Musculoskeletal Health Assessment Quiz

Skeletal Muscle Movements

• Abduction: Moving a body part away from the midline of the body.
• Adduction: Moving a body part towards the midline of the body.
• Circumduction: Circular movement of a limb.
• Extension: Straightening a limb at a joint, increasing the joint angle.
• Flexion: Bending a limb at a joint, decreasing the joint angle.
• Dorsiflexion: Toes pointing upwards towards the ankle.
• Plantarflexion: Toes pointing downwards away from the ankle.
• Pronation: Turning or facing downward.
• Supination: Turning or facing upward.
• Rotation: Turning of a bone on its own axis.

Joints

• Joint (or articulation): A point where two or more bones meet.
• Bursa: Fluid-filled sac that cushions and reduces friction between bones, tendons, and ligaments.

Elbow Joint Movements

• Flexion: Bending the elbow.
• Extension: Straightening the elbow.
• Pronation: Turning the forearm so the palm faces downward.
• Supination: Turning the forearm so the palm faces upward.

Shoulder Joint Movements

• Flexion: Raising the arm forward.
• Extension: Moving the arm backward.
• Abduction: Raising the arm to the side.
• Adduction: Lowering the arm to the side.
• Internal rotation: Rotating the arm inward.
• External rotation: Rotating the arm outward.
• Circumduction: Circular movement of the arm.

Hip Joint Movements

• Flexion: Bending the hip.
• Extension: Straightening the hip.
• Abduction: Moving the leg away from the midline.
• Adduction: Moving the leg towards the midline.
• Internal rotation: Rotating the leg inward.
• External rotation: Rotating the leg outward.
• Circumduction: Circular movement of the leg.

Knee Joint Movements

• Flexion: Bending the knee.
• Extension: Straightening the knee.
• Internal rotation: Rotating the lower leg inward.
• External rotation: Rotating the lower leg outward.

Collecting Subjective Data: Nursing Health History

• Effect of Weight Gain on the Musculoskeletal System: Excess weight puts stress on joints, leading to pain and stiffness.
• Joint, Muscle, and Bone Pain:
  • Ask about the location, onset, duration, character, quality, intensity, and aggravating and relieving factors.
  • Character or Quality: Use descriptive words like sharp, dull, aching, burning, or stabbing.
• Personal Health History:
  • Past Problems or Injuries: Ask about previous musculoskeletal problems, injuries, and surgeries.
  • Menopause: Decreased estrogen levels may contribute to osteoporosis.
• Family History: Ask about family history of musculoskeletal conditions like rheumatoid arthritis.
• Lifestyle and Health Practices:
  • Activity Level/Exercise: Determine the patient's regular exercise habits, types of activities, and frequency.
  • Medications: Ask about any current medications, especially those that can affect musculoskeletal function, like steroids or statins.
  • Tobacco, Caffeine, and Alcohol Use: Heavy alcohol consumption and smoking can increase the risk of osteoporosis.
  • Typical 24-hour Diet: Assess dietary intake of calcium and vitamin D for bone health.
  • ADLs: Evaluate the patient's ability to perform activities of daily living (ADLs).
  • Social Health and Sexual Activity: Social isolation and lack of physical activity can contribute to musculoskeletal decline.
  • Body Image: Ask about body image and how it affects the patient's self-esteem.
  • Stress: Stress management techniques can help with pain management.
• Medications: Some medications, like steroids, can suppress bone formation and increase the risk of osteoporosis. Statins can cause muscle pain.
• Smoking, Caffeine, and Alcohol: Regular smoking, excessive alcohol consumption, and high caffeine intake are associated with an increased risk of osteoporosis.
• Nutrients for Skeletal Muscle Health:
  • Calcium is essential for strong bones and muscle function.
  • Vitamin D is essential for calcium absorption.
  • Protein is vital for muscle growth and repair.
• Risk Factors for Osteoporosis:
  • Decreased estrogen levels.
  • Low calcium intake.
  • Insufficient Vitamin D.
  • Smoking.
  • Excessive alcohol consumption.
  • Sedentary lifestyle.
  • Certain medical conditions, such as rheumatoid arthritis and hyperthyroidism.

Additional Information

• Splenomegaly: Enlargement of the spleen, which can be caused by various conditions, including infections, liver disease, and certain types of cancers.
• Blunt Percussion of the Kidneys: Percuss lightly over the costovertebral angle (CVA) to assess for tenderness. Tenderness may indicate pyelonephritis or kidney stones.
• Light and Deep Palpation: Start with light palpation to assess for surface tenderness then deepen palpation to examine underlying organs and structures.
• Palpating the Aorta: Palpate the aorta in the epigastric area. Avoid palpating if the patient has a history of aortic aneurysm.
• Ascites: Accumulation of fluid in the peritoneal cavity, possibly caused by liver disease, heart failure, or cancer.
• Fluid Wave Test: A test used to assess for ascites by generating a fluid wave through the abdomen.
• Appendicitis: Inflammation of the appendix, characterized by pain, nausea, vomiting, and fever.
• Peritoneal Irritation: Inflammation of the peritoneum, the lining of the abdominal cavity, often associated with appendicitis or other abdominal infections.
• Rebound Tenderness (Blumberg Sign): Pain that occurs when pressure is released from the abdomen. A positive sign indicates peritoneal irritation.
• Reffered Rebound Tenderness (Rovsing Sign): Pain in the right lower quadrant when pressure is applied to the left lower quadrant.
• Psoas Sign: Pain in the right lower quadrant when the right thigh is extended against resistance. A positive sign could indicate appendicitis.
• Cholecystitis: Inflammation of the gallbladder, often caused by gallstones.
• Murphy's Sign: Pain that occurs when the examiner palpates the right upper quadrant and the patient takes a deep breath. A positive sign indicates cholecystitis.

Abdominal Signs

• Abdominal Distention: Usually an abnormal finding, indicating underlying conditions such as gas, fluid retention, or organ enlargement.
• Abdominal Bulges: Can indicate hernias, such as umbilical, epigastric, diastasis recti, or incisional hernia.

Bones

• Functions of Bones: Provide support, protection, movement, mineral storage, and blood cell production.
• Osteoporosis: A condition characterized by decreased bone density and increased fracture risk.
• Risk Factors for Osteoporosis:
  • Modifiable: Low calcium and vitamin D intake, smoking, alcohol abuse, lack of exercise, certain medications.
  • Non-modifiable: Age, female gender, family history, certain medical conditions.
• Patient Education for Preventing Bone Loss:
  • Ensure adequate calcium and vitamin D intake.
  • Engage in regular weight-bearing exercise.
  • Avoid smoking and excessive alcohol consumption.

Collecting Objective Data: Physical Examination

• Joint Assessment:
  • Inspection: Look for swelling, redness, deformity, and asymmetry.
  • Palpation: Palpate the joint for warmth, tenderness, crepitus (grating sensation), and effusion (fluid accumulation).
  • Range of Motion (ROM): Assess the joint's ability to move through its full range of motion.
  • Goniometer: A tool used to objectively measure joint angles.
• Muscle Assessment:
  • Inspection: Look for muscle wasting, atrophy, hypertrophy, and involuntary movements (spasms or fasciculations).
  • Palpation: Palpate for tenderness, muscle tone, and spasms.
  • Muscle Strength Testing: Use a 0-5 scale to assess muscle strength.
  • 0: No muscle contraction.
  • 1: Slight movement.
  • 2: Full ROM against gravity.
  • 3: Full ROM against slight resistance.
  • 4: Full ROM against moderate resistance.
  • 5: Full ROM against full resistance.
  • Passive ROM: Movement of a joint by the examiner.
  • Active ROM: Movement of a joint by the patient.
• Posture and Gait Assessment:
  • Inspection: Assess the patient's posture for symmetry and alignment.
  • Gait: Observe the patient's walking pattern to note any abnormalities, such as limp, shuffling, or uneven stride.
  • Abnormal Curvatures: Kyphosis (excessive curvature of the thoracic spine), lordosis (excessive curvature of the lumbar spine), and scoliosis (lateral curvature of the spine).
  • Older Adult Considerations: Normal gait may have a wider base of support and a slower pace.

TMJ (Temporomandibular Joint)

• Inspection: Observe for any swelling or asymmetry of the jaw.
• Palpation: Palpate the TMJ for tenderness or crepitus.
• TMJ Dysfunction: Can cause pain, clicking, popping, locking, and difficulty opening the mouth.
• Crepitus: A grating or crackling sound in the TMJ during movement.

Cervical, Thoracic, and Lumbar Spine

• Inspection: Look for spinal curvature, muscle symmetry, and any signs of inflammation or swelling.
• Palpation: Palpate the spinous processes and paravertebral muscles for tenderness or spasms.
• Normal Findings: Spine should be aligned with a normal lordosis in the cervical and lumbar regions and kyphosis in the thoracic region.
• Abnormal Findings:
  • Herniated Disc: Can cause pain, numbness, tingling, and weakness in the affected area.
  • Ankylosing Spondylitis: A chronic inflammatory disease that affects the spine, leading to stiffness and pain.
  • Pregnancy: Lumbar lordosis may increase.
  • Obesity: Increased strain on the lower back.
  • Compression Fractures: Can occur in the vertebrae due to osteoporosis or trauma.
  • Lumbosacral Muscle Strains: Can cause pain, stiffness, and muscle spasms.
• Thoracic Kyphosis: Exaggerated outward curvature of the thoracic spine.
• Lordosis: Exaggerated inward curvature of the lumbar spine.
• Scoliosis: Lateral curvature of the spine.
• Flattening of the Lumbar Curvature: May be seen in conditions such as ankylosing spondylitis or pregnancy.
• Older Adult Considerations:
  • Kyphosis may increase with age as intervertebral disks shrink.
  • Osteoporosis can increase the risk of compression fractures.

Testing for Back and Leg Pain

• Straight Leg (Lasegue) Test: With the patient lying supine, raise one leg straight up. Pain in the back or leg may indicate a herniated disc or nerve root compression.

Shoulders, Arms, and Elbows

• Inspection: Look for muscle atrophy, swelling, or joint deformities.
• Palpation: Palpate the shoulder, arm, and elbow for tenderness, crepitus, and swelling.
• Abnormal Findings:
  • Dislocation: Displacement of the humerus from the glenoid fossa.
  • Tenderness: May indicate muscle strain, tendonitis, or bursitis.
  • Rotator Cuff Tear: Can cause pain, weakness, and limited ROM.
  • Bursitis: Inflammation of the fluid-filled sacs (bursae) in the shoulder joint.
• ROM Testing:
  • Shoulder: Flexion, extension, abduction, adduction, internal rotation, and external rotation.
  • Elbow: Flexion, extension, pronation, and supination.

Wrists

• Palpation: Palpate the anatomical snuffbox (the depression on the radial side of the wrist).
• Snuffbox Tenderness: May indicate a scaphoid fracture.
• Carpal Tunnel Syndrome (CTS): A condition affecting the median nerve that passes through the carpal tunnel.
• Phalen Test: Position the wrists in full flexion for one minute. Positive test: numbness or tingling in the median nerve distribution.
• Tinel Sign: Lightly tap over the median nerve in the carpal tunnel area. Positive test: numbness or tingling in the median nerve distribution.

Hands and Fingers

• Rheumatoid Arthritis: Characterized by joint inflammation, swelling, warmth, and pain.
• Osteoarthritis: Degenerative joint disease characterized by joint pain, stiffness, and limited ROM.
• Heberden Nodes: Bony nodules that develop on the distal interphalangeal (DIP) joints of the fingers.
• Bouchard Nodes: Bony nodules that develop on the proximal interphalangeal (PIP) joints of the fingers.

Hips

• Inspection: Look for any signs of asymmetry, muscle wasting, or leg length discrepancies.
• Palpation: Palpate the hip joint and surrounding muscles for tenderness, swelling, or crepitus.
• Normal Findings: Symmetrical hips and muscle mass, full range of motion.
• Abnormal Findings:
  • Impaired ROM: can indicate conditions such as arthritis, hip fracture, or muscle contractures.
  • Hip Dislocation: Displacement of the femoral head from the acetabulum.
  • Bursitis: Inflammation of the bursa in the hip joint.