntary

Composed of Bundles of muscle fibers or fasciculi

Muscle is attached to bones via tendons

Skeletal muscles produce the following movements Flexion – bending Extension – straightening Abduction – away from midline Adduction – toward midline Pronation – palm down Supination – palm up Circumduction - circular

Flexion – bending

Extension – straightening

Abduction – away from midline

Adduction – toward midline

Pronation – palm down

Supination – palm up

Circumduction - circular

Skeletal muscles produce the following movements Inversion – sole inward Eversion – sole outward Rotation – head around central axis Protraction –forward movement parallel to ground (chin) Retraction – backward parallel movement Depression/elevation – Shoulders up & down

Inversion – sole inward

Eversion – sole outward

Rotation – head around central axis

Protraction –forward movement parallel to ground (chin)

Retraction – backward parallel movement

Depression/elevation – Shoulders up & down

 

Temporomandibular Joint (TMJ) Articulation of temporal & mandible Depression anterior to tragus of ear Jaw function for chewing & speaking Movements Hinge – open/close Gliding – protrusion/retraction Gliding- side to side

Articulation of temporal & mandible

Depression anterior to tragus of ear

Jaw function for chewing & speaking

Movements

Hinge – open/close

Gliding – protrusion/retraction

Gliding- side to side

Spine 33 Vertebrae Spinous process posterior midline 7 Cervical 12 Thoracic 5 Lumbar 5 Sacral 3 – 4 Coccygeal

33 Vertebrae

Spinous process posterior midline

7 Cervical

12 Thoracic

5 Lumbar

5 Sacral

3 – 4 Coccygeal

C7 & T1 prominent base of neck Inferior angle of scapula in line with T7 & T8 Highest point iliac crest at L4 Curves Double S – lateral view cervical & lumbar are concave;(inward) Thoracic & sacrococcygeal are convex Intervertebral discs cushion the spine = shock absorber

C7 & T1 prominent base of neck

Inferior angle of scapula in line with T7 & T8

Highest point iliac crest at L4

Curves Double S – lateral view

cervical & lumbar are concave;(inward)

Thoracic & sacrococcygeal are convex

Intervertebral discs cushion the spine = shock absorber

Shoulder Articulation of humerus & glenoid fossa of scapula Ball & socket – enclosed by rotator cuff (4 muscles and tendons) Acromion process – bump at top of shoulder

Articulation of humerus & glenoid fossa of scapula

Ball & socket – enclosed by rotator cuff (4 muscles and tendons)

Acromion process – bump at top of shoulder

Elbow Articulation humerus, radius, & ulna Landmarks are the Medial & lateral epicondyles of the humerus & large olecranon process of the ulna in between Sensitive ulnar nerve

Articulation humerus, radius, & ulna

Landmarks are the Medial & lateral epicondyles of the humerus & large olecranon process of the ulna in between

Sensitive ulnar nerve

Wrists and Carpals Wrist –articulation of radius & carpal bones Permits flexion, extension & side to side deviation Metacarpophalangeal & interphalangeal joints – permit finger flexion and extension

Wrist –articulation of radius & carpal bones

Permits flexion, extension & side to side deviation

Metacarpophalangeal & interphalangeal joints – permit finger flexion and extension

Hip Acetabulum & femur Ball & socket joint Weight bearing function Landmarks ( IM injections) Anterior, superior iliac crest Ischial tuberosity ( ↓ gluteus maximus, flex hip) Greater trochanter of femur

Acetabulum & femur

Ball & socket joint

Weight bearing function

Landmarks ( IM injections)

Anterior, superior iliac crest

Ischial tuberosity ( ↓ gluteus maximus, flex hip)

Greater trochanter of femur

Knee Femur, tibia & patella Largest joint Hinged joint & largest synovial membrane 2 cartilages – medial & lateral menisci cushion the tibia & femur

Femur, tibia & patella

Largest joint

Hinged joint & largest synovial membrane

2 cartilages – medial & lateral menisci cushion the tibia & femur

Ankle & Foot Ankle joint is the articulation of Tibia, fibula & talus Hinged joint Dorsiflexion Plantar flexion Landmarks Medial & lateral malleolus

Ankle joint is the articulation of Tibia, fibula & talus

Hinged joint

Dorsiflexion

Plantar flexion

Landmarks

Medial & lateral malleolus

Aging adult Loss of bone density = osteoporosis Postural changes ↓ height due to shortening of the vertebral column

Loss of bone density = osteoporosis

Postural changes

↓ height due to shortening of the vertebral column

Subjective Data Joints Pain Stiffness Swelling, heat, redness Muscles Pain, cramps weakness

Joints

Pain

Stiffness

Swelling, heat, redness

Muscles

Pain, cramps

weakness

Subjective Data Bones Pain Deformity Trauma Functional Assessment ( ADL’s ) Self – care behaviors

Bones

Pain

Deformity

Trauma

Functional Assessment ( ADL’s )

Self – care behaviors

Objective Assessment Physical Exam Musculoskeletal Purpose To assess function for ADL’s Screen for abnormalities

Purpose

To assess function for ADL’s

Screen for abnormalities

Screening Exams Inspection Palpation ROM with movement active or passive if apparent limitations Age Specific

Inspection

Palpation

ROM with movement active or passive if apparent limitations

Age Specific

Important to : Client comfort Systemic approach Support joints Bilateral exam

Client comfort

Systemic approach

Support joints

Bilateral exam

Equipment Tape measure Goniometer Skin marking pen

Tape measure

Goniometer

Skin marking pen

Inspection Size & contour of joint Color, swelling, masses, deformity

Size & contour of joint

Color, swelling, masses, deformity

Palpation Each joint Temperature Muscles Bony articulations joint capsule Tenderness, swelling, masses

Each joint

Temperature

Muscles

Bony articulations joint capsule

Tenderness, swelling, masses

ROM Active ROM Limitation – try passive motion or in ROM, use a goniometer to measure angles

Active ROM

Limitation – try passive motion

or in ROM, use a goniometer to measure angles

Muscle Testing Repeat movements for Active ROM Client flexes & holds against opposing force = bilaterally, resists opposing force

Repeat movements for Active ROM

Client flexes & holds against opposing force

= bilaterally, resists opposing force

Grade muscle strength (pg. 616) Values 0- 5 Grade 5= Normal –Full ROM against gravity, full resistance

Values 0- 5

Grade 5= Normal –Full ROM against gravity, full resistance

 

TMJ Swelling, tenderness, crepitation Crepitation = audible & palpable crunching or grating with movement

Swelling, tenderness, crepitation

Crepitation = audible & palpable crunching or grating with movement

Cervical Spine Inspection Head & neck alignment Spine Palpation Spinous processes, Trapezius, Paravertebral muscles ROM, flexion, extension, hyperextension, lateral flexion, rotation, circumduction Repeat applying opposing force

Inspection

Head & neck alignment

Spine

Palpation

Spinous processes, Trapezius, Paravertebral muscles

ROM, flexion, extension, hyperextension, lateral flexion, rotation, circumduction

Repeat applying opposing force

Shoulders Inspect Bilateral comparison Palpate Bilaterally for muscle spasms, atrophy, swelling, heat, tenderness Clavicle to acromioclavicular joint, scapula, greater tubercle of humerus, subacromal bursa, biceps groove & anterior aspect glenohumeral joint

Inspect

Bilateral comparison

Palpate

Bilaterally for muscle spasms, atrophy, swelling, heat, tenderness

Clavicle to acromioclavicular joint, scapula, greater tubercle of humerus, subacromal bursa, biceps groove & anterior aspect glenohumeral joint

Test for Shoulder ROM Flexion Extension Internal rotation External rotation Abduction Adduction Circumduction Test for strength; shrug shoulders, flex forward, up & abduct against resistance

Flexion

Extension

Internal rotation

External rotation

Abduction

Adduction

Circumduction

Test for strength; shrug shoulders, flex forward, up & abduct against resistance

Elbow Inspect Size & contour with flexion, extension Deformity, redness, swelling Olecranon bursa Palpate Flexed 70 degrees Olecranon process, medial & lateral epicondyles of humerus Olecronon bursa for heat, swelling, tenderness, nodules

Inspect

Size & contour with flexion, extension

Deformity, redness, swelling

Olecranon bursa

Palpate

Flexed 70 degrees

Olecranon process, medial & lateral epicondyles of humerus

Olecronon bursa for heat, swelling, tenderness, nodules

ROM of Elbow Flexion Extension pronation supination

Flexion

Extension

pronation

supination

Muscle Strength of Elbow Flex elbow – then extend against resistance applied just proximal to the wrist

Flex elbow – then extend against resistance applied just proximal to the wrist

Wrist and Hand Inspect Palmar & dorsal surface Position, contour and shape Swelling, redness, deformity or nodules

Inspect

Palmar & dorsal surface

Position, contour and shape

Swelling, redness, deformity or nodules

Wrist and Hand Palpate Wrist and hand joints Support hand, use both thumbs to palpate Metacarpophanlangeal joints Use thumb and index finger in a pinching motion to palpate interphalangeal joints

Palpate

Wrist and hand joints

Support hand, use both thumbs to palpate

Metacarpophanlangeal joints

Use thumb and index finger in a pinching motion to palpate interphalangeal joints

ROM of Wrists and Hands Hyperextension Palmar flexion Flexion of fingers Abduction for fingers Opposition Ulnar deviation, Radial deviation

Hyperextension

Palmar flexion

Flexion of fingers

Abduction for fingers

Opposition

Ulnar deviation, Radial deviation

Muscle Strength for Wrist and Hands Flex wrist against palm resistance Phalen’s test – both hands flexed & back to back for 60 secs. Normally no symp. Carpel tunnel syndrome will give a + result of numbness & burning Tinel’s Sign – direct percussion @ median nerve of wrist. In carpel tunnel + result = burning & tingling

Flex wrist against palm resistance

Phalen’s test – both hands flexed & back to back for 60 secs. Normally no symp. Carpel tunnel syndrome will give a + result of numbness & burning

Tinel’s Sign – direct percussion @ median nerve of wrist. In carpel tunnel + result = burning & tingling

Hip Inspect hip joint with spine when client is standing Client is supine, palpate the hip joints ROM

Inspect hip joint with spine when client is standing

Client is supine, palpate the hip joints

ROM

Knee Supine with legs extended ( knees can be flexed or dangling for inspection) Swelling = ? Soft tissue or ↑ fld in the joint Bulge Sign – stroke up medial aspect 2-3x. Tap lateral aspect. Watch for a bulge in the medial hollow. Ballottement of the Patella – lger amt of flds

Supine with legs extended ( knees can be flexed or dangling for inspection)

Swelling = ? Soft tissue or ↑ fld in the joint

Bulge Sign – stroke up medial aspect 2-3x. Tap lateral aspect. Watch for a bulge in the medial hollow.

Ballottement of the Patella – lger amt of flds

Ankle & foot Inspect while nonweight- bearing, then standing & walking ROM Muscle strength

Inspect while nonweight- bearing, then standing & walking

ROM

Muscle strength

Spine Standing Inspect Palpate spinous processes ROM of spine is checked by asking to touch toes

Standing

Inspect

Palpate spinous processes

ROM of spine is checked by asking to touch toes

Leg measurement True leg length = measure b/t fixed points, the anterior iliac spine cross the medial side of the knee to the medial malleolus

True leg length = measure b/t fixed points, the anterior iliac spine cross the medial side of the knee to the medial malleolus

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