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Questions and Answers
Which of the following options describes a primary function of bones?
What is a modifiable risk factor for osteoporosis?
When performing a joint assessment, which technique is most appropriate for evaluating passive range of motion?
Which statement is true regarding skeletal muscle movements?
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What lifestyle change can significantly impact musculoskeletal health?
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Which movement involves moving a limb away from the midline of the body?
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What is a consequence of decreased estrogen levels in women during menopause?
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Which nutrient is essential for calcium absorption in the body?
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What technique would be appropriate to assess joint stability in the knee during a physical examination?
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Which skeletal muscle movement involves turning a bone on its own axis?
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What effect might smoking have on the risk of developing osteoporosis?
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Which joint movement is characterized by bending the extremity at the joint?
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What lifestyle factor is commonly assessed to evaluate musculoskeletal health?
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What is the primary purpose of routine exercise in relation to the musculoskeletal (MSK) system?
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Which device is used to measure the range of motion (ROM) when a limitation is identified?
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How is muscle strength rated on a scale from 0 to 5?
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What are the clinical manifestations of TMJ dysfunction?
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What does the straight leg (Lasegue) test check for?
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Which condition is indicated by tenderness in the anatomic snuffbox?
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Which nodes are associated with acute rheumatoid arthritis and where are they located?
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Impaired range of motion in the hips may signify which of the following conditions?
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Study Notes
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.
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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.
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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.
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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.
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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.
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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.
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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.
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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
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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Description
Test your knowledge on musculoskeletal health with this quiz focused on bone functions, risk factors for osteoporosis, and joint assessment techniques. Explore the impact of lifestyle changes on musculoskeletal health as well as essential nutrients for bone health. Assess your understanding of skeletal movements and their implications.
