Muscoloskeletal System

Musculoskeletal System Consists of:

BonesMusclesJointscartilage

function

Support to stand erectMovementProtect inner vital organsHemopoiesis – Bone marrow produces

white & red bld cells and plateletsReservoir for storage of minerals & energy

– Ca. & Phosphorus in the bones.

Bones

206Bones & cartilage are types of Connective

tissueBone is hard and rigid and dense

Joints

2 or more bones connectingMobility Nonsynovial = immovable, skull suturesSynovial = movableSynovial 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.

Muscles

40 – 50 % body weightContract & produce movementSkeletal muscle is voluntaryComposed of Bundles of muscle fibers or

fasciculiMuscle is attached to bones via tendons

Skeletal muscles produce the following movements

Flexion – bendingExtension – straighteningAbduction – away from midlineAdduction – toward midlinePronation – palm downSupination – palm upCircumduction - circular

Skeletal muscles produce the following movements

Inversion – sole inwardEversion – sole outwardRotation – head around central axisProtraction –forward movement parallel to

ground (chin)Retraction – backward parallel movementDepression/elevation – Shoulders up &

down

Temporomandibular Joint (TMJ)

Articulation of temporal & mandibleDepression anterior to tragus of earJaw function for chewing & speakingMovements

– Hinge – open/close– Gliding – protrusion/retraction– Gliding- side to side

Spine

33 VertebraeSpinous process posterior midline7 Cervical12 Thoracic5 Lumbar5 Sacral3 – 4 Coccygeal

C7 & T1 prominent base of neck Inferior angle of scapula in line with T7 & T8Highest point iliac crest at L4Curves 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

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

Wrists and Carpals

Wrist –articulation of radius & carpal bones

Permits flexion, extension & side to side deviation

Metacarpophalangeal & interphalangeal joints – permit finger flexion and extension

Hip

Acetabulum & femurBall & socket joint Weight bearing functionLandmarks ( IM injections)

– Anterior, superior iliac crest– Ischial tuberosity (↓ gluteus maximus, flex

hip)– Greater trochanter of femur

Knee

Femur, tibia & patellaLargest jointHinged joint & largest synovial membrane2 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

Aging adult

Loss of bone density = osteoporosisPostural changes↓ height due to shortening of the vertebral

column

Subjective Data

Joints– Pain– Stiffness– Swelling, heat, redness

Muscles– Pain, cramps– weakness

Subjective Data

Bones– Pain– Deformity– Trauma

Functional Assessment ( ADL’s )Self – care behaviors

Objective AssessmentPhysical Exam Musculoskeletal

Purpose – To assess function for ADL’s – Screen for abnormalities

Screening Exams

InspectionPalpationROM with movement active or passive if

apparent limitations Age Specific

Important to :

Client comfortSystemic approachSupport jointsBilateral exam

Equipment

Tape measureGoniometerSkin marking pen

Inspection

Size & contour of jointColor, swelling, masses, deformity

Palpation

Each jointTemperature MusclesBony articulations joint capsuleTenderness, swelling, masses

ROM

Active ROMLimitation – try passive motion or in ROM, use a goniometer to

measure angles

Muscle Testing

Repeat movements for Active ROMClient flexes & holds against opposing

force= bilaterally, resists opposing force

Grade muscle strength (pg. 616)

Values 0- 5Grade 5= Normal –Full ROM against

gravity, full resistance

TMJ

Swelling, tenderness, crepitationCrepitation = 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

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

Test for Shoulder ROM

FlexionExtension Internal rotation External rotationAbductionAdductionCircumduction 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

ROM of Elbow

FlexionExtension pronationsupination

Muscle Strength of Elbow

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

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

ROM of Wrists and Hands

HyperextensionPalmar flexionFlexion of fingersAbduction for fingers Opposition Ulnar deviation, Radial deviation

Muscle Strength for Wrist and Hands

Flex wrist against palm resistancePhalen’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 jointsROM

Knee

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

Swelling = ? Soft tissue or ↑ fld in the jointBulge 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

ROMMuscle strength

Spine

StandingInspect Palpate spinous processesROM 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