Treatment Return to top Treatment depends on the cause of the disorder: Congenital kyphosis requires corrective surgery at an early age. Scheuermann's disease is initially treated with a brace and physical therapy. Occasionally surgery is needed for large (greater than 60 degrees), painful curves. Multiple compression fractures from osteoporosis can be left alone if there is no neurologic problems or pain, but the osteoporosis needs to be treated to help prevent future fractures. For debilitating deformity or pain, surgery is an option. Kyphosis caused by infection or tumor needs to be treated more aggressively, often with surgery and medications. Treatment for other types of kyphosis depends on the cause. Surgery may be necessary if neurological symptoms develop. Expectations (prognosis) Return to top Adolescents with Scheuermann's disease tend do well even if they need surgery, and the disease stops once they stop growing. If the kyphosis is due to degenerative joint disease or multiple compression fractures, correction of the defect is not possible without surgery, and improvement of pain is less reliable. Complications Return to top Disabling back pain Neurological symptoms including leg weakness or paralysis Decreased lung capacity Round back deformity
There are three general causes of scoliosis: Congenital scoliosis is due to a problem with the formation of vertebrae or fused ribs during prenatal development. Neuromuscular scoliosis is caused by problems such as poor muscle control or muscular weakness or paralysis due to diseases such as cerebral palsy , muscular dystrophy , spina bifida, and polio. Idiopathic scoliosis is of unknown cause, and appears in a previously straight spine. Idiopathic scoliosis in adolescents is the most common type. Some people may be prone to the curving of the spine. Most cases occur in girls. Curves generally worsen during growth spurts. Scoliosis in infants and juveniles are less common. They commonly affect a similar number of boys and girls. Scoliosis may be suspected when one shoulder appears to be higher than the other, or the pelvis appears to be tilted. Untrained observers usually can't notice the curving. Routine scoliosis screening is now done in middle and junior high schools. Many cases, which previously would have gone undetected until they were more advanced, are now being caught at an early stage. There may be fatigue in the spine after prolonged sitting or standing. Pain will become persistent if irritation results. The greater the initial curve of the spine, the greater the chance the scoliosis will get worse after growth is complete. Severe scoliosis (curves in the spine greater than 100 degrees) may cause breathing problems. Symptoms Return to top The spine curves abnormally to the side (laterally) Shoulders or hips appearing uneven Backache or low-back pain Fatigue Treatment depends on the cause of the scoliosis, the size and location of the curve, and how much more growing the patient is expected to do. Most cases of adolescent idiopathic scoliosis (less than 20 degrees) require no treatment, but should be checked often, about every 6 months. As curves get worse (above 25 to 30 degrees in a child who is still growing), bracing is usually recommended to help slow the progression of the curve. There are many different kinds of braces used. The Boston Brace, Wilmington Brace, Milwaukee Brace, and Charleston Brace are named for the centers where they were developed. Each brace looks different. There are different ways of using each type properly. The selection of a brace and the manner in which it is used depends on many factors, including the specific characteristics of your curve. The exact brace will be decided on by the patient and health care practioner. A back brace does not reverse the curve. Instead, it uses pressure to help straighten the spine. The brace can be adjusted with growth. Bracing does not work in congenital or neuromuscular scoliosis, and is less effective in infantile and juvenile idiopathic scoliosis. Curves of 40 degrees or greater usually require surgery because curves this large have a high risk of getting worse even after bone growth stops. Surgery involves correcting the curve (although not all the way) and fusing the bones in the curve together. The bones are held in place with one or two metal rods held down with hooks and screws until the bone heals together. Sometimes surgery is done through a cut in the back, on the abdomen, or beneath the ribs. A brace may be required to stabilize the spine after surgery.
Assessment of the musclo skletal system
Assessment of theMusculo-Skeletal System
Review of Anatomy and Physiology• The musculo-skeletal system consists of the muscles, tendons, bones and cartilage together with the joints• The primary function of which is to produce skeletal movements
MusclesThree types of muscles exist in the body• 1. Skeletal Muscles – Voluntary and striated• 2. Cardiac muscles – Involuntary and striated• 3. Smooth/Visceral muscles – Involuntary and NON-striated
TENDONSBands of fibrous connective tissue that tie • bones to muscles
LIGAMENTSStrong, dense and flexible bands of fibrous • tissue connecting bones to another bone
BONES• Variously classified according to shape, location and size• Functions 1. Locomotion 2. Protection 3. Support and lever 4. Blood production 5. Mineral deposition
JOINTSThe part of the Skeleton where two or more • bones are connected
CARTILAGES A dense connective tissue that consists of •fibers embedded in a strong gel-like substance
BURSAESac containing fluid that are located around • the joints to prevent friction
• CHECK YOUR EQUIPMENT PRIORTO ENTERING THE PATIENT’SROOM. MAKE SURE YOU HAVEEVERYTHING YOU NEED TOCOMPLETE YOUR ASSESSMENTPRIOR TO ENTERING THEPATIENT’S ROOM
Make the Patient Comfortable• Showing concern for privacy and patient modesty must become ingrained in your professional behavior• Be sure to close nearby doors or examination room PRIOR to beginning physical examination• Your goal is to visualize one area of the body at a time
Make the Patient Comfortable• Be sensitive to the patient’s feelings and physical comfort• When you have completed the examination, show your attentiveness, by rearranging the patients pillows, or adding blankets for warmth; make sure their immediate environment is to their satisfaction• Be sure to lower the bed completely, and make sure side rails are up and call bell is in the patient’s reach• As you leave be sure to WASH YOUR HANDS
Cardinal Techniques of Examination• Inspection• Palpation• Percussion• Auscultation
Outlines2. Review of Anatomy and physiology of musculoskeletal system3. Physical Exam4. Inspection5. Palpation6. ROM (Rang of motion)
Objectives• Apply knowledge of Anatomy and physiology of musculoskeletal system• Differentiate between normal and abnormal• Implement physical assessment
Musculoskeletal• Muscle or joint pain• Stiffness• Arthritis• Gout• Backache• If present, describe location or affected joints or muscles, any swelling, redness, pain, tenderness, stiffness, weakness, or limitation of motion or activity; include timing of symptoms duration, and any history of trauma• Neck or low back pain• Joint pain with systemic features such as fever, chills, rash, anorexia, weight loss, or weakness
Skin• Rashes• Lumps• Sores• Itching• Dryness• Changes in color• Changes in hair or nails
What do muscles do ?• Muscles simply move you!• Without muscles you couldnt open your mouth, speak, shake hands, walk, talk, or move your food through your digestive system.• There would be no exploring, running, climbing, smiling, blinking, breathing. You couldnt move anything inside or outside you. The fact is, without muscles, you wouldnt be alive for very long
The skeleton is the name given to the collection of bones that holds our body up.Our skeleton is very important to us. It does three major jobs.1. It protects our vital organs such as the brain, the heart, and the lungs.2. It gives us the shape that we have. Without our skeleton we would just be a blob of blood and tissue on the floor.3. It allows us to move. Because our muscles are attached to our bones, when our muscles move, they move the bones, and we move
Physical Exam1. Inspection• Observe any lack of symmetry and any evidence of trauma or disease.• Look for muscle wasting;• Inspect the joint contour (shape) and observe any evidence of swelling, deformity or inflammation.
• Ask the client to point to, or otherwise identify, any painful areas, including sites of radiation ofpain. Screening questions for musculoskeletal disorders 1. Do you have any pain or stiffness in your arms, legs or back? 2. Can you walk up and down stairs without difficulty? 3. Can you dress yourself in everyday clothes without any difficulty?
• Assessment of Gait• Ask the patient to walk back and forth across the room.• Observe for equality of arm swing , balance and rapidity and ease of heels turning.• Next, ask the patient to walk on his tiptoes, then on heels.• Ask the patient to tandem walk.• Test patients ability to stand with feet tiptoes together with eyes open and then closed. (Rombergs test). Reassure patient that you will support him, in case he becomes unsteady.• Normal: Person can walk in balance with the arms swinging at sides and can turn smoothly. Person should be able to stand with feet together without falling with eyes open or closed. tandem
Upper Extremity Muscles• Inspect the muscles of the shoulder, arm, forearm and hand.• Note muscle size (bulk).• Look for asymmetry, atrophy and fasciculation.• Look for tremor and other abnormal movement at rest and with arms outstretched.
Determine muscle power by• Gently trying to Abduction overpower contraction of each group of muscles. – Shoulder: Abduction (Deltoid) Adduction –, Adduction –, (Trapezius) (Trapezius
– Hand: Grip Grip– opposition of thumb and index finger– opposition of thumb and little finger and– finger abduction and
• Determine limb tone (resistance to passive stretch).• With the patient relaxed• Gently move the limb at the shoulder, elbow and wrist joints and note whether tone is normal, increased or decreased
Normal findings• Muscles are symmetrical in size with no involuntary movements.• In some, muscles may be slightly larger on the dominant side.• Muscle power obviously varies. You should not be able to overpower with reasonable resistance.• You have to learn to appreciate the normal tone from practice.
Neck: Range of Motion of• Fix the head with one hand while you examine neck• Inspection – Note the normal concavity of cervical spine – Identify Transverse process of C7 – Observe Trapezius and Sternomastoid muscles• Palpation – Feel each spinous process looking for focal areas of tenderness – Joint • Feel for crepitus during passive motion Touch chin – Para spinal muscles• Range of motion – Active • Touch chin for flexion • Throw head back for extension Throw head back
• Touch each shoulder with ears for lateral flexion • Touch each shoulder with chin for lateral rotation – Passive • Feel for crepitus during passive motion• Normal: – 30 degree rotation, able to touch chest with chin, 55 degree extension and 40 degree lateral bend. – No resistance during the range of motion.
Muscles of Lower Extremity Inspect the muscles of the hip, knee and ankle.• Note muscle size (bulk).• Look for asymmetry, atrophy and fasciculation. Hip flexion• Look for abnormal movement.• Determine muscle power by gently trying to overpower contraction of each group of muscles. – Hip: Flexion (Iliopsoas), Extension (Gluteus maximus), Abduction, Adduction.
Assessment of the Musculoskelet al System Muscle Strength scale0 No detection of muscular contraction1 A barely detectable flicker or trace of contraction with observation or palpation.2 Active movement of body part with elimination of gravity.3 Active movement against gravity only and not against resistance4 Active movement against gravity & some resistance5 Active movement against full resistance without evident fatigue (Normal muscle strength)
The Knee Exam• Inspection• Make sure that both knees are fully exposed. The patient should be in either a gown or shorts. Rolled up pant legs do not provide good exposure!• Watch the patient walk.• Do they limp or appear to be in varus Knee pain? deormity ,more• When standing, is there evidence marked on the left of bowing (varus) or knock- leg kneed (valgus) deformity? There is a predilection for degenerative joint disease to affect the medical aspect of the knee, a common cause of bowing.
• Is there evidence of atrophy of the quadriceps, hamstring, or calf muscle groups? Knee problems/pain can limit the use of the affected leg, leading to While both legs have well developed wasting of the muscles. musculature, the left calf and hamstring are bulkier than the right
– Knee : Flexion (Hamstrings), Extension (Quadriceps) – Ankle : Dorsiflexion (Tibialis Knee extension anterior), Plantar flexion (Gastronemius).• Determine limb tone resistance to passive stretch. With the patient relaxed, gently move the limb at the hip, knee and ankle and note Knee flexion whether tone is normal, increased or dicreased. Flex the hip and knee.• Support the knee, dorsiflex the Dorsiflexion ankle sharply and hold the foot in this position checking for clonus.
(Spine (Bone• The examiner should stand behind the patient and observe the alignment of the spine in the flexed position to determine scoliosis.• View the spine from the side to determine kyphosis.• Ask the patient if he is aware of sore spots. Palpate the spinous process and be gentle with the sore spots. Percuss one vertebra at a time, starting from head.• .
• Assess range of motion of spine by having patient bend down to pick up an object without bending his legs while you hold his hips.• Normal:• Gentle concavities in cervical and lumbar regions and a convexity in the thorax.• Vertebral line and gluteal cleft align
Posture Normal - • Comfortably erectLook for straight lines across body parts