1、Assessment of the Musculoskeletal System,Sara H. Mitchell, Ph.D., RN, CPNP,The impact of diseases of the musculoskeletal system,1. 2. 3 4 5 6.,Composition of the Musculoskeletal System,The skeleton proper (bones & joints)Skeletal musclesTendonsLigaments,Nutrition & Musculoskeletal Function,FluorideM
2、agnesiumZincIodine,AluminumCopperIronManganese,Assessment of the musculoskeletal system,History-taking Inspect & Palpate joints Assess range of motion Assess muscle strength 1 2 3 4 5,Joint motion - a review of terms,Flexion Extension Dorsiflexion Plantar flexion Adduction Abduction,Inversion Eversi
3、on Internal rotation External rotation Pronation Suppination,Measuring Range of Motion,If any limitation or increase in ROM is noted, use a _ to measure the angles precisely,Cervical Spine Assessment,Abnormal findings H A T,Upper Extremity Assessment,Abnormal findings: L P S M A C,ROM of wrist & han
4、d,Flexion Extension Hyperextension Ulnar deviation Radial deviation ,Spinal Assessment,Abnormal findings: S T S,Torso Range of Motion,Abnormalities: L P,Lower Extremity ROM,Hip flexion with knee straight Hip flexion with knee flexed: Internal & External rotation : Abduction : Adduction :,Range of Mo
5、tion of the Knee,Flexion-extension 1350Hyperextension - 100,Ballottement,Used to test for joint effusion If there is an effusion present a palpated tap will be present and the transmitted impulse will be felt by the fingers on either side of the patella,Ankle Range of Motion,Dorsiflexion 20o Plantar
6、 Flexion 500 Inversion of hind foot 50 Eversion of hind foot - 50,Alterations of Musculoskeletal Function,Musculoskeletal Injuries s s Disorders of bone m I b,Disorders of joints n i Disorders of skeletal muscle s m m I,Primary symptoms of musculoskeletal disease,P W D L S J,Phalens test,Ask the per
7、son to hold both hands back to back while flexing the wrists 90 degrees. Acute flexion of the wrist for 60 seconds produces numbness and burning in a person with carpal tunel syndrome,Tinels Sign,In carpal tunnel syndrome, percussion of the median nerve produces burning and tingling along its distri
8、bution, which is a positive Tinels sign,The musculoskeletal system of the young,CEBS,Musculoskeletal assessment in the pediatric patient,OLGGS,Limp TLIS,_ Maneuver for Congenital Dislocated Hip,With a dislocated hip, the head of the femur is not cupped in the acetabulum but rests posterior to it.Hip
9、 instability feels like a clunk as the head of the femur pos into place. This is a positive _,Lower Extremity Findings in Children,_: “bowlegged” stance is normal through the first two years of life. Resolves with growth and ambulation _: knock-kneed stance occurs normally between 2 and 3 years of a
10、ge,_,Dislocation of the hip functionally shortens and weakens hip and pelvis muscles.When a child stands on the dislocated hip, the opposite side of the pelvis drops,Scoliosis,_ scoliosis is flexible. It is apparent with standing and disappears with forward standing. _ scoliosis is fixed. The curvat
11、ure shows both on standing and on bending forward,The Musculoskeletal system of the elderly,Muscle atrophy Osteoporosis Kyphosis Decreased intervertebral disc space Joint stiffness,Osteoarthritis Reduced range of motion Degenerative changes,Degenerative Joint Disease of Osteoarthritis,Osteoarthritis
12、 is characterized by hard, nontender nodules, 203 mm or more. These osteophytes (bony over-growths) of the distal interphalangeal joints are called _ nodes and those of the proximal interphalangeal joints are called _ nodes,Osteoporosis,Risk Factors Classification Diagnosis Prevention Treatment,Area
13、s of yellow indicate bone loss from osteoporosis,The Musculoskeletal system of the elderly (continued),“Musculoskeletal problems have the most significant impact on the aged population. More than 1 billion dollars is spent annually by Medicare for hospitalization of elderly patients with these condi
14、tions. This represents 20% of all Medicare payments.,Reaching a conclusion,Based on history & physical examination does there appear to be a musculoskeletal disease or impairment? Do the history and finding suggest a primary musculoskeletal concern or signs & symptoms of a systemic disease? What is
15、the differential diagnosis? What additional tests (labs, diagnostic studies) are indicated?,Differential diagnoses - what is the primary problem,Fracture Sprain Dislocation or subluxation Joint or muscle inflammation Age specific abnormality Systemic illness (examples) neuropathy myopathy connective
16、 tissue disease,Test for musculoskeletal function,Bone function g s r a b b,Joint function a a M a Muscular function S_, U EMG f m,Remember.,“Diseases of the musculoskeletal system rank first among disease conditions that alter the quality of lifethe cost of which exceeds 60 billion dollars annually”,
