The musculoskeletal system consists of bones, muscles, joints, and cartilage that work together to allow for movement, provide support for standing, and protect internal organs. Key functions include bone marrow production and mineral storage. There are over 200 bones and joints include synovial joints that allow movement between bones covered in cartilage. Ligaments and bursae also support joints. Muscles make up 40-50% of body weight and contract to produce movement. The document provides details on assessing each body region including inspection, palpation, range of motion testing, and muscle strength testing to evaluate the musculoskeletal system.

1. Muscoloskeletal System

2. Musculoskeletal System Consists of: Bones Muscles Joints cartilage

3. function Support to stand erect Movement Protect inner vital organs Hemopoiesis – Bone marrow produces white & red bld cells and platelets Reservoir for storage of minerals & energy – Ca. & Phosphorus in the bones.

4. Bones 206 Bones & cartilage are types of Connective tissue Bone is hard and rigid and dense

5. Joints 2 or more bones connecting Mobility Nonsynovial = immovable, skull sutures Synovial = movable Synovial joints – ends of bones are covered with cartilage & enclosed in a joint cavity filled with synovial fld.

6. Ligaments are fibrous bands – connect one bone to another. Strengthen joint & prevent movement in the wrong direction Bursa – enclosed sac filled with synovial fld.& are located in areas of potential friction = shoulder, knee. Help muscles & tendons glide over bone.

7. Muscles 40 – 50 % body weight Contract & produce movement Skeletal muscle is voluntary Composed of Bundles of muscle fibers or fasciculi Muscle is attached to bones via tendons

8. Skeletal muscles produce the following movements Flexion – bending Extension – straightening Abduction – away from midline Adduction – toward midline Pronation – palm down Supination – palm up Circumduction - circular

9. Skeletal muscles produce the following movements Inversion – sole inward Eversion – sole outward Rotation – head around central axis Protraction –forward movement parallel to ground (chin) Retraction – backward parallel movement Depression/elevation – Shoulders up & down

11. Temporomandibular Joint (TMJ) Articulation of temporal & mandible Depression anterior to tragus of ear Jaw function for chewing & speaking Movements Hinge – open/close Gliding – protrusion/retraction Gliding- side to side

12. Spine 33 Vertebrae Spinous process posterior midline 7 Cervical 12 Thoracic 5 Lumbar 5 Sacral 3 – 4 Coccygeal

13. C7 & T1 prominent base of neck Inferior angle of scapula in line with T7 & T8 Highest point iliac crest at L4 Curves Double S – lateral view cervical & lumbar are concave;(inward) Thoracic & sacrococcygeal are convex Intervertebral discs cushion the spine = shock absorber

14. Shoulder Articulation of humerus & glenoid fossa of scapula Ball & socket – enclosed by rotator cuff (4 muscles and tendons) Acromion process – bump at top of shoulder

15. Elbow Articulation humerus, radius, & ulna Landmarks are the Medial & lateral epicondyles of the humerus & large olecranon process of the ulna in between Sensitive ulnar nerve

16. Wrists and Carpals Wrist –articulation of radius & carpal bones Permits flexion, extension & side to side deviation Metacarpophalangeal & interphalangeal joints – permit finger flexion and extension

17. Hip Acetabulum & femur Ball & socket joint Weight bearing function Landmarks ( IM injections) Anterior, superior iliac crest Ischial tuberosity ( ↓ gluteus maximus, flex hip) Greater trochanter of femur

18. Knee Femur, tibia & patella Largest joint Hinged joint & largest synovial membrane 2 cartilages – medial & lateral menisci cushion the tibia & femur

19. Ankle & Foot Ankle joint is the articulation of Tibia, fibula & talus Hinged joint Dorsiflexion Plantar flexion Landmarks Medial & lateral malleolus

20. Aging adult Loss of bone density = osteoporosis Postural changes ↓ height due to shortening of the vertebral column

21. Subjective Data Joints Pain Stiffness Swelling, heat, redness Muscles Pain, cramps weakness

22. Subjective Data Bones Pain Deformity Trauma Functional Assessment ( ADL’s ) Self – care behaviors

23. Objective Assessment Physical Exam Musculoskeletal Purpose To assess function for ADL’s Screen for abnormalities

24. Screening Exams Inspection Palpation ROM with movement active or passive if apparent limitations Age Specific

25. Important to : Client comfort Systemic approach Support joints Bilateral exam

26. Equipment Tape measure Goniometer Skin marking pen

27. Inspection Size & contour of joint Color, swelling, masses, deformity

28. Palpation Each joint Temperature Muscles Bony articulations joint capsule Tenderness, swelling, masses

29. ROM Active ROM Limitation – try passive motion or in ROM, use a goniometer to measure angles

30. Muscle Testing Repeat movements for Active ROM Client flexes & holds against opposing force = bilaterally, resists opposing force

31. Grade muscle strength (pg. 616) Values 0- 5 Grade 5= Normal –Full ROM against gravity, full resistance

33. TMJ Swelling, tenderness, crepitation Crepitation = audible & palpable crunching or grating with movement

34. Cervical Spine Inspection Head & neck alignment Spine Palpation Spinous processes, Trapezius, Paravertebral muscles ROM, flexion, extension, hyperextension, lateral flexion, rotation, circumduction Repeat applying opposing force

35. Shoulders Inspect Bilateral comparison Palpate Bilaterally for muscle spasms, atrophy, swelling, heat, tenderness Clavicle to acromioclavicular joint, scapula, greater tubercle of humerus, subacromal bursa, biceps groove & anterior aspect glenohumeral joint

36. Test for Shoulder ROM Flexion Extension Internal rotation External rotation Abduction Adduction Circumduction Test for strength; shrug shoulders, flex forward, up & abduct against resistance

37. Elbow Inspect Size & contour with flexion, extension Deformity, redness, swelling Olecranon bursa Palpate Flexed 70 degrees Olecranon process, medial & lateral epicondyles of humerus Olecronon bursa for heat, swelling, tenderness, nodules

38. ROM of Elbow Flexion Extension pronation supination

39. Muscle Strength of Elbow Flex elbow – then extend against resistance applied just proximal to the wrist

40. Wrist and Hand Inspect Palmar & dorsal surface Position, contour and shape Swelling, redness, deformity or nodules

41. Wrist and Hand Palpate Wrist and hand joints Support hand, use both thumbs to palpate Metacarpophanlangeal joints Use thumb and index finger in a pinching motion to palpate interphalangeal joints

42. ROM of Wrists and Hands Hyperextension Palmar flexion Flexion of fingers Abduction for fingers Opposition Ulnar deviation, Radial deviation

43. Muscle Strength for Wrist and Hands Flex wrist against palm resistance 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 Tinel’s Sign – direct percussion @ median nerve of wrist. In carpel tunnel + result = burning & tingling

44. Hip Inspect hip joint with spine when client is standing Client is supine, palpate the hip joints ROM

45. Knee Supine with legs extended ( knees can be flexed or dangling for inspection) Swelling = ? Soft tissue or ↑ fld in the joint Bulge Sign – stroke up medial aspect 2-3x. Tap lateral aspect. Watch for a bulge in the medial hollow. Ballottement of the Patella – lger amt of flds

46. Ankle & foot Inspect while nonweight- bearing, then standing & walking ROM Muscle strength

47. Spine Standing Inspect Palpate spinous processes ROM of spine is checked by asking to touch toes

48. Leg measurement True leg length = measure b/t fixed points, the anterior iliac spine cross the medial side of the knee to the medial malleolus