NurseReview.Org - Muscoloskeletal System

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http://NurseReview.Org Muscoloskeletal System

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  • Found a helpful website that I thought may help others. This website has practice exams for various nursing classes as well as videos, presentations, notes, nclex help, and many other tools that already are helping me. Hope they help :-)
    www.RNpedia.com
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NurseReview.Org - Muscoloskeletal System

  1. 1. Muscoloskeletal System
  2. 2. Musculoskeletal System Consists of: <ul><li>Bones </li></ul><ul><li>Muscles </li></ul><ul><li>Joints </li></ul><ul><li>cartilage </li></ul>
  3. 3. function <ul><li>Support to stand erect </li></ul><ul><li>Movement </li></ul><ul><li>Protect inner vital organs </li></ul><ul><li>Hemopoiesis – Bone marrow produces white & red bld cells and platelets </li></ul><ul><li>Reservoir for storage of minerals & energy – Ca. & Phosphorus in the bones. </li></ul>
  4. 4. Bones <ul><li>206 </li></ul><ul><li>Bones & cartilage are types of Connective tissue </li></ul><ul><li>Bone is hard and rigid and dense </li></ul>
  5. 5. Joints <ul><li>2 or more bones connecting </li></ul><ul><li>Mobility </li></ul><ul><li>Nonsynovial = immovable, skull sutures </li></ul><ul><li>Synovial = movable </li></ul><ul><li>Synovial joints – ends of bones are covered with cartilage & enclosed in a joint cavity filled with synovial fld. </li></ul>
  6. 6. <ul><li>Ligaments are fibrous bands – connect one bone to another. Strengthen joint & prevent movement in the wrong direction </li></ul><ul><li>Bursa – enclosed sac filled with synovial fld.& are located in areas of potential friction = shoulder, knee. Help muscles & tendons glide over bone. </li></ul>
  7. 7. Muscles <ul><li>40 – 50 % body weight </li></ul><ul><li>Contract & produce movement </li></ul><ul><li>Skeletal muscle is voluntary </li></ul><ul><li>Composed of Bundles of muscle fibers or fasciculi </li></ul><ul><li>Muscle is attached to bones via tendons </li></ul>
  8. 8. Skeletal muscles produce the following movements <ul><li>Flexion – bending </li></ul><ul><li>Extension – straightening </li></ul><ul><li>Abduction – away from midline </li></ul><ul><li>Adduction – toward midline </li></ul><ul><li>Pronation – palm down </li></ul><ul><li>Supination – palm up </li></ul><ul><li>Circumduction - circular </li></ul>
  9. 9. Skeletal muscles produce the following movements <ul><li>Inversion – sole inward </li></ul><ul><li>Eversion – sole outward </li></ul><ul><li>Rotation – head around central axis </li></ul><ul><li>Protraction –forward movement parallel to ground (chin) </li></ul><ul><li>Retraction – backward parallel movement </li></ul><ul><li>Depression/elevation – Shoulders up & down </li></ul>
  10. 11. Temporomandibular Joint (TMJ) <ul><li>Articulation of temporal & mandible </li></ul><ul><li>Depression anterior to tragus of ear </li></ul><ul><li>Jaw function for chewing & speaking </li></ul><ul><li>Movements </li></ul><ul><ul><li>Hinge – open/close </li></ul></ul><ul><ul><li>Gliding – protrusion/retraction </li></ul></ul><ul><ul><li>Gliding- side to side </li></ul></ul>
  11. 12. Spine <ul><li>33 Vertebrae </li></ul><ul><li>Spinous process posterior midline </li></ul><ul><li>7 Cervical </li></ul><ul><li>12 Thoracic </li></ul><ul><li>5 Lumbar </li></ul><ul><li>5 Sacral </li></ul><ul><li>3 – 4 Coccygeal </li></ul>
  12. 13. <ul><li>C7 & T1 prominent base of neck </li></ul><ul><li>Inferior angle of scapula in line with T7 & T8 </li></ul><ul><li>Highest point iliac crest at L4 </li></ul><ul><li>Curves Double S – lateral view </li></ul><ul><ul><li>cervical & lumbar are concave;(inward) </li></ul></ul><ul><ul><li>Thoracic & sacrococcygeal are convex </li></ul></ul><ul><li>Intervertebral discs cushion the spine = shock absorber </li></ul>
  13. 14. Shoulder <ul><li>Articulation of humerus & glenoid fossa of scapula </li></ul><ul><li>Ball & socket – enclosed by rotator cuff (4 muscles and tendons) </li></ul><ul><li>Acromion process – bump at top of shoulder </li></ul>
  14. 15. Elbow <ul><li>Articulation humerus, radius, & ulna </li></ul><ul><li>Landmarks are the Medial & lateral epicondyles of the humerus & large olecranon process of the ulna in between </li></ul><ul><li>Sensitive ulnar nerve </li></ul>
  15. 16. Wrists and Carpals <ul><li>Wrist –articulation of radius & carpal bones </li></ul><ul><li>Permits flexion, extension & side to side deviation </li></ul><ul><li>Metacarpophalangeal & interphalangeal joints – permit finger flexion and extension </li></ul>
  16. 17. Hip <ul><li>Acetabulum & femur </li></ul><ul><li>Ball & socket joint </li></ul><ul><li>Weight bearing function </li></ul><ul><li>Landmarks ( IM injections) </li></ul><ul><ul><li>Anterior, superior iliac crest </li></ul></ul><ul><ul><li>Ischial tuberosity ( ↓ gluteus maximus, flex hip) </li></ul></ul><ul><ul><li>Greater trochanter of femur </li></ul></ul>
  17. 18. Knee <ul><li>Femur, tibia & patella </li></ul><ul><li>Largest joint </li></ul><ul><li>Hinged joint & largest synovial membrane </li></ul><ul><li>2 cartilages – medial & lateral menisci cushion the tibia & femur </li></ul>
  18. 19. Ankle & Foot <ul><li>Ankle joint is the articulation of Tibia, fibula & talus </li></ul><ul><li>Hinged joint </li></ul><ul><ul><li>Dorsiflexion </li></ul></ul><ul><ul><li>Plantar flexion </li></ul></ul><ul><li>Landmarks </li></ul><ul><ul><li>Medial & lateral malleolus </li></ul></ul>
  19. 20. Aging adult <ul><li>Loss of bone density = osteoporosis </li></ul><ul><li>Postural changes </li></ul><ul><li>↓ height due to shortening of the vertebral column </li></ul>
  20. 21. Subjective Data <ul><li>Joints </li></ul><ul><ul><li>Pain </li></ul></ul><ul><ul><li>Stiffness </li></ul></ul><ul><ul><li>Swelling, heat, redness </li></ul></ul><ul><li>Muscles </li></ul><ul><ul><li>Pain, cramps </li></ul></ul><ul><ul><li>weakness </li></ul></ul>
  21. 22. Subjective Data <ul><li>Bones </li></ul><ul><ul><li>Pain </li></ul></ul><ul><ul><li>Deformity </li></ul></ul><ul><ul><li>Trauma </li></ul></ul><ul><li>Functional Assessment ( ADL’s ) </li></ul><ul><li>Self – care behaviors </li></ul>
  22. 23. Objective Assessment Physical Exam Musculoskeletal <ul><li>Purpose </li></ul><ul><ul><li>To assess function for ADL’s </li></ul></ul><ul><ul><li>Screen for abnormalities </li></ul></ul>
  23. 24. Screening Exams <ul><li>Inspection </li></ul><ul><li>Palpation </li></ul><ul><li>ROM with movement active or passive if apparent limitations </li></ul><ul><li>Age Specific </li></ul>
  24. 25. Important to : <ul><li>Client comfort </li></ul><ul><li>Systemic approach </li></ul><ul><li>Support joints </li></ul><ul><li>Bilateral exam </li></ul>
  25. 26. Equipment <ul><li>Tape measure </li></ul><ul><li>Goniometer </li></ul><ul><li>Skin marking pen </li></ul>
  26. 27. Inspection <ul><li>Size & contour of joint </li></ul><ul><li>Color, swelling, masses, deformity </li></ul>
  27. 28. Palpation <ul><li>Each joint </li></ul><ul><ul><li>Temperature </li></ul></ul><ul><ul><li>Muscles </li></ul></ul><ul><ul><li>Bony articulations joint capsule </li></ul></ul><ul><ul><li>Tenderness, swelling, masses </li></ul></ul>
  28. 29. ROM <ul><li>Active ROM </li></ul><ul><li>Limitation – try passive motion </li></ul><ul><li>or in ROM, use a goniometer to measure angles </li></ul>
  29. 30. Muscle Testing <ul><li>Repeat movements for Active ROM </li></ul><ul><li>Client flexes & holds against opposing force </li></ul><ul><li>= bilaterally, resists opposing force </li></ul>
  30. 31. Grade muscle strength (pg. 616) <ul><li>Values 0- 5 </li></ul><ul><li>Grade 5= Normal –Full ROM against gravity, full resistance </li></ul>
  31. 33. TMJ <ul><li>Swelling, tenderness, crepitation </li></ul><ul><li>Crepitation = audible & palpable crunching or grating with movement </li></ul>
  32. 34. Cervical Spine <ul><li>Inspection </li></ul><ul><ul><li>Head & neck alignment </li></ul></ul><ul><ul><li>Spine </li></ul></ul><ul><li>Palpation </li></ul><ul><ul><li>Spinous processes, Trapezius, Paravertebral muscles </li></ul></ul><ul><ul><li>ROM, flexion, extension, hyperextension, lateral flexion, rotation, circumduction </li></ul></ul><ul><ul><li>Repeat applying opposing force </li></ul></ul>
  33. 35. Shoulders <ul><li>Inspect </li></ul><ul><ul><li>Bilateral comparison </li></ul></ul><ul><li>Palpate </li></ul><ul><ul><li>Bilaterally for muscle spasms, atrophy, swelling, heat, tenderness </li></ul></ul><ul><ul><li>Clavicle to acromioclavicular joint, scapula, greater tubercle of humerus, subacromal bursa, biceps groove & anterior aspect glenohumeral joint </li></ul></ul>
  34. 36. Test for Shoulder ROM <ul><li>Flexion </li></ul><ul><li>Extension </li></ul><ul><li>Internal rotation </li></ul><ul><li>External rotation </li></ul><ul><li>Abduction </li></ul><ul><li>Adduction </li></ul><ul><li>Circumduction </li></ul><ul><li>Test for strength; shrug shoulders, flex forward, up & abduct against resistance </li></ul>
  35. 37. Elbow <ul><li>Inspect </li></ul><ul><ul><li>Size & contour with flexion, extension </li></ul></ul><ul><ul><li>Deformity, redness, swelling </li></ul></ul><ul><ul><li>Olecranon bursa </li></ul></ul><ul><li>Palpate </li></ul><ul><ul><li>Flexed 70 degrees </li></ul></ul><ul><ul><ul><li>Olecranon process, medial & lateral epicondyles of humerus </li></ul></ul></ul><ul><ul><ul><li>Olecronon bursa for heat, swelling, tenderness, nodules </li></ul></ul></ul>
  36. 38. ROM of Elbow <ul><li>Flexion </li></ul><ul><li>Extension </li></ul><ul><li>pronation </li></ul><ul><li>supination </li></ul>
  37. 39. Muscle Strength of Elbow <ul><li>Flex elbow – then extend against resistance applied just proximal to the wrist </li></ul>
  38. 40. Wrist and Hand <ul><li>Inspect </li></ul><ul><ul><li>Palmar & dorsal surface </li></ul></ul><ul><ul><ul><li>Position, contour and shape </li></ul></ul></ul><ul><ul><li>Swelling, redness, deformity or nodules </li></ul></ul>
  39. 41. Wrist and Hand <ul><li>Palpate </li></ul><ul><ul><li>Wrist and hand joints </li></ul></ul><ul><ul><li>Support hand, use both thumbs to palpate </li></ul></ul><ul><ul><li>Metacarpophanlangeal joints </li></ul></ul><ul><ul><li>Use thumb and index finger in a pinching motion to palpate interphalangeal joints </li></ul></ul>
  40. 42. ROM of Wrists and Hands <ul><li>Hyperextension </li></ul><ul><li>Palmar flexion </li></ul><ul><li>Flexion of fingers </li></ul><ul><li>Abduction for fingers </li></ul><ul><li>Opposition </li></ul><ul><li>Ulnar deviation, Radial deviation </li></ul>
  41. 43. Muscle Strength for Wrist and Hands <ul><li>Flex wrist against palm resistance </li></ul><ul><li>Phalen’s test – both hands flexed & back to back for 60 secs. Normally no symp. Carpel tunnel syndrome will give a + result of numbness & burning </li></ul><ul><li>Tinel’s Sign – direct percussion @ median nerve of wrist. In carpel tunnel + result = burning & tingling </li></ul>
  42. 44. Hip <ul><li>Inspect hip joint with spine when client is standing </li></ul><ul><li>Client is supine, palpate the hip joints </li></ul><ul><li>ROM </li></ul>
  43. 45. Knee <ul><li>Supine with legs extended ( knees can be flexed or dangling for inspection) </li></ul><ul><li>Swelling = ? Soft tissue or ↑ fld in the joint </li></ul><ul><li>Bulge Sign – stroke up medial aspect 2-3x. Tap lateral aspect. Watch for a bulge in the medial hollow. </li></ul><ul><li>Ballottement of the Patella – lger amt of flds </li></ul>
  44. 46. Ankle & foot <ul><li>Inspect while nonweight- bearing, then standing & walking </li></ul><ul><li>ROM </li></ul><ul><li>Muscle strength </li></ul>
  45. 47. Spine <ul><li>Standing </li></ul><ul><li>Inspect </li></ul><ul><li>Palpate spinous processes </li></ul><ul><li>ROM of spine is checked by asking to touch toes </li></ul>
  46. 48. Leg measurement <ul><li>True leg length = measure b/t fixed points, the anterior iliac spine cross the medial side of the knee to the medial malleolus </li></ul>

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