Health Assessments and Joint Function Quiz
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Questions and Answers

What movement involves bending a limb at a joint?

  • Flexion (correct)
  • Extension
  • Adduction
  • Eversion

    • Which action is NOT permitted by the temporomandibular joint (TMJ)?

  • Gliding action for side-to-side movement
  • Rotational action for chewing (correct)
  • Gliding action for protrusion and retraction
  • Hinge action to open and close jaws

    • How does the intervertebral disc function as a shock absorber?

  • By reinforcing vertebrae against fractures
  • By providing stability without movement
  • By allowing movement and cushioning through elasticity (correct)
  • By absorbing impact through compression only

    • What is the correct definition of supination?

    <p>Turning forearm so that palm is up</p> Signup and view all the answers

    Which condition can occur if the intervertebral discs experience excessive compression?

    <p>Herniated nucleus pulposus</p> Signup and view all the answers

    What aspect of health history should be assessed regarding bones?

    <p>Presence of deformity due to injury or trauma</p> Signup and view all the answers

    Which of the following best assesses limitations in Activities of Daily Living (ADLs)?

    <p>Joint or muscle problems limiting usual ADLs</p> Signup and view all the answers

    Which type of information is least relevant when conducting a patient-centered care assessment?

    <p>Patient's favorite recreational activities</p> Signup and view all the answers

    What symptom characteristic should be evaluated when assessing back pain?

    <p>Duration of back pain fluctuations</p> Signup and view all the answers

    Which neurological symptoms should be monitored during a health assessment?

    <p>Presence of numbness or tingling</p> Signup and view all the answers

    What should be observed when testing muscle strength of prime mover muscle groups?

    <p>Muscle strength should equal bilaterally and resist opposing force fully.</p> Signup and view all the answers

    What does a grading of 2/5 indicate in muscle strength testing?

    <p>Full ROM with gravity eliminated.</p> Signup and view all the answers

    What should be taken into account when palpating the temporomandibular joint (TMJ)?

    <p>Check for a snap or click that is audible during mouth opening.</p> Signup and view all the answers

    When testing the integrity of cranial nerve V, which motion is expected?

    <p>Moving the jaw forward and laterally against resistance.</p> Signup and view all the answers

    What indicates a muscle strength grading of 0/5?

    <p>No contraction.</p> Signup and view all the answers

    What type of curvature do the cervical and lumbar regions of the spine exhibit?

    <p>Concave</p> Signup and view all the answers

    Which movement is NOT associated with the shoulder joint?

    <p>Dorsiflexion</p> Signup and view all the answers

    How many cervical vertebrae are present in the human body?

    <p>7</p> Signup and view all the answers

    What is the primary function of the rotator cuff muscles?

    <p>Stabilize the shoulder joint</p> Signup and view all the answers

    Which of the following is a movement type of the elbow joint?

    <p>Flexion</p> Signup and view all the answers

    What type of joint action does the hip joint predominantly perform?

    <p>Ball-and-socket</p> Signup and view all the answers

    What characterizes the thoracic and sacrococcygeal curves of the spine?

    <p>They are convex.</p> Signup and view all the answers

    What type of joint action is allowed at the radiocarpal joint of the wrist?

    <p>Flexion, extension, and side-to-side deviation</p> Signup and view all the answers

    What is the most common motion dysfunction found in hip disease?

    <p>Limitation of abduction</p> Signup and view all the answers

    When inspecting the hip joint, which feature is NOT typically assessed?

    <p>Flexibility of the ankle</p> Signup and view all the answers

    What indicates an abnormal alignment of the lower leg during a knee examination?

    <p>Patella tracking laterally</p> Signup and view all the answers

    Which test is NOT part of the knee examination?

    <p>Phalen Test</p> Signup and view all the answers

    During the palpation of the foot, which area is typically assessed?

    <p>Metatarsophalangeal joints</p> Signup and view all the answers

    What is indicated by the presence of calluses on the foot during inspection?

    <p>Areas of abnormal friction</p> Signup and view all the answers

    Which condition is characterized by a pronounced lumbar curve?

    <p>Lordosis</p> Signup and view all the answers

    Which observation is a sign of a healthy spinal alignment during inspection?

    <p>Straight spine</p> Signup and view all the answers

    What is the primary cause of osteoporosis in postmenopausal women?

    <p>Decreased estrogen levels</p> Signup and view all the answers

    Which of the following is a characteristic joint feature of osteoarthritis?

    <p>Asymmetrical joint involvement</p> Signup and view all the answers

    Which factor is NOT typically associated with an increased risk of developing osteoporosis?

    <p>Consumption of high-calcium foods</p> Signup and view all the answers

    What symptom is commonly observed in gouty arthritis?

    <p>Redness and warmth in the affected joint</p> Signup and view all the answers

    Which of the following is a common contributor to muscle atrophy?

    <p>Nerve damage resulting from compression</p> Signup and view all the answers

    Which condition is associated with a loss of mineralized bone mass?

    <p>Osteoporosis</p> Signup and view all the answers

    What is a common feature of acute rheumatoid arthritis?

    <p>Symmetrical joint involvement</p> Signup and view all the answers

    Which of the following symptoms is associated with fibromyalgia syndrome?

    <p>Widespread musculoskeletal pain</p> Signup and view all the answers

    Which factor can contribute to secondary osteoporosis?

    <p>Long-term steroid use</p> Signup and view all the answers

    What physical change occurs in a shoulder affected by a torn rotator cuff?

    <p>Hunched position and limited abduction</p> Signup and view all the answers

    Study Notes

    Musculoskeletal System

    • The musculoskeletal system comprises bones, joints, and muscles.
    • It provides support, allowing an upright stance.
    • It's essential for movement.
    • It encases and protects vital internal organs.
    • It produces red blood cells (RBCs) within bone marrow.
    • It stores essential minerals.

    Musculoskeletal Components

    • Bones and cartilage are specialized connective tissues.
    • Fibrous, cartilaginous, and synovial joints are articulation points of two or more bones.
      • Joints are places where bones connect.
    • Ligaments are fibrous bands connecting bones, strengthening and preventing unwanted movement.
    • Bursae are fluid-filled sacs cushioning and reducing friction between tissues.
    • Muscles are skeletal, voluntary muscles controlled by conscious thought/action; they are connected to bones by tendons.

    Types of Joints

    • Fibrous joints are connected by fibrous tissue or cartilage, offering no movement. Sutures in the skull are an example.
    • Cartilaginous joints are separated by fibrocartilaginous discs, permitting limited movement. Vertebrae are an example.
    • Synovial joints are freely movable, separated by a cavity lined with a synovial membrane that releases synovial fluid. This fluid lubricates the joint and helps to nourish the cartilage; ligaments surround and stabilize the joint.

    Terminology

    • Articular disease: affecting the joints
    • Extra-articular disease: affecting tissues outside the joints
    • Crepitation: A crackling or grating sound that may occur during movement, particularly in joints.

    Synovial Joint (Diagram)

    • Includes cartilage, synovial membrane, synovial cavity, and capsular ligaments
    • Facilitates smooth movement
    • Exhibits a cushioning function through bursae.

    Muscles

    • Muscles account for 40-50% of body weight.
    • Muscle contractions facilitate movements.
    • Muscles are classified as skeletal, smooth, and cardiac.
    • This study focuses on voluntary (skeletal) muscles.
    • Skeletal muscles contain fasciculi (bundles of muscle fibers).

    Skeletal Muscle Movements

    • Flexion: bending a limb at a joint
    • Extension: straightening a limb at a joint
    • Abduction: moving a limb away from the body's midline
    • Adduction: moving a limb toward the body's midline
    • Pronation: turning the forearm so the palm faces downwards
    • Supination: turning the forearm so the palm faces upwards
    • Circumduction: moving an arm in a circular motion around the shoulder
    • Inversion: moving the sole of the foot inwards towards the midline
    • Eversion: moving the sole of the foot outwards away from the midline
    • Rotation: movement around a central axis
    • Protraction: moving a body part forward, parallel to the ground
    • Retraction: moving a body part backward, parallel to the ground
    • Elevation: raising a body part
    • Depression: lowering a body part

    Temporomandibular Joint (TMJ)

    • Articulation of mandible and temporal bone.
    • Located anterior to the tragus of the ear.
    • Three motions:
      • Hinge action for opening and closing jaws
      • Gliding for protrusion/retraction
      • Gliding for side-to-side movement of the lower jaw

    Spine and Vertebrae

    • Vertebrae are 33 connecting bones vertically stacked
    • Intervertebral discs act as shock absorbers.
    • Each disc has a soft, semiliquid nucleus pulposus.
    • Spinal movement causes compression on one side, with expansion on the other.
    • Excessive compression can lead to disc rupture and herniation of the nucleus pulposus into the spinal column.
    • It potentially compresses the spinal nerves and causes pain.

    Spinal Curvatures

    • Spine has a double-S shape with four curves.
    • Cervical and lumbar curves are concave (inward)
    • Thoracic and sacrococcygeal curves are convex (outward).

    Surface Landmarks of Spine

    • Vertebrae number in the human body:
      • 7 cervical
      • 12 thoracic
      • 5 lumbar
      • 5 sacral
      • 3-4 coccygeal

    Shoulder Girdle

    • Includes humerus, scapula, and clavicle and their associated muscles and tendons
    • Provides high mobility to the upper limb (more than in other joint combinations)
    • The rotator cuff comprises four important muscles that support the shoulder joint.

    Shoulder Joint (Diagram)

    • Shows various parts of the shoulder joint including muscles, bursae, and the glenohumeral joint

    Rotator Cuff Tear (Diagram)

    • Anatomical visual of normal and torn rotator cuff tendons

    Elbow and Carpals

    • The elbow joint connects the humerus, radius, and ulna.
      • Includes the medial and lateral epicondyles, for example.
    • The elbow's movement occurs through flexion and extension, with radioulnar joints also present.
    • The wrist joint (radiocarpal joint) connects the radius to the carpal bones (in 2 planes).
      • Its motions include flexion, extension, rotation, radial, and ulnar deviation.
    • The midcarpal joint allows further motion.

    Trivia

    • Over half the bones in the human body are located in the hands and feet.

    Hip

    • The hip joint combines the acetabulum and the head of the femur.
    • Provides ball-and-socket action.
    • Offers stability for weight bearing and enhances movement.
    • Important bony landmarks for examination include the iliac crest and the greater trochanter of the femur.

    Knee

    • The knee joint is an articulation of the femur, tibia, and patella
    • Hinge joint: motion occurs in a single plane, with flexion and extension of lower leg on a single plane.
    • Contains wedge-shaped cartilages (medial and lateral menisci) to act as cushions.
    • Stabilizers of the knee include collateral ligaments (medial and lateral) and cruciate ligaments (anterior and posterior).

    Ankle and Foot

    • The ankle (tibiotalar) joint comprises the tibia, fibula, and talus.
    • A hinge joint that permits flexion (dorsiflexion) and extension (plantar flexion)
    • Important landmarks include the medial malleolus and the lateral malleolus.
    • Joints below the ankle allow inversion and eversion.

    Subjective Data

    • Collect information on pain, stiffness, swelling, heat, redness, and limited movement in body joints, muscles, and bones.
    • Evaluate knee injuries if present.

    Health History Questions

    • Joints:
      • Pain (location, quality, and severity, onset, duration, frequency).
      • Aggravating or precipitating factors
      • Associated clinical presentations (limitations of motion, swelling, or erythema)
      • Impact on ADLs
    • Muscles:
      • Location of pain or cramping
      • Pain during walking versus rest (consider claudication) if related to peripheral arterial disease (PAD)
      • Associated clinical presentations
      • Muscle characteristics (weakness, etc)
      • Symptom patterns (onset and duration)
    • Bones:
      • Pain (at rest and/or with movement, associated with posture).
      • Deformities or trauma history with impacts on ROM
      • History of accidents or trauma & impact on bones
      • Medical/surgical treatment (residual deficits)
      • Neurological or physical deficits (numbness, tingling, limping, etc.)

    Functional Assessment (ADLs)

    • Determine the impact of joint, muscle, or bone problems on everyday activities (bathing, dressing, eating, toileting etc).

    Patient-Centered Care

    • Gather data on occupational hazards, exercise patterns, diet, medications, supplements, smoking history, and impact on activities of daily living (ADLs), psychosocial stressors, pain, depression.
    • Explore the impact of acute/chronic disability or self-esteem disturbances.
    • Investigate relevant questions about functional abilities and safety risks.

    Aging Adult

    • Assess for new onset weakness, falls, use of mobility devices.
    • Recommend DXA screening as appropriate based on age and risk factors

    Physical Examination Preparation

    • The aim of musculoskeletal examinations is to gauge function and identify abnormalities related to daily activities.
    • Record observations, and note any age-specific abnormalities.
    • Begin examination with an orderly approach (head to toe, proximal to distal, & midline outwards).
    • Comparative observations between body sides (left and right) helps identify asymmetries and potential problems.

    Order of Examination

    • Inspection is the initial step. Note joint size, contour, skin color, swelling, and any masses for identification of abnormalities.
    • Palpation involves feeling the joint, skin tissues for temperature, tenderness, swelling, bony areas, muscles and the joint capsule for identification of abnormalities.
    • Range of motion (ROM) assessment is next. Involves observing active & passive motion, including any limitations.
    • Muscle Testing involves probing areas related to prime mover muscle groups and their strengths.

    Muscle Grading Scale

    • A standardized system grading muscle strength from 0-5.

    Temporomandibular Joint (TMJ) - palpation

    • Assess for palpation of contracted muscles, especially in relation to teeth clenching.
    • Look for clicks/snaps.
    • Compare strength and size between both sides of the jaw.
    • Utilize resistance to test movement functions, including side-to-side and forward movements
    • Note swelling, movement limits, and associated pain or other relevant issues

    Cervical Spine

    • Observe and document posture & spinal alignment.
    • Palpate spinous processes, sternomastoid and trapezius muscle to search for tenderness - especially in relation to muscle spasms
    • Check ROM (range of motion), and observe for symmetry in movement.
      • Use resistance method for full range of motion testing.
    • Note any related neurological or other problems.

    Shoulder

    • Observe and document shoulder alignment in a posterior and anterior view.
    • Test for underlying neck trauma.
    • Identify areas of reported discomfort to ensure no related problems to the area.
    • Palpate for atrophy, swelling, tenderness, and any muscle spasms.
    • Use methodical methods evaluating strength and ROM.
    • Ensure appropriate assessment methods for cranial nerve XI, specifically, in relation to the shoulder shrug.

    Elbow

    • Assess size and contour of elbow joint in both flexed and extended positions.
    • Examine for deformity, redness, and swelling; also, palpate the olecranon bursa
    • Assess the normally present hollows to check for abnormal swelling
    • Palpate with elbow flexed at 70° in relaxed position, using stabilizing techniques to assess ROM and muscle strength accurately.

    Wrist and Hand

    • Inspect both dorsal and palmar surfaces and look for position, contour, swelling, nodules, redness, deformity.
    • Palpate each joint in wrist and hands for assessment of strength and ROM, and examine muscle function
    • Use stabilizing techniques for muscle testing, to precisely assess their strength and range of motion.

    Testing for Carpal Tunnel Syndrome:

    • Phalen Test: Assess median nerve palmaris function.
    • Tinel Sign: Assesses median nerve function (used in conjunction with the Phalen test).

    Hip

    • Simultaneously examine the hip and spine; observe posture alignment of iliac crests, gluteal folds, and buttocks during stance.
    • Observe gait for evenness and symmetric movements, as well as range of motion (ROM).
    • Examine and palpate hip joints for tenderness or crepitation in a supine posture.
    • Assess range of abduction (ability to take the hip away from the body midline) and evaluate any common motion dysfunctions.

    Knee

    • Ensure the patient is in either a supine or sitting position.
    • Observe lower leg alignment, assessing knee shape and contour.
    • Screen the quadriceps muscle in the anterior thigh.
    • Assess the ROM for limitations and any present pain.
    • Perform relevant exams such as ballottement of the patella, bulge sign, and McMurray tests.

    Ankle and Foot

    • Examine ankles and feet while the patient is standing and during walking, noting joint positions, contour, and any relevant issues.
    • Observe the long and longitudinal arches (flat feet status).
    • Take note for any calluses or unusual friction patterns present.
    • Review any relevant shoes for signs of abnormal wear or accommodation.
    • Assess the plantar (pointing downwards) and dorsiflexion (pointing upwards) motions against resistance.
    • Palpate metatarsophalangeal joints (between thumbs and fingers).

    Spine

    • Assess if the patient is standing, draped, and upright.
    • Assess and document spinal alignment, posture and relevant abnormalities (kyphosis or lordosis), especially associated with aging
    • Evaluate for tenderness and any associated pain as required.
    • Assess range of motion (including flexibility, spinal curves, and any problems) to discover any limitations.

    Straight Leg Raise (Lasègue's) Test

    • Assess back and leg pain, potentially linked to herniated nucleus pulposus.
    • Elevate the affected leg (with the knee extended) to just before pain emerges (or to where pain occurs).
    • Dorsiflex the foot (flex the foot upward).
      • Positive findings would demonstrate sciatic pain.
    • The unaffected leg remains flat. Observe the affected leg and inquire into any involved side issues.

    Genetics and Environment

    • Bone mineral density (BMD): Higher BMD signifies denser bone, while lower BMD predicts hip and vertebral fractures/osteoporosis.
    • Racial/ethnic differences: Non-Hispanic Black adults exhibit higher BMD. However, they also face higher mortality after hip fracture.
    • Gender differences: Women generally have earlier peak BMD and undergo a more rapid decline compared to men. This is associated with higher fracture risk in post-menopausal white women.

    Developmental Competence (Infants, Adolescents, Pregnancy, Aging Adults)

    • Infants & Adolescents: Methods of musculoskeletal examination for infants/adolescents are similar to adults. Adolescents commonly experience kyphosis due to prolonged poor posture, but scoliosis is also important to detect.
    • Pregnancy: Hormonal changes commonly increase mobility in pregnancy, impacting joints and posture. Progressive lordosis (an exaggerated curve) in the lumbar spine is a common finding.
    • Aging adult: Bone remodeling (resorption/deposition) is involved in bone health in aging patients and potentially impacted by factors like low bone mass. Age-related posture changes (e.g., kyphosis) and loss of muscle mass (atrophy) contribute to musculoskeletal issues among the elderly.

    Common Musculoskeletal Abnormalities

    • Rheumatoid arthritis: Systemic, chronic inflammatory joint disease manifesting with heat, redness, swelling, and especially morning stiffness improving with movement.
    • Osteoarthritis: Degenerative, non-inflammatory joint affliction that gradually involves cartilage destruction, frequently accompanied by pain and stiffness.
    • Osteoporosis: Bone disease due to reduced bone density/mineral content, rising the risk of fractures. Factors like lack of physical activity contribute to its development in women and older individuals.
    • Common abnormalities include joint effusion(fluid build up), torn rotator cuff, gouty arthritis, carpal tunnel syndrome, and scoliosis (abnormal spinal curvature).

    Health Promotion and Patient Teaching

    • Diet: Maintain a diet rich in calcium & vitamin D to support bone health.
    • Smoking Cessation: Important for overall and musculoskeletal health.
    • Alcohol Intake: Recommend moderation of alcohol intake for musculoskeletal health.
    • Exercise Promotion: Encourage suitable exercise levels (weight-bearing, etc).
    • Osteoporosis Screening: Promote screening appropriate for the population based on factors like age.
    • Fall prevention: Important for elderly persons (to reduce the risk of fractures).
    • Assess for any losses of function, self-care deficits, or potential safety risks.
    • Investigate whether they have had new onset weakness, falls or any stumbling issues.
    • Note whether the patient uses a mobility device, which suggests potential concerns with mobility.
    • Consider recommendations for DXA screening (for females age 65 or older and/or postmenopausal, younger women).

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    Musculoskeletal System Chapter 23 PDF

    Description

    This quiz tests your understanding of health assessments related to joint functions, the intervertebral discs, and activities of daily living (ADLs). You'll explore key concepts such as limb movements, definitions of terms like supination, and relevant health history aspects. Perfect for students in health sciences or nursing programs!

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