Chapter 23: Musculoskeletal System Exam 2022/2023

Chapter 23: Musculoskeletal System Exam 2022/2023 What does the musculoskeletal system consist of? - Answer- bones, joints, and muscles What does this system do and why do we need it? - Answer- 1)For support, to sta ...

Chapter 23: Musculoskeletal System Exam 2022/2023 What does the musculoskeletal system consist of? - Answer- bones, joints, and muscles What does this system do and why do we need it? - Answer- 1)For support, to stand erect 2)For movement 3)to encase and protect the inner vital organs (brain, spinal cord, heart) 4)To produce RBC,WBC, platelets in the bone marrow (hematopoiesis) 5) As a reservoir for storage of essential minerals such as calcium and phosphorus in the bones How many bones does the body have? - Answer- 206 Note to self: -The skeleton is the bony framework of the body What do the bones do? - Answer- -Support the body like post and beams of a building What are specialized forms of connective tissue? - Answer- Bones & Cartilage What are the characteristics of bones? - Answer- -hard -rigid -very dense Note to self: -Its cells are continually turning over and remodeling. What are joints (articulation)? - Answer- -Is the place of union of two or more bones -Joints are functional units of the musculoskeletal system because they permit the mobility needed for activities of daily living (ADLs). -Surrounded by fibrous capsule and supported by ligaments. What are fibrous joints? - Answer- -Bones are united by interjacent fibrous tissue or cartilage and are immovable Example: The sutures of the skull What are Cartilaginous joints? - Answer- -separated by fibrocartilaginous discs and are only slightly moveable. Example: vertebrae What are Synovial Joints? - Answer- -are freely moveable because their bones are separated from one another and enclosed in a joint cavity -This cavity is lined with synovial membrane that secretes a lubricant, or synovial fluid. Example: -Just like grease on gears, synovial fluid allows sliding of opposing surfaces, and this sliding permits movement. Resilient Cartilage - Answer- A layer that covers the surface of opposing bones Is cartilage vascular or avascular? - Answer- Avascular Note to self: -It is a very stable connective tissue with a slow cell turnover. It has a tough, firm, inconsistency yet it is flexible. Ligament - Answer- -Are fibrous bands running directly from one bone to another that strengthen the joint and help prevent movement in undesirable directions. Note to self: BONE->BONE Bursa - Answer- What is it? -an enclosed sac filled with viscous synovial fluid, like a joint Where is it located? -In areas of potential friction -It helps muscles and tendon glide smoothly over the bone. Example: -subacromial bursa of the shoulder; prepatellar bursa of the knee. Muscles - Answer- -Account for 40-50% of body weight. -when they contract they produce movement What are the three types of muscles: - Answer- 1)Skeletal 2)Smooth 3)Cardiac Skeletal Muscle: - Answer- -Composed of bundles of muscle, fibers or fasciculi -It is attaches to bone by a tendon. Tendon - Answer- connect muscle to bone What movements do skeletal muscles produce? - Answer- Flexion Extension Abduction Adduction Pronation Supination Circumduction Inversion Eversion Rotation Protraction Retraction Elevation Depression Flexion - Answer- Bending a limb at the joint Abduction - Answer- moving the limb away from the midline of the body Extension - Answer- Straightening a limb at the joint Adduction - Answer- moving the limb toward the midline of the body Pronation - Answer- Turning the forearm so the palm is down Supination - Answer- Turning the forearm so that the palm is up Circumduction - Answer- Moving the arm in a circle around the shoulder Inversion - Answer- Moving the sole of the foot inward at the ankle Eversion - Answer- Moving the sole of the foot outward at the ankle Rotation - Answer- Moving the head around a central axis Protraction - Answer- Moving a body part forward and parallel to the ground Retraction - Answer- Moving a body part backward and parallel to the ground Elevation - Answer- Raising a body part Depression - Answer- lowering a body part Vertebrae - Answer- -Consist of 33 connecting bones that are stacked in a vertical column. -Can feel spinous processes in a furrow down the midline of the neck How many vertebrae are in each section? - Answer- Cervical - 7 Thoracic- 12 Lumbar-5 Sacral- 5 Coccygeal- 4 What are the surface landmarks that will orient you to the vertebrae levels? - Answer- -The spinous processes of C7 and T1 are prominent at the base of the neck -The inferior angle of the scapula normally is at the level of the interspace between T7 &T8. -An imaginary line connecting the highest point on each iliac crest crosses L4. The cervical and lumbar curse are concave ________________ - Answer- inward or anterior The thoracic and sacrococcygeal curves are ______________ - Answer- convex Intervertebral Discs - Answer- -Elastic fibrocartilaginous plates that constitute one fourth- of the length of the column Double S curve normal finding - Answer- insert picture When is peak bone mass and bone mineral density (BMD) reached? - Answer- -Late 20's for Caucasians Note to self: -Females reach their peaks significantly earlier than males Bone Remodeling - Answer- -Cyclic process of bone reabsorption and deposition responsible for skeletal maintenance at sights that need repair or replacements What happens when bone resorption (loss of bone matrix) occurs more rapidly? - Answer- -The net effect is a gradual loss of density or osteoporosis Osteoporosis - Answer- A disease involving the loss of mineralized bone mass leading to porous bone and thus risk of fractures. Note to self: -Aging women have a greater amount of bone loss compared with aging men. -Decreased estrogen levels in both sexes are partially responsible because osteoblasts that form new bone have estrogen receptors What changes are evident with aging? - Answer- Postural Changes What does not shorten with age? - Answer- Long Bones What happens to your vertebrae as you get older? - Answer- -Decreased height of 3 to 5 cm occurs with shortening of the vertebral column, this is caused by a loss of water content and thinning of the intervertebral discs and by a decrease in the height of the individual vertebrae from osteoporosis What age is there a progressive decrease in height? - Answer- -Progressive decrease in height is not significant until the age of 60. -A greater decrease occurs in the 70s and 80s as a result of osteoporotic collapse of the vertebrae. What happens when subcutaneous fats leave bony prominences more marked and what happens when absolute muscle mass occurs? - Answer- -Loss of subcutaneous fat leaves bony prominences more marked Example: Tips of vertebrae, ribs, iliac crest -Body hallows deeper Example: cheeks, axillae Note to self: -An absolute loss of muscle mass occurs; some muscles decrease in size, and some atrophy produces weakness. How does lifestyle affect musculoskeletal changes? - Answer- -Sedentary lifestyle hastens musculoskeletal changes of aging. -Physical exercise increases skeletal mass and helps prevent or delay osteoporosis. -Physical activity delays or prevents bone loss in postmenopausal women in dosedependent manner Culture and Genetics in women - Answer- -Substantial race/ethnic differences exists in bone mineral density (BMD) among women in the US globally. -A higher BMD value means a denser bone -A low BMD value is a strong consistent predictor of hip and vertebral fractures among postmenopausal women. Evidence in comparing BMD in older women in 4 countries compares US Caucasian Women to the following : - Answer- Afro-Caribbean Women -BMD hip measurements were 21-31% higher in Afro-Caribbean Women African American Women: -BMD hip measurements 13-23% higher in African -The higher BMD values confer a lower fracture risk among women of African American heritage. American women. Hong- Kong Chinese women: -Similar numbers to those above South Korean women: -Highest out of all What is the most efficient way to slow the process of decline in BMD? - Answer- - Physical activity data discussed earlier suggest that weight baring, physical activity (fast walking), is imperative during the reproductive and middle adult years to slow the process of decline in BMD Subjective Data - Answer- -joints >pain >stiffness >swelling, heat, redness >limitation of movement -knee joint (if injured) -muscles >pain (cramps) >weakness -Bones >pain >deformity >trauma (fractures, sprains, dislocations) -Functional Assessment (ADLS) -Patient Centered Care Joint Pain - Answer- -loss of function are most common musculoskeletal concerns that prompt a person to seek care. -Joint pain 10-14 days after an untreated strep throat suggests rheumatic fever. -Joint injury occurs from trauma or repetitive motion -Assess for lyme disease Rheumatoid Arthritis (RA) - Answer- -involves symmetric joints, other musculoskeletal illnesses involve isolated or unilateral joints. -RA pain is worse in the morning when arising and after rest periods. -Movement increases most joint pain except in RA, in which movement decreases pain Osteoarthritis - Answer- is worse later in the day Tendinitis - Answer- is worse in the morning and improves during the day What can decreased ROM cause? - Answer- Decreased ROM can cause joint injury to cartilage or capsule to muscle contracture. Knee Joint Pain - Answer- -Pop may mean tear in ligament or fracture -With direct knee trauma, obtain x-ray if the patient is unable to flex knee to 90 degrees or unable to bear weight for 4 steps. -If pain is experienced at fibula head or patella, or if the patient is under 55 years old (Ottawa knee rules). Muscles: Myalgia - Answer- -Usually felt as cramping or aching -viral illness Claudication - Answer- is how much can someone walk until they cant anymore. Is there pain when they walk Atrophy - Answer- muscles get smaller they break down When does lower back pain occur? - Answer- -Occurs with degenerative discs, osteoporosis, lumbar stenosis, or is non-specific What can chronic muscle pain do? - Answer- Increase anxiety symptoms Regular High Dose exercise - Answer- increase bone strength and reduces fracture risk What increases the risk of future falls? - Answer- A history of falls What are the screening intervals when there are changes is BMD? - Answer- - Screening intervals of 2 years is suggested to measure any change in BMD. -Recent evidence shows if baseline BMD is normal or osteopenia is mild, rescreening intervals of 15 years may suffice. -Intervals of 5 years for women with moderate osteopenia. Inspection: What do have to take note of for every joint? - Answer- size & contour How do we inspect the skin and tissues over joints? - Answer- -Inspect skin and tissue for color, swelling, and any masses or deformity. -Presence of swelling is significant in joint irritation. -Use the contralateral side for comparison. Palpation: How do you palpate each joint? - Answer- -include its skin for temperature, its muscles, bony articulations, and area of joint capsules. -Notice any heat, tenderness, swelling, or masses. -Joints normally are not tender to palpation. What membrane is normally not palpable? - Answer- -The synovial membrane is not palpable. When thickened it feels "doughy" or "boggy" -A small amount of fluid is present in the normal joint, but it is not palpable Active Voluntary ROM: - Answer- While modeling the movements yourself as appropriate; you can make your own movements as a control. Familarize yourself with the type of each joint and its normal ROM so you can recognize limitations. Muscle Testing - Answer- -Test the strength of the prime-mover muscle groups for each joint. -Repeat the motions that you elicit for active ROM -Now ask the person to flex and hold as you apply opposing force. -Muscle strength should be bilaterally and fully resistant to your opposing force. Voluntary movement grading system =: - Answer- 5-> Full ROM against gravity, full resistance-> Normal 4->Full ROM against gravity, some resistance-> Good 3->Full ROM with gravity -> Fair 2->Full ROM with gravity eliminated-> Poor 1->Slight contraction-> Trace 0-> No contraction-> zero What do deformities include: - Answer- Fracture- break in bone Dislocation- complete loss of contact between two bone in a joint Subluxation- two bones in a joint stay in contact but their alignment is off Contracture- shortening of a muscle leading to limited ROM of joint Ankylosis- stiffness or fixation of a joint Why is palpable fluid abnormal? Explain. - Answer- -Palpable fluid is abnormal because fluid is contained in an enclosed sac. -If you push on one side of the sac, the fluid will shift and cause visible bulging on another side What is the most sensitive sign of joint disease? - Answer- -Limited ROM is the most sensitive sign of joint disease -The amount of limitation may alert you to the cause of disease. Articular Disease - Answer- -located inside the joint capsules Example: arthritis -produces swelling and tenderness around the whole joint. -It limits all planes of range of motion in both active and passive motion. Extra-Articular Disease - Answer- -injury to a specific tendon, ligament, nerve -Produces swelling and tenderness to that one spot in the joint and affects only certain planes of ROM especially during active voluntary motion. Crepitation - Answer- -is an audible and palpable crunching or grating that accompanies movement -Occurs when articular surfaces is joints are roughened as with RA. Palpate: Temporomandibular Joint: - Answer- -Place the tips of your two fingers in front of each ear. -Ask the person to open and close their mouth. -Drop your fingers into the depressed area over the joint and note the smooth notion of the mandible -An audible or palpable click occurs in many healthy people as the mouth opens. Motion and Expected Range of Temporomandibular Joint: - Answer- -You can measure the space between the upper and lower incisors. -Normal is 3-6cm (or 3 fingers inserted sideways). -Lateral motion, normal extent is 1-2 cm. TMJ dysfunction: - Answer- -crepitus and pain occur with TMJ dysfunction during movement or chewing. -Malocclusion of teeth also causes palpable crepitus or audible dick. Swollen temporomandibular joint: - Answer- Looks like round bulge over the joint, although it must be moderate or marked to be visible Decreased ROM occurs with: - Answer- TMJ, Inflammation, and arthritis Note to self: -Lateral motion may be lost earlier and more significantly than vertical motion. Cervical Spine: - Answer- Inspect: -The alignment of the head and neck Palpate: -The spinous processes and the sternomastoid, trapezius, and paravertebral muscles. -They should feel firm, with no muscle spasms, or tenderness. Detect Range of Motion: -Instruct patient to Touch chin the chest, lift chin toward the ceiling, touch each ear to the corresponding shoulder, turn the chin toward each shoulder. -Repeat the motions while applying opposing force. The person normally can maintain flexion against your full resistance. -This also tests the integrity of cranial nerve X1 (SPINAL). Abnormal Findings: Cervical Spine - Answer- -Head tilted to one side -Asymmetry of muscles -Tenderness and hard muscles with muscle spasms. -Tenderness with arthritis or postural disorders with desk or office work. -Limited ROM occurs with arthritis -Pain with movement occurs with arthritis or muscle overuse. -The person cannot hold flexion Upper Shoulder: Shoulder - Answer- Inspect: -Inspect and compare both shoulders posteriorly and anteriorly. -Check the size and contour of the joint and compare shoulders for equality of bony landmarks. -Normally no redness, muscular atrophy, or swelling is present. -Check joint capsule and the subacromial bursa for abnormal swelling. How to test ROM? - Answer- -By asking the person to perform 4 ranges of motion. -Cup one hand over the shoulder during rom and note any crepitation; normally non is present. 1)With arms at sides and elbows extended, move both arms forward and up in wide vertical arcs then move them back 2)Rotate arms internally behind back, place back of hands as high possible towards scapulae 3)With arms at sides and elbows extended, raise both arms in wide arcs in the coronal plane. Touch palms together above head. 4)Touch both hands behind the head with elbows fixed and rotated posteriorly. Abnormal Shoulder Findings: - Answer- -Dislocated shoulder loses normal rounded shape and looks flattened laterally. -Swelling from excess fluid is best seen anteriorly -Limited ROM, Asymmetry, Pain with motion -Crepitus with motion -Rotator cuff lesions may cause limited ROM, pain, and muscle spasm during abduction, whereas forward flexion stays fairly normal. CONTINUES.......