Musculoskeletal System Chapter 24 PDF

MUSCULOSKELETAL SYSTEM Chapter 24  STRUCTURE AND FUNCTION Joints Muscles Nonsynovial or synovial Fasciculi Cartilage Tendon Ligament Skeletal muscle Bursa...

MUSCULOSKELETAL SYSTEM Chapter 24  STRUCTURE AND FUNCTION Joints Muscles Nonsynovial or synovial Fasciculi Cartilage Tendon Ligament Skeletal muscle Bursa movements Copyright © 2019 Elsevier, Inc. SYNOVIAL JOINT Copyright © 2019 Elsevier, Inc. SKELETAL MUSCLE MOVEMENTS Copyright © 2019 Elsevier, Inc. L ANDMARKS OF THE SPINE Copyright © 2019 Elsevier, Inc. SHOULDER Copyright © 2019 Elsevier, Inc.  STRUCTURE AND FUNCTION Elbow Medial and lateral epicondyles Olecranon process of ulna Wrist and carpals Radiocarpal joint Midcarpal joint Metacarpophalangeal joints Interphalangeal joints Copyright © 2019 Elsevier, Inc. RIGHT ELBOW Copyright © 2019 Elsevier, Inc. BONES OF HAND Copyright © 2019 Elsevier, Inc.  STRUCTURE AND FUNCTION (4 OF 4) Hip Ankle and foot Acetabulum and head of femur Tibiotalar joint Anterosuperior iliac spine Medial and lateral Ischial tuberosity malleoli Greater trochanter of femur Metatarsals Knee Femur, tibia, and patella Suprapatellar pouch Medial and lateral menisci Cruciate ligaments Prepatellar bursa Quadriceps muscle Copyright © 2019 Elsevier, Inc. L ANDMARKS OF THE KNEE Copyright © 2019 Elsevier, Inc. ANKLE AND FOOT Copyright © 2019 Elsevier, Inc.  D E V E LO P M E N TA L C O N S I D E RAT I O N S Infants and children Ossification of cartilage Epiphyses Spinal curvature Developmental dysplasia of hip “Growing pains” Pregnant women Increased joint mobility Lordosis Spinal curvature Older adults Osteoporosis Decreased height Influence of exercise on skeletal mass Copyright © 2019 Elsevier, Inc.  PROMOTING HEALTH: PREVENTING OSTEOPOROSIS Risk for osteoporosis Gender Age Postmenopausal state Ethnocultural background Lifestyle choices Family history Osteoporosis Canada recommendations (2010): Risk assessment in those >50 years of age Bone mineral density (BMD) testing All women age >65 years Those at risk for fragility fractures after age 40 years Family history of hip fracture Prolonged use of glucocorticoids Copyright © 2019 Elsevier, Inc.  PROMOTING HEALTH: PREVENTING OSTEOPOROSIS Treatment Hormone replacement therapy (HRT): ↑ risk for breast cancer and myocardial infarction Alternative therapies: exercise and diet Recommendations for bone health Diet Exercise Lifestyle Medical options Supplements Copyright © 2019 Elsevier, Inc.  SUBJECTIVE DATA: HEALTH HISTORY Joints Functional assessment Pain (activities of daily living) Stiffness Self-care behaviours Swelling, heat, and redness Limitation of movement Muscles Pain (cramps) Weakness Bones Pain Deformity Trauma (fractures, sprains, dislocations) Copyright © 2019 Elsevier, Inc.  ADDITIONAL HEALTH HISTORY QUESTIONS For infants and children For older adults Birth trauma Weakness Anoxia Injury Milestones Mobility Bone injuries Bone deformities For adolescents Athletics Sports equipment Warming up Injury Time management Copyright © 2019 Elsevier, Inc.  OBJECTIVE DATA: PHYSICAL EXAM (1 OF 6) Preparation Order of examination Screening Inspection musculoskeletal Size and contour of joint examination Skin and tissues over joint Complete Palpation musculoskeletal Skin temperature examination Muscles, bony articulations, area of joint capsule Equipment needed Range of motion Tape measure Muscle testing Apply opposing force Skin marking pen Grading muscle strength Copyright © 2019 Elsevier, Inc. OBJECTIVE DATA: PHYSICAL EXAM (2 OF 6) Temporomandibular joint Inspect joint area Palpate as person opens mouth Motion and expected range Have patient: Open mouth maximally Protrude lower jaw and move side to side Stick out lower jaw Palpate muscles of mastication Copyright © 2019 Elsevier, Inc. OBJECTIVE DATA: PHYSICAL EXAM (3 OF 6) Cervical spine Shoulders Inspect alignment of head Inspect joint and neck Palpate shoulders and axilla Palpate spinous processes Motion and expected range and muscles Have patient: Motion and expected range Move arms forward and up Move arms behind back and Have patient: hands up Touch chin to chest Move arms to sides and up Lift chin over head Touch hands behind head Move each ear to shoulder Turn chin to each shoulder Copyright © 2019 Elsevier, Inc.  OBJECTIVE DATA: PHYSICAL EXAM (4 OF 6) Wrist and hand Elbow Inspect joints on dorsal and Inspect joint in flexed and palmar sides extended positions Palpate each joint Palpate joint and bony Motion and expected range prominences Have patient: Motion and expected Bend hand up, down range Bend fingers up, down Have patient: Turn hands out, in Bend and straighten elbow Spread fingers, make fist Pronate and supinate hand Touch thumb to each finger Phalen test Muscle strength Tinel’s sign Copyright © 2019 Elsevier, Inc.  OBJECTIVE DATA: PHYSICAL EXAM (5 OF 6) Hip Knee Inspect as person stands Inspect joint and muscle Palpate with person supine Palpate Motion and expected range Motion and expected range Have patient: Bend patient’s knee Raise leg Extend the knee Bend knee to chest Check the knee during Flex knee and hip; ambulation swing foot out, in Swing leg laterally, medially Stand and swing leg back Copyright © 2019 Elsevier, Inc.  OBJECTIVE DATA: PHYSICAL EXAM (6 OF 6) Ankle and foot Spine Inspect with person sitting, Inspect while patient stands standing, and walking Palpate spinous processes Palpate joints Motion and expected range Motion and expected range Have patient: Bend sideways, backward Have patient: Twist shoulders to each side Point toes down, up Turn soles out, in Flex and straighten toes Muscle strength Copyright © 2019 Elsevier, Inc. DEVELOPMENTAL CONSIDERATIONS (1 OF 2) Infants Feet and legs: positional deformities (varus, valgus; metatarsal adductus; tibial torsion) Hips: Ortolani manoeuvre, Allis test Hands and arms: palmar creases, simian crease Back: C-shaped curve, spinal dimple Preschool and school-age children Posture, genu varum, genu valgum, pes planus Gait, Trendelenburg’s sign Adolescents Scoliosis (forward bend test) Copyright © 2019 Elsevier, Inc. DEVELOPMENTAL CONSIDERATIONS (2 OF 2) Pregnant women Progressive lordosis Waddling gait Older adults Lengthening of arm-trunk axis, kyphosis Functional assessment for activities of daily living (ADLs) Walking with shoes on Climbing up stairs Picking up objects from floor Rising from sitting in chair Rising from lying in bed Copyright © 2019 Elsevier, Inc.  ABNORMAL FINDINGS (1 OF 5) Multiple Joints Shoulders Inflammatory Atrophy conditions Dislocated shoulder Rheumatoid arthritis Joint effusion Ankylosing spondylitis Tear of the rotator cuff Osteoarthritis Frozen shoulder (degenerative joint (adhesive capsulitis) disease) Subacromial bursitis Osteoporosis Copyright © 2019 Elsevier, Inc.  ABNORMAL FINDINGS (2 OF 5) Abnormalities of the elbow Olecranon bursitis Gouty arthritis Epicondylitis (“tennis elbow”) Copyright © 2019 Elsevier, Inc.  ABNORMAL FINDINGS (3 OF 5) Abnormalities of the wrist and hand Ganglion cyst Ulnar deviation or drift Carpal tunnel syndrome Degenerative joint disease or osteoarthritis Dupuytren’s contracture Acute rheumatoid arthritis Swan-neck and Syndactyly boutonnière deformities Polydactyly Gout in thumb Copyright © 2019 Elsevier, Inc.  ABNORMAL FINDINGS (4 OF 5) Abnormalities of the knee Abnormalities of the Mild synovitis ankle and foot Prepatellar bursitis Swelling of menisci Achilles tenosynovitis Osgood-Schlatter disease Tophi with chronic gout Acute gout Hallux valgus with bunion and hammer toes Callus Ingrown toenail Plantar wart Copyright © 2019 Elsevier, Inc.  ABNORMAL FINDINGS (5 OF 5) Abnormalities of Common congenital or the spine pediatric abnormalities Scoliosis Congenital dislocated Functional hip Structural Talipes equinovarus (clubfoot) Spina bifida Copyright © 2019 Elsevier, Inc. CHAPTER 24 QUESTION Musculoskeletal System Copyright © 2019 Elsevier, Inc. 1. ANKYLOSIS IS: A. one or more bones in a joint being out of position. B. partial dislocation of a joint. C. shortening of a muscle leading to limited range of motion of a joint. D. stiffness or fixation of a joint. Copyright © 2019 Elsevier, Inc. 2. WHY WOULD THE EXAMINER ASK A HIGH- SCHOOL ATHLETE, “WHAT DO YOU DO WHEN YOU GET HURT?” A. Because so many young athletes are injured, it is important to plan ahead. B. Many athletes are reticent about reporting injuries because they think it will limit their playing time. C. It is important for young athletes to understand the risks involved in playing sports. D. It is important for the athlete to report an injury to a clinician, rather than to a coach, who may not take Copyrightthe injury © 2019 Elsevier, Inc. seriously.  ANSWER TO CHAPTER 24 QUESTIONS 1. Correct Answer: D Option A is dislocation; Option B is subluxation; Option C is contracture. 2. Correct answer: B It is important for athletes to understand that their health is more important than playing time and that their long-term ability is dependent on prompt, thorough treatment of any injuries that do occur. Option A is incorrect because planning should be focused on reducing the number of injuries. Option C is true but is not the reason for this question. Option D implies lack of professionalism on the part of coaches, which is neither fair nor accurate. Copyright © 2019 Elsevier, Inc. JARVIS: PHYSICAL EXAMINATION & HEALTH ASSESSMENT, 3RD CANADIAN EDITION Audience Response System Questions Chapter 24: Musculoskeletal System Copyright © 2019 Elsevier, Inc. 1. A PAT IE N T T E L L S T H E N U R S E T H AT S H E H AS R H E U M AT OID A RT H R I T I S (RA). T H E S Y M P T OM S T H AT T H IS PAT IE N T IS L IK E LY T O E XH IB I T AR E PA IN AN D S TIF F N E S S I N T H E : 1. joints, increasing with activity. 2. joints, being relieved with rest. 3. right elbow and left knee, being relieved with medication. 4. joints, being worse in the morning and improving with activity. Copyright © 2019 Elsevier, Inc. 2. T H E N UR S E IS AS S E S S I N G A PAT IE N T ’ S R I S K OF D E VE LOP IN G OS T E OP OR OS IS. W H IC H OF T H E F OL LOW IN G PAT IE N T S IS C ON S I D E R E D T O B E AT H IGH R I S K F OR OS T E OP OR OS IS ? 1. A 65-year-old man being treated for hypertension 2. A 55-year-old woman who has had right knee replacement surgery 3. A 30-year-old woman who smokes and is taking oral contraceptives 4. A 21-year-old man who plays numerous college sports Copyright © 2019 Elsevier, Inc. 3. THE NURSE IS CONDUCTING A M U S C U LO S K E L E TA L A S S E S S M E N T A N D , U P O N I N S P E C T I O N , N O T I C E S T H AT T H E PAT I E N T H A S STIFFNESS IN HER JOINTS. THE NURSE DESCRIBES THIS AS: 1. dislocation. 2. subluxation. 3. contracture. 4. ankylosis. Copyright © 2019 Elsevier, Inc.  ANSWER TO ARQ QUESTION1 1. The correct answer is 4. RA is worse in the morning and improves with activity. Answer 1 is incorrect because activity helps alleviate the symptoms of RA. Answer 2 is incorrect because rest will increase the stiffness associated with RA. Answer 3 is incorrect because unilateral joint involvement is a symptom of osteoarthritis (OA). Copyright © 2019 Elsevier, Inc.  ANSWER TO ARQ QUESTION 2 2. The correct answer is 2. A postmenopausal woman who has had joint replacement surgery (resulting in limited physical activity) is at a higher risk for osteoporosis compared with the patients in Options 1, 3, and 4. Answer 1 is incorrect because hypertension and male gender do not increase the risk of osteoporosis. Answer 3 is incorrect because smoking and taking oral contraception place this patient at risk for a cerebrovascular accident, but does not increase the risk of osteoporosis. Answer 4 is incorrect because this patient is decreasing his risk of getting osteoporosis by playing sports. Copyright © 2019 Elsevier, Inc.  ANSWER TO ARQ QUESTION 3 3. The correct answer is 4. Ankylosis is stiffness or fixation of a joint. Answer 1 is incorrect because dislocation is one or more bones in a joint being out of position. Answer 2 is incorrect because subluxation is the partial dislocation of a joint. Answer 3 is incorrect because contracture is the shortening of a muscle leading to limited range of motion of the joint. Copyright © 2019 Elsevier, Inc.