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what do you need the musculoskeletal system for?
- support to stand erect
- for movement
- it encases and protects inner vital organs
- produce the red blood cells, and platelets in the bone marrow
- reservoir for storage of essential minerals such as calcium and phosphorus in the bones
what is the functional unit of the musculoskeletal system?
joint
what is a place of union of 2 or more bones and that permits the mobility needed for ADL's?
joint
what is this joint?
- in these joints, the bones are united by interjacent fibrous tissue or cartilage and are immovable
- example: sutures in the skull
fibrous joint
what is this joint?
- separated by fibrous cartilage discs and are one slightly movable
- example: vertebrae
cartilaginous joints
what is this joint?
- freely movable because their bones are separated from one another and enclosed in a joint cavity
- lined with synovial membrane which secretes a lubricant, or synovial fluid
- contains a layer of avascular cartilage
- surrounded by ligaments
- bursae are located in areas of potential friction to facilitate movement of muscles and tendons
synovial joint
what does this describe?
- cushions the bone
- avascular
- receives nourishment from synovial fluid
- slow cell turnover
- tough and firm but flexible
cartilage
what does this describe?
- connect bone to bone
- fibrous bands running directly from one bone to another bone that strengthens joint and help prevent movement in undesirable directions
ligaments
What is ankylosis?
stiffness or fixation of a joint
what is an enclosed sac filled with viscous synovial fluid, located in areas of potential friction, and helps muscles and tendons glide smoothly over bone?
bursa
what are these muscles?
- composed of bundles of muscle fibers or fasciculi
- attached to bone by a tendon
skeletal
what is a strong fibrous cord that connects muscle to bone?
tendon
what is this movement?
bending a limb at a joint
flexion
what is this movement?
straightening a limb at a joint
extension
what is this movement?
moving a limb away from the midline of the body
abduction
what is this movement?
moving a limb toward the midline of the body
adduction
what is this movement?
turning the forearm so the palm is down
pronation
what is this movement?
turning the forearm so the palm is up
supination
what is this movement?
moving the arm in a circle around the shoulder
circumduction
what is this movement?
moving the sole of the foot inward at the ankle
inversion
what is this movement?
moving the sole of the foot outward at the ankle
eversion
what is this movement?
moving the head around a central axis
rotation
what is this movement?
moving a body part forward and parallel to ground
protraction
what is this movement?
moving a body part backward and parallel to ground
retraction
what is this movement?
raising a body part
elevation
what is this movement?
lowering a body part
depression
what are the 3 motions of TMJ?
- hinge action to open and close jaws
- gliding action for protrusion and retraction
- gliding side to side movement of lower jaw
what is the articulation of the mandible and temporal bone?
temporomandibular joint
where can you feel the TMJ?
in the depression anterior to tragus of ear
the _________ permits jaw function of speaking and chewing
TMJ
when looking at the TMJ what should you observe?
- compare right and left sides for firmness, size, and strength
- listen for snap of jaw when opening, this is normal
- slight deviation, abnormal finding
- swelling
describe the bones of the spine?
33 connecting bones
- 7 cervical
- 12 thoracic
- 5 lumbar
- 5 sacral
- 3 to 4 coccygeal
what are the movements of the spine?
extension
flexion
lateral bending
rotation
what are the movements of the cervical spine?
extension
flexion
lateral bending
rotation
what are the movements of the shoulder?
flexion
rotation
hyperextension
abduction
adduction
external rotation
what is this pertaining to the shoulder?
- belt of 3 bones (humerus, scapula, clavicle)
- joints and muscles
shoulder girdle
what is the articulation of the humerus with the glenoid fossa of the scapula?
glenohumeral joint
what muscles and tendons stabilize the shoulder?
the group of SITS muscles or rotator cuff muscles
what are palpable landmarks in the shoulder?
- scapula and clavicle form the shoulder girdle
- you can feel the bump of the acromion process at the top of the shoulder
what does this describe?
- elastic fibrocartilaginous plates that constitute 1/4th of the length of the column
- each disc center has a nucleus pulposus made of soft, semifluid, mucoid material that has the consistency of toothpaste in the young adult
- disc cushion spine like a shock absorber and help it move
intervertebral discs of the spine
what are the movements of the wrist and hand?
flexion
extension
abduction
adduction
what is the articulation of the distal radius and a row of 8 carpal bones?
wrist or radiocarpal joint
what permits movement in 2 planes at right angle (flexion and extension, side-to-side deviation)?
condyloid action
what is the articulation that allows flexion, extension, and some rotation?
midcarpal joint
what permits finger flexion and extension?
metacarpophalangeal and interphalangeal joint
What are the 3 bony articulations of the elbow?
humerus, radius, ulna of forearm
what movement does the the elbow do?
pronation and supination
flexion and extension
what movements do the hip do?
flexion
extension
adduction
abduction
what are the muscles of the hip?
iliopsas
gluteus maximus
what is the articulation between acetabulum and head of femur, it is a ball and socket joint, provides stability for weight-bearing, and the bursae facilitate movement?
hip
what do focused musculoskeletal assessments assess?
range of motion
muscle strength
joint function
what are common concerns of the musculoskeletal system?
joint pain, stiffness
muscle pain
weakness
ADL concerns
what should not be present when doing an musculoskeletal assessment?
muscular spasm
heat
atrophy
swelling
tenderness
redness
deformities
crepitation
when inspecting during a musculoskeletal assessment what do we inspect?
response
LOC
tone
involuntary movements
muscle size
motor function
what do we palpate during a musculoskeletal assessment?
joints
articulation
swelling
muscle strength/movement
the patient should have a __________ gait
stable
___________ causes crepitus because ________ tears down the cartilage between 2 bones
arthritis
what is usually felt as cramping or aching?
myalgia
what ROM allows the patient complete control?
active ROM
what ROM requires the nurse to intervene and assist?
passive ROM
what are the aging concerns of the musculoskeletal system?
- posture (kyphosis)
- contour
- prominence
- osteoporosis
- decreased height
- ROM
- some atrophy
- loss of water content and thinning of intervertebral discs
- loss of subcutaneous fat
- muscle size decrease
what is the phalen test? what does it test for?
- Ask the person to hold both hands back to back while flexing the wrists 90 degrees.
- Acute flexion of the wrist for 60 seconds produces no symptoms in the normal hand.
- this test reproduces numbness and burning in a person with carpal tunnel syndrome.
What is Tinel sign used to diagnose? and how do you do it?
carpal tunnel syndrome
percuss median nerve in the wrist if patient has burning and tingling this is abnormal and patient may have carpal tunnel
what is the strength grading of muscles and joints?
5 - full ROM against gravity, full resistance 100%
4 - full ROM against gravity some resistance 75%
3 - full ROM with gravity 50%
2 - full ROM with gravity eliminated (passive ROM) 25%
1 - slight contraction 1%
0 - no contraction 0%
what 3 bones are the articulation of the knee joint?
femur
tibia
patella
What kind of joint is the knee?
hinge joint
what cushion the tibia and femur?
medial and lateral menisci
what are the 2 ligaments that stabilize the knee?
- cruciate: anterior and posterior stability, help control rotation
- collateral: medial and lateral stability, prevent dislocation
what are the movements of the knee?
flexion and extension
what kind of joint are the ankle and foot?
hinge joint
what are the movements of the ankle and foot?
dorsiflexion
plantar flexion
eversion
inversion
what joint in the ankle permits inversion and eversion of the foot?
subtalar joint
what are the two bony prominences of the ankle and foot?
medial malleolus
lateral malleolus
what type of joint is the elbow and knee?
hinge joint
what type of joint are the hip and shoulder?
ball and socket
greater than 10 seconds with the get up and go test considers the patient?
a risk for falls
what are the 3 things to remember about rheumatoid arthritis?
swan neck fingers
ulnar deviation
boutonniere
what are common symptoms of RA?
swollen
inflamed
warm to touch
subcutaneous nodules
redness
stiffening of joints
What is an autoimmune disorder when the body attacks its joints and the cartilages between joints?
Rheumatoid Arthritis
What is swan neck deformity?
joints stiffen up and is caused by RA
what arthritis is caused by heavy wear and tear on the joints and aging and obesity are risk factors?
osteoarthirits
what is the build-up of uric acid/purine, common in toes, painful, gets swollen, recoverable in a few weeks, and normally contained to one area?
gout
what does ROM prevent?
contractures
what are contractures?
permanent stiffening of a joint or muscle
What is atrophy?
decrease in muscle size
what is dystrophy?
loss of tissue mass
What is hypertrophy?
increase in muscle size
what is the straight leg test testing for?
possible sciatica/herniated disc
What is the bulge sign test? tests for?
Firmly stroke up on medial aspect of the knee 2-3 times to displace fluid. Then tap lateral aspect and watch medial side in the hollow for a bulge from a fluid wave.
- tests for small amounts of fluid in the knee
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