Musculoskeletal system assesment Flashcards
(21 cards)
Special considerations: infants and children
Cartilage ossifies: infant to child then adolescence.
Epiphyses – growth plates/last closure around age 20.
Scoliosis (shoulders, hips) (Donahue, nd)
Birth History
Childhood Illnesses
considerations older adults:
After age 40 loss of bone matrix
Osteoporosis: Density decreases (↑absorption = ↓formation)
Postural changes: Dowager’s Hump- kyphosis, flexion of hips and knees.
(Weber & Kelley, 2022)
Dehydration of intervertebral discs. Usually fluid-filled/gelatinous
Loss of muscle mass and size (atrophy). Decreased agility, gait changes, potential balance issues.
GREATER RISK FOR FALLS
considerations pregnancy
Increased level of hormones
Increased mobility
Cause Lordosis
Resultant upper cervical compensation
Possible pressure on the ulnar and median nerves causing numbness and tingling in hands
Health history (subjective)
Musculoskeletal problems,
pain or disease
PMH
Medications, OTC
Accidents or trauma
Nutrition
Personal Habits (Smoking & Caffeine use)
Exercise
ADLS, activity limitations
Occupation
Pain: bone-deep, dull, throbbing; muscle- cramping/ soreness. Time of Day: RA worse in the am/OA worse in the pm
Weakness: Proximal-myopathy, distal-neuropathy.
Stiffness: RA-rest/OA-movement
Menopause
Specific history
Child: Cerebral Palsy at birth
Family History (gout, arthritis, osteoporosis)
Bone Scan (>65 years for females)
Past Injuries
Immunizations current (tetanus)
Allergies (milk, Calcium & Vit. D)
lifestyle
Annual physical
Body mechanics
Typical day
Nutrition habits
Weight
Hobbies, sports, recreation
Type of work
Cope with stress
Health promotion activities
Stairs
Live by yourself
Sexual activity
Social supports
Drugs
Alcohol
Smoke
Exercise
Sleep
shoes
physical assessment
Technique:
Inspection – size shape, color, symmetry
Palpation- fluid/tenderness/crepitus/etc
Systematic, head to toe, compare L to R
General Survey:
Assess posture, gait, cerebellar function
Measure limbs-length/circumference
Assess joints and test movement
Assess strength and ROM
Tests for shoulder, elbow, wrist, spine, hip, and knee as indicated by the history
Skin
Muscle / motion rating scale
palpation joints:
Edema
Heat
Erythema
Tenderness
Deformity
Crepitus
Inspection of gait
Observe as client enters the room
Base of support
Weight-bearing stability
Foot position
Stride, length, cadence of
stride
Arm swing
inspect posture
Erect and head midline,
shoulders over hips, normal spinal curvature.
Shoulder slumping
Spine = Concave (cervical)
Convex (thoracic)
Concave (lumbar)
Convex (sacral)
Kyphosis
Scoliosis
Lordosis
posture
Assessment of balance: romberg test
Tandem walking (heel to toe)
Deep Knee Bend (squat)
Romberg
Romberg and Pronator Drift test:
Ask patient to stand with heels together. eyes closed then eyes open
eyes open: swaying cerebellar deficit
eyes closed: proprioceptive deficit
Wrist evaluation
Anatomic snuff box – pain can indicate scaphoid fx
Radial & ulnar artery blood supply
Allen Test:
Carpal tunnel syndrome
Phalen’s Test: 1 minute, numbness/tingling = + sign
Tinel’s Test: Percuss lightly, numbness/ tingling = + sign
Hand assessment
Adduct/abduct fingers
Bend and flex the fingers
Normal joints, osteoarthritis and rheumatoid arthritis joints
Osteoarthritis
Develops slowly and worsen over time
Pain and stiffness affects hands, fingers or knees (possibly spine and hip)
1 joint affected
One side worse than the other
Morning stiffness less than 30 minutes
Based on wear and tear- degenerative
Destroys cartilage
Rheumatoid Arthritis
Rapid development
Pain, stiffness, swelling affecting multiple joints
Symmetrical
Morning stiffness longer than 30 minutes
Fever, fatigue, malaise, weight loss, loss of appetite
Autoimmune
spinal evaluation
Kernig’s sign: Supine, hip/knee flexed, straighten leg. Assess for pain
Brudzinski’s sign: Supine, place hands behind head and flex head onto chest.
Both tests stretch the spinal cord and reproduce pain. Pain = nerve root irritation. ?meningitis
hip evaluation
Trendelenburg Test: Evaluates strength of the gluteus medius muscle. Stand behind the patient and observe dimples overlying posterior superior iliac spines. Have patient stand on one leg.
Ortolani Click: Congenital Hip Dysplasia. Abduct and externally rotate flexed thigh. A click sound or sensation is abnormal
Ortolani Click
lower extremity evaluation
Bulge Test: Fluid behind knee.
Bulge Test
Patellar Ballottement: Larger amounts of fluid
McMurray’s: Meniscus (if c/o clicking in knee) (Weber & Kelley, 2018)
Drawer test: Anterior cruciate ligament
stability (Physiopedia, n.d.)
Feet: Inspect, palpate, ROM
diagnostics/treatment
Medications
X-rays
CT-scan
MRI
Physical Therapy
Surgery
