Podcast
Questions and Answers
Which type of joint allows for the most movement?
Which type of joint allows for the most movement?
What is the main characteristic of synarthrosis joints?
What is the main characteristic of synarthrosis joints?
Which movement involves bending a limb at a joint?
Which movement involves bending a limb at a joint?
What is the primary function of ligaments in the musculoskeletal system?
What is the primary function of ligaments in the musculoskeletal system?
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Which muscle movement refers to straightening a limb at a joint?
Which muscle movement refers to straightening a limb at a joint?
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What type of cartilage is primarily found within freely movable joints?
What type of cartilage is primarily found within freely movable joints?
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Which of the following movements would be classified as abduction?
Which of the following movements would be classified as abduction?
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In which anatomical structure do tendons primarily function?
In which anatomical structure do tendons primarily function?
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Which method is used to observe the presence of swelling in joints?
Which method is used to observe the presence of swelling in joints?
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What does the term Range of Motion (ROM) refer to in joint assessment?
What does the term Range of Motion (ROM) refer to in joint assessment?
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What should be noted when palpating a joint?
What should be noted when palpating a joint?
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Which joint classification allows for the greatest range of movement?
Which joint classification allows for the greatest range of movement?
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During a Range of Motion assessment, what should be considered to determine normal limits?
During a Range of Motion assessment, what should be considered to determine normal limits?
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Why is it important to differentiate between crepitation and normal ‘crack’ sounds in joints?
Why is it important to differentiate between crepitation and normal ‘crack’ sounds in joints?
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What is not typically assessed through palpation during a joint examination?
What is not typically assessed through palpation during a joint examination?
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Which observation would most likely indicate joint irritation during a physical assessment?
Which observation would most likely indicate joint irritation during a physical assessment?
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What movement occurs when touching the chin to the chest?
What movement occurs when touching the chin to the chest?
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Which joint movement allows the arm to move away from the body?
Which joint movement allows the arm to move away from the body?
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Which of the following is NOT a movement assessed during the elbow examination?
Which of the following is NOT a movement assessed during the elbow examination?
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What type of joint is primarily responsible for wrist flexion?
What type of joint is primarily responsible for wrist flexion?
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Which muscle action occurs during raising the shoulders?
Which muscle action occurs during raising the shoulders?
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During which examination would radial and ulnar wrist deviation be assessed?
During which examination would radial and ulnar wrist deviation be assessed?
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Which muscle strength test involves having the patient spread fingers apart?
Which muscle strength test involves having the patient spread fingers apart?
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What joint action is tested when a patient performs supination and pronation of the forearm?
What joint action is tested when a patient performs supination and pronation of the forearm?
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Study Notes
Musculoskeletal System
- The musculoskeletal system is the body's bony framework, consisting of specialized connective tissues—bone and cartilage.
- Bone is a hard, rigid, and dense tissue.
- Joints, or articulations, are where two or more bones connect.
- The musculoskeletal system includes bones, cartilage, ligaments, tendons, and joints.
Musculoskeletal Components
- Bone: A primary component of the musculoskeletal system.
- Cartilage: A specialized connective tissue.
- Ligaments: Connect bone to bone.
- Tendons: Connect muscle to bone.
- Joints: Synovial (freely movable) and nonsynovial (immovable or slightly movable). Specific locations include TMJ, spine, shoulder, elbow, wrist/carpal, hip, knee, and ankle/foot.
Joints
- A joint, or articulation, forms where two bones meet.
- Joint classifications include synarthrosis (immovable), amphiarthrosis (slightly movable), and diarthrosis (freely movable).
Muscles/Tendons/Ligaments
- Tendons attach muscles to bone.
- Ligaments connect bone to bone.
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 down.
- Supination: Turning the forearm so the palm faces up.
- Circumduction: Moving a limb in a circular motion.
- Inversion: Moving the sole of the foot inward.
- Eversion: Moving the sole of the foot outward.
- Rotation: Turning the head or other body part 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.
Skeleton
- The human skeleton has 206 bones.
- Bones are made of connective tissue.
- Bone cells constantly remodel and regenerate.
- Joints are the functional units where bones meet.
Joint Types
- The different types of joints include ball and socket, hinge, pivot, and ellipsoid.
Temporomandibular Joint
- The temporomandibular joint (TMJ) is located in the jaw.
- Specific anatomical structures (external auditory meatus, zygomatic arch, condyle of mandible, etc.) delineate the TMJ.
Spine
- The spine, composed of vertebrae (named T1, T7, T8, L1, T12, L4, S2, Coccyx etc.), provides support and mobility.
- Landmarks on the spine like the iliac crest and the posterior superior iliac spine assist in locating the vertebrae.
Shoulder
- The shoulder joint includes the acromion, clavicle, greater tubercle of humerus, deltoid muscle, subscapularis bursa.etc.
Wrist/ Carpals & Elbow
- The wrist/carpal and elbow joints feature the radius, ulna, and various ligaments and other anatomical components are critical.
Hip
- The hip joint has the head of femur, acetabulum, articular capsule, iliopectineal bursa, pubis, and obturator foramen.
Knee
- The knee joint includes the patella, patellar ligament, lateral and medial epicondyles of the femur, lateral and medial meniscus, and tibial tuberosity.
Ankle / Foot
- Subtalar joint, calcaneofibular ligament, calcaneus, talus, and metatarsals are key elements of the ankle/foot structure.
Aging Adult
- Bone remodeling peaks in the 25-35 year range but begins to decline after age 40.
- Reduced height is often due to vertebral column shortening from thinning intervertebral disks.
- Subcutaneous fat redistribution occurs with age.
- Posture changes may include kyphosis, flexion at the hip and knee.
- Muscle weakness can also occur with age
Physical Activity and Aging
- Physical activity can help slow and/or prevent bone loss.
- It's important to increase bone mass.
- It's also important when considering osteoporosis
Focused Health History
- Assessing pain, onset of symptoms, deformities, paralysis, trauma, and chronic conditions is crucial.
- When assessing older adults, consider changes over time in strength and falls.
Subjective Data: Functional Assessment
- Subjective data about muscle/bone problems and daily activities are important.
Subjective Data: Joints
- Joint issues that need to be assessed subjectively include pain, swelling/heat/redness, stiffness, and limitation of movement.
Subjective Data: Muscles
- Assess for muscle pain or cramping, weakness, symptoms of neuro/atrophy/tear, exacerbating or relieving factors, and associated symptoms like flu/fever myalgia.
Subjective Data: Bones
- Assess for bone pain, trauma/injury, back pain, radicular symptoms, numbness/tingling, and limping.
Objective Data: Physical Examination
- The physical exam involves inspecting, palpating, assessing range of motion, and muscle testing, from head to toe and proximal to distal.
Measurements
- Various joint measurements are crucial tools in assessing musculoskeletal health.
Inspection
- Physical assessment of the body, including the patient's gait, ease of movement with joint positions, and symmetry of joint size and contour.
Palpation
- Palpate the joint structures (temperature of skin, muscles, bony articulations, and the joint capsule), and notice any signs of inflammation (heat, tenderness, swelling, and masses).
Range of Motion (ROM)
- Active and passive ROM assessments are necessary to determine any limitations.
Muscle Testing
- Evaluate muscle strength using different tests to assess muscle strength and using a grading scale.
Muscle Strength Scale
- A numerical grading scale (0-5) to assess muscle strength.
Question 1
- The correct answer is B, the vertebral column, as it shortens with age, causing decreased height.
Physical Examination Head
- Assess the TMJ for crepitus and pain; evaluate ROM (open mouth, side-to-side jaw movement, protrusion), and test masseter and temporalis muscle strength.
Physical Examination Neck
- Assess neck range of motion (flexion, extension, rotation, lateral bending).
Physical Examination Shoulder
- Assess posture (straight or hunched), symmetry, and position of clavicles. Palpate deltoid and associated muscles. Assess shoulder range of motion (forward flexion, extension, abduction, adduction, internal and external rotation).
Physical Examination Elbow
- Assess the posterior surface, medial and lateral epicondyles of humerus, and olecranon process of the ulna. Assess elbow flexion/extension, supination, and pronation.
Physical Examination Wrist
- Assess wrist structures (radius, ulna, radiocarpal joint). Evaluate wrist ROM (flexion, extension, hyperextension, radial deviation, ulnar deviation, and circumduction). Assess wrist strength.
Physical Examination Hand
- Assess metacarpophalangeal and interphalangeal joints. Assess hand ROM in flexion/extension, hyperextension and abduction/adduction movements. Assess strength of thumb and finger opposition.
Assessing Upper Extremity Strength
- Assess strength of various upper limb movements and joints.
Physical Examination Hip
- Examine hip structures, focusing on surrounding tissues, to determine symmetry and identify potential anatomical issues. Assess hip ROM (flexion, extension, hyperextension, abduction, adduction, internal and external rotation), and strength.
Physical Examination Knee
- Inspect knee alignment for deformities and evaluate the contour of the quadriceps muscle. Palpate the suprapatellar pouch to detect tenderness or edema. Assess knee ROM (flexion and extension).
Physical Examination Ankle
- Examine ankle contour and symmetry. Assess Achilles tendons to rule out possible issues. Evaluate ankle ROM (dorsiflexion, plantar flexion, inversion, eversion, circumduction). Check ankle muscle strength.
Physical Examination Foot
- Assess skin integrity, nail condition, and any foot skeletal deformities. Palpate metatarsal bones and joints. Assess foot ROM (flexion, extension, abduction, adduction).
Assessing Lower Extremity Strength
- Evaluate various lower extremity movement strength.
Physical Examination Spine
- Evaluate spine posture and symmetry, palpating for tenderness. Evaluate spine mobility and range of motion (flexion, extension, lateral bending, and rotation).
Additional Assessment - Older Adult
- Evaluate functional status in activities like walking, climbing stairs, rising from a seated or lying position, picking up objects.
Bulge Sign
- A method to assess for small effusions in the suprapatellar pouch.
Sports Injuries
- When assessing sports injuries, focus on the severity and extent of the injury, signs of ongoing or worsening conditions, involvement of joints, loss of function, or indications of an infection immediately.
Sample Charting
- Provide sample charting notes for a patient with no musculoskeletal issues, including the patient's subjective and objective findings. Summarize their condition and ability for mobility.
Developmental Considerations- Pregnancy
- During pregnancy, posture is affected by increased joint mobility. A notable change is lordosis, which balances the weight of the fetus, sometimes causing low back pain. Nerve pressure from posture changes (e.g. in the neck) can also occur leading to pain.
Developmental Considerations- Infants
- Infant spines have a C-curve at birth but develop other curves over time (e.g., anterior curves in the cervical and lumbar spine during the first 1.5 years of life). Bone growth is rapid.
Developmental Considerations- Children
- Children's long bones develop in two dimensions (diameter and length). Epiphyses are growth centers on long bones. Age 20 usually represents closure (and cessation) of bone growth. Fat and muscle develop differently with age (e.g. hormones).
Developmental Considerations- Aging Adult (Cont.)
- A decline in bone remodeling happens with age causing osteoporosis. Reduced height is linked to vertebral column shortening. Muscle weakness and decreased fat is linked to osteoporosis.
Osteoporosis
- Osteoporosis is characterized by decreased bone density, increasing the risk of fractures, and detailed information on daily calcium requirements for various age groups during different life stages.
Osteoporosis (Cont.)
- Details on osteoporosis, and its affects on height and bone integrity. Visual aids help show the effects of the condition.
Abnormals to Know!!!
- List of musculoskeletal conditions that need further investigation.
References
- A referenced citation for the source of the material provided.
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