Musculoskeletal System PDF

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Musculoskeletal System Structure and Function 

Joints - Nonsynovial joints – bones united by fibrous tissue, immovable (skull) - Synovial joints – freely moveable, bones separate, enclosed in a joint cavity - Cartilage – covers surface of opposing bones - Ligament – fibrous bands running directly from one bone to another - Bursa - enclosed sac with viscous synovial fluid

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Muscles - Fasciculi – muscle fibers - Tendon – attach muscle to bone - Skeletal muscle movements – flexion, extension, abduction, adduction, supination, pronation, circumduction, inversion, eversion, rotation, protraction, retraction, elevation, depression

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Temporomandibular joint Spine - Vertebrae - Landmarks of the spine - Intervertebral disks Shoulder - Glenohumeral joint - Rotator cuff - Subacromial bursa - Acromion process - Greater tubercle of the humerus - Coracoid process

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Knee - Femur, tibia and patella - Suprapatellar pouch - Medial and lateral menisci - Curiate ligaments - Prepatellar bursa - Quadriceps muscle

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Ankle and Foot - Tibiotalar joint - Medial and lateral malleolus - Metatarsals

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Elbow - Medial and lateral epicondyles - Olecranon process of ulna

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Wrist and carpals - Radiocarpal joint - Metacarpal - Metacarpophalangeal joint - Interphalangeal joints

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Joints - Pain - Stiffness - Swelling, heat and redness Muscles - Pain (cramps) - Weakness Bones - Pain - Deformity - Trauma (fractures, sprains, dislocations) Functional assessment Self care

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Hip - Acetabulum and head of femur - Anterior superior iliac spine - Ischial tuberosity - Greater trochanter or femur

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Functional Assessment: Activities of Daily Living Grade self care 0 – 4 scale Level 0: performs self care independent Level 1: Requires assistive device Level 2: requires assistance from person Level 3: assistance from person & equipment Level 4: dependant/ unable

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Objective Data – The Physical Exam

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Preparation - Screening musculoskeletal exam - Complete musculoskeletal exam

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Equipment needed - Tape measure - Goniometer, to measure Joint angles - Skin marking pen

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Order of the examination - Inspection Size and contour of joint Skin and tissues over joint - Palpation Skin temperature Muscles, bony articulations, area of joint capsule - Range of motion - Grading muscle strength

Temporomandibular Joint  Inspect joint area  Palpate as person opens mouth  Motion and expected range - Open mouth maximally - Protrude lower jaw and move side to side - Stick out lower  Palpate muscles of mastication Cervical Spine - Inspect alignment of head and neck - Palpate spinous processes - Motion and expected range Chin to chest

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Lift chin Each ear to shoulder Shoulders - Inspection joint - Palpate shoulders - Motion and expected range Arms forwards and up Arms behind back and hands up Arms to sides and up over head Touch hands behind head

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Elbow - Inspect joint in flexed and extended positons - Palpate joint and bony prominences - Motion and expected range ( bend and straighten elbow, pronate and supinate hand)

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Wrist and Hand - Inspect joints on dorsal and palmar sides - Palpate each joint - Motion and expected range Bend hand up, down Bend fingers up, down Turn hands out, in Spread fingers, ,make first Touch thumb to each finger - Phalens test - Tinel’s sign

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Hip - Inspect as person stands - Palpate with person supine - Motion and expected range Raise leg Knee to chest Flex knee and hip; swing foot out, in Swing laterally, medially Stand and swing leg back

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Knee - Inspect joint and muscle - Palpate - Bulge sign - Ballottement of patella - Motion and expected range Bend knee Extend knee

Check knee while ambulate Ankle and Foot  Inspect with person sitting, standing and walking  Palpate joints  Motion and expected range - Point toes down, up - Turn soles out, in - Flex and straighten toes Spine   

Inspect while person stands Palpate spinous processes Motion and expected range - Bend sideways, backward - Twist shoulders to each side

Abnormalities – Affecting Multiple Joints  Inflammatory conditions - Rheumatoid arthritis (RA) 

Degenerative Conditions - Osteoarthritis - Osteoporosis

Abnormalities – Abnormalities of the shoulder     

Atrophy Dislocated shoulder Joint effusion Tear of the rotator cuff Frozen shoulder – adhesive capsulitis

Abnormalities – Abnormalities of the Elbow  Olecranon bursitis  Gouty arthritis  Subcutaneous nodules  Epicondylitis – tennis elbow Abnormalities - Abnormalities of the Wrist and Hand  Ganglion cyst  Carpal tunnel syndrome  Ankyloses  Duputyren’s contracture  Ulnar deviation or drift  Degenerative joint disease or osteoarthritis

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Acute rheumatoid arthritis Syndactyly Polydactyly

Abnormalities - Abnormalities of the Knee   

Mild synovitis Prepatellar bursitis Swelling of menisci

Abnormalities - Abnormalities of the Ankle or foot  Achilles tenosynovitis  Choronic/acute gout  Hallux vagus (RA) with bunion and hammer toes  Callus  Planter wart  Ingrown toenail Abnormalities- Spine  Scoliosis  Herniated nucleus Abnormalities – Common Congenital & Pediatric  Congenital dislocated hip  Talipes equinovarus (clubfoot)  Spina bifida Diagnostic Tests of Musculoskeletal Functions          

Radiographic studies X- rays – dx fractures, degenerative conditions, impingement, tumors MRI – identify trauma, tumors, spinal conditions Computed tomography (CT scan) – trauma Bone scan – metastatic processes in bone Bone mineral density – osteoporosis Myelography – injection of radiopaque solution along spinal canal to identify abnormalities Arthrography – radiographic study of joints after injection of contrast material \ Arthroscopy – visual exam of joint (scope) athletic injury Electromyography – graphic reading of nerve & muscle responses to electrical stimulation...