Exam 3 chap 24 (MSK) - Lecture notes 1-10 PDF

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Chapter 24- Assesment of the musculoskeletal System 1) DESCRIBE THE STRUCTURE AND THE FUNCTION OF THE MUSCULOSKELETAL SYSTEM (MSK) SYSTEM. The body’s bones, muscles, and joints compose the musculoskeletal system. Controlled and innervated by the nervous system, the musculoskeletal system’s overall purpose is to provide structure and movement for body parts. Bones ● It provides structure and protection, serve as levers, stores calcium, and produces blood cells. ● A total of 206 bones makes up the axial skeleton (head and trunk) and appendicular skeleton (extremities, shoulders, and hips). ● Composed of osseous tissues, it can be divided into two types: compact and spongy bone. - Compact: hard and dense and makes up the shaft and outer layers - Spongy: which contains numerous spaces and makes up the ends and centers of the bones. ● Bone tissue is made up of pg active cells known as osteoblasts a nd degraded by cells called osteoclasts, ● REDBONE MARROW→ produce blood cells ● YELLOW BONE MARROW→ composed mostly fat Periosteum covers the bones and contains osteoblasts and blood vessels that promote nourishment and rise to new bone tissue. ● Short bones- carpals, tarsals ● Long bone- humerus, femur ● Flat bones- sternum, ribs ● Irregular- vertebrae, hips

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Muscles Consists of three types of muscles: skeletal, smooth and cardia - The body is made up of 650 skeletal (voluntary) muscles, they are under conscious control and are made up of long muscle fibers (fasciculi) arranged together into bundles and joined by connective tissues. Skeletal muscles attach to bones by way of strong, fibrous cords called tendons. These muscles assist with posture, produce body heat, and allow the body to move. Skeletal muscle movements include: - Abduction: Moving away from the midline of the body - Adduction: Moving toward midline of the body - Circumduction: Circular motion - Inversion: Moving inward - Eversion: Moving outward - Extension: Straightening the extremity at the joint and increasing the angle of the joint - Hyperextension: Joint bends greater than 180 degrees - Flexion: Bending the extremity at the joint and decreasing the angle of the joint - Dorsiflexion: Toes draw upward to ankle - Plantar flexion: Toes point away from the ankle - Pronation: Turning or facing downward - Supination: Turning or facing upward - Protraction: Moving forward - Retraction: Moving backward - Rotation: Turning of a bone on its own long axis - Internal rotation: Turning of a bone toward the center of the body - External rotation: Turning of a bone away from the center of the body

Joints

The joint (or articulation) is the place where two or more bones meet. Joints provide a variety of ranges of motion (ROM) for the body parts and may be classified as fibrous, cartilaginous, or synovial. ● Fibrous joints (e.g., sutures between skull bones) are joined by fibrous connective tissue and are immovable. ● Cartilaginous joints (e.g., joints between vertebrae) are joined by cartilage. ● Synovial joints (e.g., shoulders, wrists, hips, knees, ankles; contain a space between the bones that are filled with synovial fluid, a lubricant that promotes a sliding movement of the ends of the bones. - Bones in synovial joints are joined by ligaments, which are strong, dense bands of fibrous connective tissue. Synovial joints are enclosed by a fibrous capsule made of connective tissue and connected to the periosteum of the bone. ● Articular cartilage smooths and protects the bones that articulate with each other. ● Some synovial joints contain bursae, which are small sacs filled with synovial fluid that serve to cushion the joint. THE MAJOR JOINTS TEMPOROMANDIBULAR Articulation between the temporal bone and mandible. Motion: Opens and closes mouth. Projects and retracts jaw. Moves jaw from side to side. ELBOW Articulation between the ulna and radius of the lower arm and the humerus of the upper arm; contains a synovial membrane and several bursae. Motion: Flexion and extension of the forearm Supination and pronation of the forearm STERNOCLAVICULAR The junction between the manubrium of the sternum and the clavicle; has no obvious movements. SHOULDER Articulation of the head of the humerus in the glenoid cavity of the scapula. The acromioclavicular joint includes the clavicle and acromion process of the scapula. It contains the subacromial and subscapular bursae. Motion: Flexion and extension Abduction and adduction Circumduction Rotation (internal and external) WRIST, FINGERS, THUMB Articulation between the distal radius, ulnar bone, carpals, and metacarpals. It contains ligaments and is lined with a synovial membrane.

Motion: Wrists: Flexion, extension, hyperextension, adduction, radial and ulnar deviation Fingers: Flexion, extension, hyperextension, abduction, and circumduction Thumb: Flexion, extension, and opposition VERTEBRAE Thirty-three bones: 7 concave-shaped cervical (C); 12 convex-shaped thoracic (T); 5 concave-shaped  lumbar (L); 5 sacral (S); and 3–4 coccygeal, connected in a vertical column. Bones are cushioned by elastic fibrocartilaginous plates (intervertebral discs) that provide flexibility and posture to the spine. Paravertebral muscles are positioned on both sides of vertebrae. Motion: Flexion Hyperextension Lateral bending Rotation HIP Articulation between the head of the femur and the acetabulum. Contains a fibrous capsule. Motion: Flexion with knee flexed and with knee extended Extension and hyperextension Circumduction Rotation (internal and external) Abduction Adduction KNEE Articulation of the femur, tibia, and patella; contains fibrocartilaginous discs (medial and lateral menisci) and many bursae. Motion: Flexion Extension ANKLE AND FOOT Articulation between the talus (large posterior foot tarsal), tibia, and fibula. The talus also articulates with the navicular bones. The heel (calcaneus bone) is connected to the tibia and fibula by ligaments. Motion: Ankle: Plantar flexion and dorsiflexion Foot: Inversion and eversion Toes: Flexion, extension, abduction, adduction 2) DISCUSS RISK FACTORS ASSOCIATED TO OSTEOPOROSIS AND WAYS TO PREVENT THE DISEASE - Osteoporosis is a disease in which bones demineralize and become porous and fragile, making them susceptible to fractures. The bone loss occurs silently and progressively, and often no symptoms are noted until the first fracture occurs. Normally, bones are densest during the early 20s, but aging causes the bone remodeling process (bone resorption and bone formation) to change, leading to lower bone mass and

osteoporosis, when bone resorption outpaces reformation. Osteoporosis fractures most commonly occur in the spine, wrist, and hip. Spinal fractures lead to loss in height and development of a curved upper back (often called a Dowager hump). ●

54 million Americans aged 50 and older are affected by osteoporosis (10.2 million) or low bone mass (43.4 million). According to the IOF (2015b), osteoporosis affects 200 million women worldwide. Europeans and Americans accounted for 51% of osteoporosis-related fractures in the year 2000, followed by people from the Western Pacific and Southeast Asia. Osteoporosis is lowest in black males and highest in white females. Osteoporosis is a global health problem and the great majority of persons at high risk of hip fracture have already had at least one osteoporotic fracture that has neither been identified nor treated.

HEALTHY PEOPLE 2020 GOAL - Healthy People 2020 (2016) has a topic category for arthritis, osteoporosis, and chronic back conditions. Osteoporosis is described as a disease that is “marked by reduced bone strength leading to an increased risk of fractures (broken bones).” Goal (for all 3 conditions) Prevent illness and disability related to arthritis and other rheumatic conditions, osteoporosis, and chronic back conditions. OBJECTIVES (OSTEOPOROSIS) Reduce the proportion of adults with osteoporosis by 10%, from 5.9% of adults aged 50 years and older in 2005–2008, to 5.3%. Reduce the number of hip fractures in adults aged 65 years and older by 10% (both females and males). SCREENING The U.S. Preventive Services Task Force (USPSTF, 2011) recommends screening for osteoporosis in women aged 65 years or older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old Caucasian woman who has no additional risk factors. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis in men. The inclusion of women under 65 years of age (and as young as 50) who have risk for fracture is a new recommendation. The risk factors these younger women must have to indicate screening include, “having parents who fractured bones, being white, a history of smoking, alcohol abuse, or a slender frame” (Goodman, 2011). The recommended screening is for a bone density scan. A simple, easy to take 1-minute osteoporosis risk assessment test can be recommended by any health care provider, either to be administered or for clients to take themselves (IOF, 2015c). RISK ASSESSMENT Fixed risk factors: ➔ Age ➔ Female gender ➔ Family history of osteoporosis

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Previous fracture Ethnicity Menopause/hysterectomy Long-term glucocorticoid therapy Rheumatoid arthritis Primary/secondary hypogonadism in men

Modifiable risk factors (for osteoporosis and for fractures): ➔ ➔ ➔ ➔ ➔ ➔ ➔ ➔ ➔

Alcohol (greater than 2 drinks a day) Smoking (past or current history) Low body mass index (...