Musculoskeletal System PDF

Musculoskeletal System Victoria Lavacca DNP, RN, CCRN Structure and Function  Skeleton – 206 bones  Joint- functional unit of the musculoskeletal system  Fibrous joints – immovable (skull sutures)  Cartilaginous joints – slightly movable (vertebrae)  Synovial joints – freely movable  Cart...

Musculoskeletal System Victoria Lavacca DNP, RN, CCRN Structure and Function  Skeleton – 206 bones  Joint- functional unit of the musculoskeletal system  Fibrous joints – immovable (skull sutures)  Cartilaginous joints – slightly movable (vertebrae)  Synovial joints – freely movable  Cartilage cushions bones and gives smooth surface to facilitate movement  Ligaments are fibrous bands that strengthen the joint  Bursa help muscles and tendons glide smoothly over bone Muscles Muscle Movements  Three types of muscles  Smooth  Cardiac  Skeletal (voluntary)  Skeletal muscle composed of fasciculi (muscle fibers)  Skeletal muscle attached to bone by a tendon  Skeletal muscles produce movement Temporomandibular Joint (TMJ) TMI jaw function for speaking and chewing 1. Hinge action - open and close the jaws 2. Gliding action – protrusion and retraction 3. Gliding action – side-to- side movement of lower jaw  Spine  Thirty-three bones stacked in a vertebral column  Cervical (7) Cervical spine - concave  Thoracic (12) curve  Lumbar (5)  Sacral (5)  Coccygeal (3 or 4) Thoracic spine – convex  Intervertebral discs curve  About ¼ of the spinal column length  Nucleus pulposus –cushion the spine  Spine enables upright posture Lumbar spine - concave  Spine enables motion flexibility curve  Flexion (bending forward)  Extension (bending back)  Abduction (to either side) Sacrococcygeal spine –  Rotation convex curve Shoulder  Shoulder Girdle – humerus, scapula, and clavicle  Glenohumeral joint – ball and socket action allowing arm mobility o Enclosed by 4 muscles and tendons that support and stabilize (rotator cuff) o SITS muscles – supraspinatus, infraspinatus, teres minor, subscapularis  Subacromial bursa helps with arm abduction  Landmarks – acromion process, greater tubercle, coracoid process  Wrist and Carpals  Wrist (radiocarpal joint) o Permits flexion and extension o Permits side-to-side deviation  Midcarpal joint o Allows flexion, extension, and some rotation  Metacarpophalangeal (MCP) and interphalangeal joints (DIP and PIP) o Permit finger flexion and extension Elbow  Elbow joint – humerus, radius, and ulna of the forearm o Allows flexion and extension  Palpable landmarks o Medial and lateral epicondyles of the humerus o Olecranon process of the ulna Hip  Hip Joint – acetabulum and the femur head  Ball and socket action permits wide range of motion (ROM)  Muscles – anterior flexor (iliopsoas, posterior extensor (gluteus maximus), adductor muscles (that swing thigh toward midline), and abductor muscles that swing thigh away from midline  Palpable Landmarks  Anterior superior iliac spine  Ischial tuberosity  Greater trochanter Knee  Knee Joint – femur, tibia, and patella (kneecap)  Largest joint in the body  Is a hinge joint  Knee’s synovial membrane is the largest in the body - suprapatellar pouch (or bursa)  Medial and lateral menisci: cushion the tibia and femur  Cruciate ligaments: anterior and posterior stability, control rotation  Collateral ligaments: medial and lateral stability, prevent dislocation  Prepatellar bursa prevents friction between patella and skin  Infrapatellar fat pad: small, triangular fat pad below patella  Landmarks – quadriceps muscle and tibial tuberosity Ankle and Foot  Ankle (tibiotalar joint) o Tibia, fibula, and talus o Hinge joint o Limited to flexion (dorsiflexion) and extension (plantar flexion)  Landmarks o Medial malleolus o Lateral malleolus o Calcaneus (heel)  Muscles o Gastrocnemius and toe flexors - plantar flexion o Anterior tibialis and toe extensors - dorsiflexion  The Aging Adult Remodeling occurs after Bone Mineral Density (BMD) reached -Normally, bone resorption (loss of bone matrix) = bone replacement -Osteoporosis – gradual loss of bone density Encourage regular physical activity Encourage maintaining healthy body weight Encourage intake of calcium and Vitamin D supplements Decreased height 3 - 5 cm (progressively decreasing height in their 60’s) Loss of fat or distribution of fat changes – bony prominences more marked Subjective Data Subjective Data Joints Bones Muscles Functional Pain Pain Pain (cramps) Assessment Stiffness Deformity Weakness Bathing / Swelling, heat Trauma toileting Redness Dressing Movement Grooming Limitation Eating Mobility Communicating Objective Data Inspection Abnormal Findings  Swelling  Masses  Deformity o Fracture o Dislocation  Size and contour of o Subluxation joints o Contracture o Ankylosis  Skin color  Compare to  Palpation and ROM - Notice any heat, tenderness, swelling, or masses - Notice “doughy” or “boggy” synovial membrane - Check for active ROM - Gently check for passive motion if ROM limitation noted - Limitation in ROM is the most sensitive sign of joint disease Articular disease (arthritis) produces swelling and tenderness around joint Extra-articular disease produces swelling and tenderness to that one spot affected Crepitation: audible and palpable crunching that accompanies movement (with Muscle Testing Normal Range of Findings Grade Description %Norm Assessment al 5 Full ROM against gravity, full resistance 100 Normal 4 Full ROM against gravity, some resistance 75 Good 3 Full ROM with gravity 50 Fair 2 Full ROM with gravity eliminated (passive 25 Poor motion) 1 Slight contraction 10 Trace 0 No contraction 0 Zero  Objective Data Temporomandibular Joint Cervical Spine -TMJ dysfunction- crepitus and -Inspect head and neck alignment pain during movement, -Palpation should feel firm with no chewing, or palpation muscle spasm or tenderness -Malocclusion of teeth also -Note asymmetry of muscles causes crepitus or audible click -80% to 90% of population have disc -Decreased ROM with TMJ degeneration in cervical spine inflammation and arthritis -Limited ROM occurs with arthritis -Pain occurs with arthritis or muscle overuse  Upper Extremity Objective Data Shoulder Abnormal Findings -Inspect both shoulders -Inequality (scoliosis), atrophy posteriorly and anteriorly (rotator cuff problem) -Check size, contour, and -Dislocated shoulder looks equality of landmarks flattened -Palpate (noting spasm, -Swelling swelling, atrophy, heat, or -Tenderness or pain tenderness) -Redness -Test ROM  Upper Extremity Objective Data Abnormal Findings Elbow -Subluxation -Inspect size and contour in both flexed and extended -Swelling and redness of olecranon positions bursa -Palpate extensor surface with -Effusion or synovial thickening as elbow flexed about 70 degrees bulge or fullness in groove on either side of olecranon process (gouty -Test ROM arthritis, bursitis) -Epicondyles (head of radius) and tendons are common sites for tennis elbow  Upper Extremity Objective Data Abnormal Findings Wrist and Hand -Subluxation: partial dislocation of -Inspect contour and shape on wrist both dorsal and palmar positions -Ulnar deviation -Palpate using gentle but firm -Ankylosis: wrist in extreme flexion pressure -Carpal tunnel syndrome with -Normal joints: smooth, no atrophy of thenar eminence swelling, no bogginess, no -Ganglion cyst nodules, no tenderness -RA: bilateral swelling and tenderness  Phalen Test Ask person to hold both hands back-to- back while flexing the wrists 90 degrees Acute flexion of the wrists for 60 seconds produces no symptoms in the normal hand Phalen test causes numbness and burning in carpal tunnel syndrome  Lower Extremity Objective Data Hip Abnormal Findings -Pain with palpation or motion -Inspect symmetric levels of iliac crests, gluteal folds, and -Crepitation equally sized buttocks (person standing) -Limited motion -Flexion flattens the lumbar; if -Inspect gait flexion deformity in the opposite -Assess hip flexion, internal hip, it is a positive Thomas test rotation, external rotation, -Limitation of abduction of the hip abduction, adduction, and while supine is the most common hyperextension of 15 degrees motion dysfunction in hip disease  Lower Extremity Objective Data Knee Abnormal Findings -Inspect skin, lower leg alignment, knee -Shiny and atrophic skin, lesions (psoriasis) shape and contour -Swelling or inflammation -Check quadriceps muscle in anterior thigh -Angulation deformity: Genu varum for atrophy (bowlegs), Genu valgum (knock-knees), or flexion contracture -Palpate: start at 10 cm above patella and proceed towards knee. Muscles and tissue -Boggy or fluctuant synovitis of suprapatellar should be solid and smooth pouch -Compare with opposite knee -Bulge sign and ballottement of the patella -Check muscle strength -Limited ROM, pain with motion, contracture, limp, sudden locking -Meniscal tears McMurray Test  Completed when patient states knee locks, gives way, or has local pain  Position person supine as you stand on affected side. Hold the heel and flex the knee and hip. Place your other hand in the with fingers on medial side.  Rotate the leg in and out to loosen joint. Externally rotate the leg and push a valgus (inward) stress on the knee. Slowly extend the knee.  A ‘click’ sound or feeling, McMurray test positive for a torn meniscus.  Lower Extremity Objective Data Ankle and Foot Abnormal Findings -Inspect while sitting, standing, and -Fullness, swelling, or tenderness walking -Hallux Valgus: distal part of the great -Compare both feet (smooth, even toe is directed away from the body coloring, no lesions) -Hammertoes, calluses, ulcers -Toes point straight forward and lie -Plantar fasciitis: localized tenderness flat under heel where fascia torn -Palpate for smoothness -Limited ROM, pain with motion -Assess muscle strength -Arthritis and/or trauma cause swelling or tenderness  Spine Objective Data -Patient should be standing, draped in Abnormal Findings gown open at the back -Difference in shoulder elevation and in level of -Inspect. Note if spine is straight and scapulae and iliac crests (scoliosis) note equal horizontal positions for the shoulders, scapulae, iliac crests, and -Lateral tilting and forward bending (herniated gluteal folds and equal spaces between nucleus pulposus) the arm and lateral thorax on the two sides -Kyphosis (enhanced thoracic curve) common in aging people -From the side, note normal convex thoracic curve and concave lumbar -Lordosis (pronounced lumbar curve) common in curve obese people -Palpate the spinous processes -Tenderness, back pain, spasm -Check ROM -Limited ROM (osteoarthritis and ankylosing spondylitis) Health Promotion and Patient Teaching  DIET  Eat the rainbow  Limit fast-food  Calcium needs vary based on age and sex  Women 50 yrs old or younger need 1000 mg daily  Women > 50 yrs old need 1200 mg daily  Men 70 yrs old or younger need 1000 mg daily  Men > 70 yrs old need 1200 mg daily  EXERCISE  OSTEOPOROSIS SCREENING  FALL PREVENTION Thank You!