Group Presentation (HIHIM 400 - Group 10) (2) - Skeletal, Muscles, Tendons, Physical Medicine & Rehab PDF

Skeletal, Muscles, Tendons, Physical Medicine & Rehab By Team 10 Kiet Quan Duong, Hannah Pulido, Irene Lee, Roland Foto, Natalia Ayala  Outline 1. Components of the Skeletal System 2. The Axial Skeleton 3. Muscles and Te...

Skeletal, Muscles, Tendons, Physical Medicine & Rehab By Team 10 Kiet Quan Duong, Hannah Pulido, Irene Lee, Roland Foto, Natalia Ayala  Outline 1. Components of the Skeletal System 2. The Axial Skeleton 3. Muscles and Tendons 4. Appendicular Skeleton 5. Muscles and Tendons of the Upper and Lower Extremities 6. Disorder and Injuries of Muscles and Tendons 7. Procedures and Pharmacology 8. Physical Medicine and Rehab 9. Interactive Component: True or False Components of the Skeletal System  What is Skeletal System? Bones Tendon Ligamen ts  Functions of the Skeletal System -Provides support -Protects internal organs -Helps facilitate movement -Stores minerals and fats -Produces blood cells -Detoxifies the blood How Do Bones Grow? Structure of Bones What are Joints? Joint Movement The Axial Skeleton The Structure of the Axial Skeleton Components of the Vertebral Column The Skull Muscles and Tendons 3 Types of Muscles Skeletal Muscles voluntary muscle attached to one or more bones Functions: -movement -posture -body heat -respiration -communication APPENDICULAR SKELETON  SHOULDER GIRDLE AND UPPER ARM The pectoral girdle Forearm, Wrist and Hand connects to the axial skeleton to the The hand and wrist are a complex structure upper limbs and helps with comprised of 27 bones movements. Muscles of the forearm allow for supination Bones of the pectoral girdle: and pronation, and flex and extend the wrist ○ joint and hand and move the hand medially Scapulae ○ and laterally Clavicle Shoulder joint-connects the Metacarpals- Five long bones that pectoral girdle to the upper limb form the palm of the hand. Humerus- bone of the upper arm Phalanges- finger bones ○ Two articulations: Hinge joint Gliding joint  BONES OF THE LOWER BODY Pelvic Girdle- two hip bones that Bones and Joints of the Hip and Tight articulate anteriorly with each other with the symphysis pubis and posteriorly The hip joint is a ball-and socket with the sacrum to form the pelvis and synovial joint that is joined between between the hip bones you have the the head of the femur and the sacroiliac joints(SI). acetabulum. The hip joint is held in place by a The pelvic girdle has four functions. thick joint capsule The hip bones are composed of three Labrum- cartilage that forms a rim bones each: around the socket of the joint 1. Ilium 2. Ischium 3. Pubis Bones and Joints of the Knee and Tight Bones and Joints of the Lower leg, Ankle, and Foot The knee is hinged joint and is composed of four bones: There are two bones in the lower leg which are the larger and medial tibia and the thinner 1. The lower end of the femur and lateral fibula 2. Flat upper end of the tibia 3. The patella The ankle has two joints: 4. The fibula 1. One between the lateral malleolus of the There are two crescent shaped cartilage pads fibula and the talus that are within the knee joint that are on top of 2. One between the medial malleolus of the the tibia that articulate with the femoral tibia and the talus condolytes. Ankle and Foot The medial and lateral menisci There are 26 bones and 33 joints in the foot. Calcaneus Tarsal bones Talus Metatarsal bones MUSCLES AND TENDONS OF THE UPPER AND LOWER EXTREMITIES  UPPER EXTREMITIES Shoulder girdle: - is a muscle that connects the arm to your upper body giving it movement. Four muscles originate from your scapula, wrap around the shoulder joint and fuse together and this fusion forms into one large tendon known as the rotator cuff which provides stability of the shoulder joint. Rotator cuff muscles: · Subscapularis-below the scapula · Supraspinatus-above the spine · Infraspinatus-beneath the spine · Teres minor- muscles that are part of the rotator cuff Upper Arm and Elbow Joint Forearm, Wrist and Hand Muscles that connect the humerus to the shoulder girdle, vertebral column and ribs. This enables your arm to move Muscles of the forearm supinate and pronate the freely at the shoulder joint. forearm; flex and extend the wrist joint and hand and move the hand medially and laterally. Major Anterior Muscles: · Deltoid Tendons pass over the wrist, and they are enveloped by synovial membrane and are held · Pectoralis major on in place by the wrist by a transverse thick · Latissimus dorsi fibrous band called a retinaculum. Muscles that move at the elbow joint and forearm are On the palm of the hand there are some connected to humerus or pectoral girdle which is inserted prominent pads of muscles called: into the bones of the forearm. · Thenar eminence On the front of the arm there are three muscles groups: · Hypothenar eminence · Biceps brachii · Brachialis The back of your hand is called the dorsum. · Brachioradialis  Muscles of the Pelvic Girdle and Lower Limb These are powerful muscles that give support to the hip The back of tight contains: joint and give movement to tight. They connect to the pelvic girdle and insertions into the femur. · Three hamstring muscles: biceps femoris, semimembranosus and semitendinosus Three gluteus muscles that are prominent: · The hollow of the back of the knee is called the · Maximus popliteal fossa. · Medius Muscles of the Lower leg · Minimus These muscles move the ankle, foot, and toes. And the adductor muscles that are part of the inner thigh ·Those in front of them are compartmentalized between the tibia and the fibula. They help dorsiflex Thigh Muscles and those on the lateral side evert the foot. These muscles move the knee joint and the lower leg. ·Those on the back of the leg plantar flex the foot, toes and invert the foot. The front of the thigh contains: o Gastrocnemius muscle · Quadriceps femoris muscle o Calcaneal Tendon (Achilles) · Quadriceps tendon Disorders and Injuries of Skeletal System Disorders and Injuries of Skeletal System Osteoporosis results from a loss of bone Achondroplasia: A condition with density when the rate of resorption abnormal conversion of cartilage into exceeds the rate of bone formation bone. Dwarfism Osteopenia is decreased calcification of bone. Osteogenic sarcoma is most common Osteomyelitis: Inflammation of an area malignant bone tumor originating in of bone to bacterial infection, usually with connective tissue/bone-producing cells staph Osteomalacia: (Rickets) a diseases Osteogenesis imperfecta: Rare genetic caused by vitamin d deficiency. Bone disorder, bone forming is incomplete → lacking calcium, which becomes soft and fractures, easily broken bones. flexible. Bowed Disorders and injuries of Muscle and Tendons → Muscle disease and disorders are Polymyalgia Rheumatica: A chronic characterized by pain and weakness. inflammatory disease of muscles that causes pain and stiffness on both sides of Fibromyalgia: A chronic condition that body → Pain in neck, shoulders, upper causes widespread pain throughout the arms, buttocks and thighs. body affecting muscles and tendons. (Most people who developed this disorder Fatigue are older than 65) → Women of caucasian. Depression Insomnia Appetite loss Lower abnormal pain and cramps Weight loss Difficult moving around (PT, stress reduction, pain Depression management)  Rheumatoid arthritis is the destruction of the Diseases of Joints joint surfaces, capsule, ligaments. Leading to deformity and joint instability. Affects the Osteoarthritis: Chronic inflammatory synovial membrane that lines the joints & tendons. disease of the joints with pain and loss of function. →Breakdown of cartilage in the → women (20-50 years) joint Age Juvenile rheumatoid arthritis is inflammation ⇒Degenerative joint disease process and stiffness of the joint begins in articular cartilage which → Children under the age of 17 becomes crack and fray revealing the underlying bone Bursitis is the overuse of joints causing inflammation of the bursa. Heberden nodes is formation of small bony spur that is result of finger joint deterioration. Myasthenia gravis: A chronic Muscular dystrophy: A hereditary autoimmune disease in which antibodies disorders that causes progressive block the passage of neurotransmitter weakness and loss of muscle mass. from motor nerves to muscles resulting in Trouble swallowing weakness of the skeletal muscles. Breathing & heart problems Facial muscle (eye and eyelid (Most people eventually need movement, chewing, and talking) wheelchair) Difficulty swallowing Heart problems Treatment → Lifestyle change, Gait Anticholinesterase medication, Duchenne muscular dystrophy Plasma exchange (DMD): A condition with symmetrical weakness and wasting of pelvic, shoulder, and proximal limb muscles. Commonly occurring among boys who have difficulty walking around the age of 3.  Injuries of Skeletal Muscle Muscle soreness: Resulting from Muscle strains: When a muscle or vigorous exercise if your muscles are not tendon is overstretched or torn. used to it. (Stretching or tearing of a ligament) Not warming up properly Buildup of lactic acid in muscle fibers Overusing muscle resulting in inflammation in the Repetitive injuries connective tissue. →24-72 hours (Part of muscle building process) Muscle cramps: Sudden painful → Stretching, more movement and contractions of a muscle or group of mobility (blood flowing), RICE muscle. Dehydration Electrolyte imbalance Muscle fatigue Not stretching enough Worst of muscle Cramps  Disorders of Spine, Shoulder, Wrist, and Pelvic Girdle Colle fractures is a common fracture of Abnormal spinal curvatures is a the radius above the wrist joint spinal disease that results in poor posture or congenital defects in the SI Joint strain (Sacroiliac ¼ inch) is an injury that connects the pelvis to the vertebrae. (scoliosis and kyphosis) lower spine. → Pain and discormbort in buttlocks/lowerback → Ligaments have been stretched/forward flexion Shoulder dislocation occurs when the ball of the humerus slips out the Diastasis syphilis pubis is the result socket of the scapula. of stretching of pelvic ligaments during pregnancy. Stretches the joint of two Separation is the dislocation of the pubic bones and cartilage disc leading acromioclavicular joint resulting from to pain over the joint (without fracture) falling on the joint. Rhabdomyolysis: The breakdown of muscle Achilles tendinitis: A small stretch fibers. This release a protein pigment called injury that causes the tendon to be myoglobin into the bloodstreams. Myoglobin swollen and painful. breaks down into toxic compounds that can caused kidney failure. Pain → Inflammation in Achilles tendon Muscle trauma (heel) which results in difficult walking or running. Severed exertion (marathon running) Swelling and warmth along the heel Alcoholism; cocaine, heroin, amphetamines Stiffness (REST, PT) Tenosynovitis: is inflammation of that sheath that surrounds the tendon. Characterized by tenderness in the tendon, difficult in movement of a join and aching. Repetitive use of wrist and hands/fingers (computers users) Treatment: Rest, immobilization, even surgery Nonsteroidal anti-inflammatory drugs (NSAIDS) Common disorders of shoulders and elbows Rotator cuff tears: are caused by wear Lateral epicondylitis: is caused by and tear of muscle/tendons from overuse overuse of elbow joint or poor techniques in work conditions. (A injury to the in playing tennis or golf. shoulder girdle) Ligament strains/bone fractures: Tendinitis: of the the shoulder joint is Heavy fall or a blow to an elbow caused when the rotator cuff and biceps tendon becomes inflamed from overuse Bursitis: Inflammation of the lubricating sacs of the rotator cuff and can be produced by overused. Bursitis: Disorder of the Ankle and Foot Bunions usually occur at the based of the Gout is painful arthritis on the big toe and toe is swelling of the bone caused by other joints caused by the buildup of uric metatarsophalangeal joint to be aligned acid in the blood, which forms needle like stick out medially. crystals that accumulated in the joints Pott fracture is a variety of fractures in Talipes equinovarus (clubfoot) is the fibula near the ankle often congenital deformity of the foot where the accompanied w foot is caved inwardly at the ankle.  Meniscus injuries is a result from a twist to Disorder of Knee the knee. Patellar problems is when the kneecaps moves out of its grooved in thighbones. (ACL) Anterior cruciate ligament is (jumper knee) Produced pain when caused often by hyperextension of the descending stairs knee joints when landing awkwardly on flat ground; Chondromalacia patella (runner’s knee) is caused by irritation of the undersurface of Patellar subluxation or dislocation patella. produces painful kneecaps. Prepatellar bursitis (housemaid’s knee): produces painful swelling over the bursa at the front of the knee due to extended periods of kneeling.  Common Disorders of the Wrist and Hand Carpal tunnel syndrome (CTS): Ganglion cysts: Fluid-filled cysts that Develops on the wrist and results from arise when synovial tendon sheaths that inflammation and swelling of overused run over the back of the wrist are irritated tendon sheath. or inflamed. → pain, numbness, and weakness in Stenosing tenosynovitis: Painful hands/fingers. inflammation of the the synovial sheaths on the back of the wrist. → Difficulty holding things paired with a shock like feeling. Procedures and Pharmacology for the Skeletal System and Muscles & Tendons Diagnostic Procedures and Therapeutic Procedures for Skeletal Disorders Diagnostic procedures Therapeutic Procedures Arthrocentesis removes excess fluid from a Arthrography is an x-ray of a joint joint, improving joint movement and relieving taken after the injection of a contrast pain which is performed frequently for osteoarthritis. medium into the joint. Total hip replacement (THP) consists of Diagnostic arthroscopy is an replacing the femoral head and the hip socket (acetabulum) with a metal prosthesis. exploratory procedure using an Total knee arthroplasty (TKA) is a surgical arthroscope to examine the internal procedure to replace the weight-bearing compartments of a joint. surfaces of the knee joint to relieve pain and disability, most commonly offered when joint Bone mineral density (BMD) used pain is not diminished by conservative sources. for women at risk of osteoporosis. It is especially used for Rheumatoid athritis Metacarpophalangeal arthroplasty replaces osteoarthritic damaged finger joint with an artificial joint made of silicone rubber. Procedures for Bone fractures Slings hold the arm in place while allowing some movement. Splints and braces immobilize the bone and allow for a small amount of movement. Casts immobilize the bone and prevent movement of the muscles that move the joint. They are made of plaster and fiberglass. Reduction is a process that helps move a bone back to its correct place. Traction uses weights, pulley, and a metal frame to pull a bone into alignment. External fixation uses fixation devices with one end inserted into the bone and the other attached to a metal frame or rod. The devices are removed when the bone has healed, around 6 to 8 weeks. Open reduction internal fixation (ORIF) also called internal fixation. It is a surgery involves an incision to view the fracture and placement of internal fixation devices. Pharmacology for the Skeletal System Osteoporosis prevention and treatment. 1200 mg daily of calcium and For rheumatoid 800 iu daily of vitamin D. Risk of fracture (osteoporosis) arthritis DMARDs such Bisphosphonates(reduces bone loss) and as Trexall are effective in calcitonin( decrease osteoclast activity) reducing sign and For osteoarthritis Acetaminophen reduces mild pain not inflammation or symptoms. swelling. Used in combination with For Tumor necrosis Excedrin, codine or vicodin or percocet as factor Orencia and prescript. NSAIDs e.g Advil and Naproxen Rituxan slow and halt works for pain. Severe osteoarthritis corticosteroids like Cortisone is used to destruction reduce pain and inflammation. Can be taken/given orally or injected directly into joint. Diagnostic Procedures and Therapeutic Procedures for Disorders of the Muscles & Tendons Diagnostic Procedures Therapeutic Procedures 2 types of blood tests: Creatinine Therapeutic Exercise: A range of motion (ROM) exercise designed by a Kinase (CK) and Erythrocyte physical therapist to ease pain. Sedimentation rate. Dry Needling : A manual therapy Electromyography ( EMG) performed by a certified in the Nerve Conduction Studies procedure physical Therapist and Magnetic Resonance Imaging (MRI) consists of inserting thin needles in the and Computerized Tomography skin targeting the muscles. It is not the scan (CT) same as Acupuncture and is evidence Ultrasonography based medicine. Muscle Biopsy (Bx) Cupping: A manual therapy used to Genetic Testing treat painful musculoskeletal issues like muscle tension. It can cause bruising. Myositis Specific Antigen (MSA) Therapeutic Procedures (Cont.) Physical Therapy Modalities: refers to the electrical, thermal or mechanical energy use for treatment. Electrical Stimulation: Interferential current therapy (IFC), a type of e-stim , uses electrical stimulation with frequent sweep patterns. Thermal modalities : use heat Soft tissue Mobilization (STM) and or cold on targeted tissues and Myofascial Release (MFR): Both manual physical agent modalities (PAM) therapies performed using manual like electrotherapy. pressure. Ultrasound: Also called Instrument Assisted : ASTYM ( a-stim) Sonography. It uses soundwaves therapy uses plastic tools like evaluator, to cavitate cells in target areas the localizer and the isolator. Grayson and it not felt by the patient. Technique requires continuing education Musculoskeletal Drugs Nonsteroidal anti-inflammatory drugs ( NSAIDS) include : 1. Acetylsalicylic Acid ( Aspirin) OTC prevention of heart attacks. 2. Ibuprofen ( Advil, Motrin) OTC: Inhibits both COX enzymes. Caldolor an injectable form. 3. Naproxen (Aleve) OTC 4. Indomethacin: high potency and serious side effects. 5. Paracetamol (acetaminophen) OTC and not a NSAIDs, 6. Skeletal Muscle Relaxants. eg Lioresal for muscle spasms and carisoprodol for multiple sclerosis. 7. Anabolic Steroids. Mimics testosterone Physical Medicine and Rehab Physiatry Physiatry: medicine dedicated to prevention Types of Treatment and treatment of all types of disabilities - Therapeutic exercise - Prosthetics/orthotics - Pain medications - EMG (electromyography) - NCS (nerve conduction studies) - Soft tissue injections - Join injections - Spine injections - Musculoskeletal ultrasound - Interventional spinal therapeutics - Spasticity Management Rehabilitation Rehabilitation medicine: focuses on Activities of daily living (ADLs): function. Being able to function is routine activities of personal care. Six essential to an individual’s independence basic ADL: eating, bathing, dressing, grooming, toileting, and transferring. and ability to have a good quality of life. Assistive devices such as reachers, Restorative rehabilitation: restores a grabbers, easy-pull sock aids, long shoe function that has been lost. (e.g. hip horns, etc are designed to make ADLs easier to perform. fracture, hip replacement, stroke) usually short term (but intense) Instrumental activities of daily living (IADLs): related to independent living. Maintenance rehabilitation: Managing monet, using a telephone, strengthens and maintains a function that cooking, driving, shopping for groceries, is gradually being lost. Less intense than housework. restorative. Long term. True or False The skeletal system does not help with the production of blood. True Fals  False Bone marrow, the inner spongy part, in the bones is a major producer of red blood cells especially those in the immune system. It produces billions of new blood cells everyday to replace and replenish the blood supply. Exercise can increase bone density and total bone mass. True Fals  True Exercise put stress on the bone which can stimulate calcium and bone forming cells into action. It encourages the bones to grow stronger and denser. Having regular exercise allows the body to have better structure which reduces falls and fractures. Skeletal muscles are only voluntary muscles. True Fals  False Skeletal muscles are indeed mostly voluntary, however there are some instances where they act on their own volition such as reflex actions.