Exam 3 - Musculoskeletal Exam Flashcards
What’s in the musculoskeletal ROS?
Muscle or joint pain, stiffness, arthritis, gout, backache
If any of these are present, describe the location and associated symptoms =
Swelling, redness, pain, tenderness, stiffness, weakness, limitation of motion or activity
Most common symptoms of musculoskeletal disease?
The most common symptoms of musculoskeletal disease = History
Pain Weakness Deformity Limitation of movement Stiffness Swelling Joint clicking
Essentials to diagnose musculoskeletal pain?
History is most important
1. Mechanism of injury
Traumatic or atraumatic, acute or chronic, high or low velocity
Does any movement aggravate or relieve pain associated with the injury?
- Always consider the age of the patient
Newborn, child, teen, adult, geriatric - Where exactly is the pain?
“Point to the pain”
Is the pain localized or diffuse, acute or chronic? - What was the patient doing when the pain first started?
- Has the patient experienced this pain before?
Is the pain associated with certain activities, rest, time of day, or posture?
Does the pain cause problems elsewhere in the body? - Describe the pain
Sharp, dull, constant, throbbing, stabbing, intermittent
Stinging 8/10 pain when weight bearing, but 4/10 when elevated - Is there a “lock,” a “click,” a “pop,” a “grinding” sensation, does it feel like it is “giving way?”
- Any limitation of motion?
- Any paresthesias?
- What has been done to make it better?
Rest, ice, heat, elevation, non-weight bearing, OTC or prescribed medications, ACE wrap, crutches - What makes it worse?
Weight-bearing, certain positions or activities - How are the patient’s ADLs being compromised?
Is the patient experiencing any life, work-related, school-related, or economic stress?
What is the occupation of the patient?
Does that patient have help at home?
What does the musculoskeletal exam mainly consist of?
Inspection, soft tissue palpation, boney tissue palpation, range of motion and neurovascular status
Always do one system above and one system below
What’s included in the musculoskeletal inspection?
Symmetry, swelling, erythema, ecchymosis, atrophy, deformity, and (surgical) scars
Favoring of a limb or joint
Gait disturbances
What’s included in the musculoskeletal palpation?
Palpation
Soft tissue palpation
Skin and muscle
Boney tissue palpation
Bone and joint
**Note any fluid collection, warmth, or pain
What’s included in ROM of m.s. exam?
Assess range of motion
Passive and active range of motion
Strength against resistance
How do we evaluate neurovascular status of body?
Evaluate neurovascular status
Pulses, temperature of skin, cap refill, paresthesias
What’s a paresthesia?
an abnormal sensation, typically tingling or pricking (“pins and needles”), caused chiefly by pressure on or damage to peripheral nerves.
What is a sprain?
Sprain = injury to ligaments and joint capsules
What is a strain?
Strain = injury to muscles or tendons
What is a valgus deformity?
Valgus deformity = angulation of an extremity at a joint with more distal part angled away from midline
Genu Valgus = knock-knees
“Jenny Valgus has knock knees”
What is a varus deformity?
Varus deformity = angulation of an extremity at a joint with the more distal part angled toward the midline
Genu Varus = bow-legged
“Jenny Varus has bow legs”
What is UE, LE, ROM, AROM, PROM, FROM, LROM, VROM, ^ROM?
UE = Upper Extremity LE = Lower Extremity ROM = Range of Motion AROM = Active Range of Motion PROM = Passive Range of Motion FROM = Full Range of Motion LROM = Limited Range of Motion ↓ROM = Decreased Range of Motion ↑ROM = Increased Range of Motion
What joints are examined?
Temporomandibular joint (TMJ) Cervical spine Shoulder Elbow Wrist Hand Fingers and thumb Thoracic spine Lumbar spine Hip Knee Ankle Foot Toes
What types of special tests are there?
Special Tests
- Provocative tests
Recreate mechanism of injury - Stress tests
Stress ligaments/tendons involved - Functional testing
Impact on ADLs
Helps management and treatment plan, patient education
Walker, straight cane, crutches, wheel chair?
What’s a goniometer?
Goniometer
Measures joint range of motion
Used primarily if abnormality noted
Used in orthopedic specialties, physical therapy, and occupational therapy
Anterior, posterior, and lateral inspection?
Inspection of overall body posture.
Note the even contour of the shoulders, level scapulae and iliac crests, and extremity symmetry and alignment.
Note the alignment of the head over the gluteal folds
The occiput, shoulders, buttocks, and heels should be able to touch the wall the patient stands against.
Inspection of extremities?
Extremities Size Deformities Enlargement Alignment Contour Symmetry
Inspection of muscles?
Muscles Bilateral symmetry Hypertrophy Atrophy Fasciculations Spasms
What’re you palpating? What for?
Palpate bones, joints, surrounding muscles Feel for Heat Tenderness Swelling Fluctuation Crepitus Resistance to pressure
What’re you looking for in ROM?
Active ROM, passive ROM for each joint and related muscle group
Note: Pain Limited/spastic movement Joint instability Deformity Contracture
Whats the expected difference between PROM and AROM?
When should they be equal?
When is it apropriate to use a goniometer?
PROM may exceed AROM by 5 degrees
AROM and PROM should be equal in contralateral joints
Use goniometer if increased or LROM
What do you compare in muscles, bilaterally?
Compare bilateral muscles
Strength Symmetry Equality Resistance Muscle function grades
Graded muscular responses - 0, 1, 2, 3, 4, 5?
0 - no contraction detected
1 - barely detectable trace of contraction
2 - active movement with gravity eliminated
3 - active movement against gravity
4 - active movement against gravity and some resistance
5 - active movement against resistance without evident fatigue - this is what you should find as “normal”.
Temporomandibular Joint Exam - Palpate?
Palpate
- Pain
- Crepitus, locking, popping
Cervical Spine Exam - Inspect?
Inspect
- Head alignment
- Symmetry of muscles and skin folds
