musculoskeletal system

Assessment of the
Musculoskeletal
system

Maria Carmela L. Domocmat, RN, MSN
Instructor, Nursing Health Assessment
School of Nursing
Northern Luzon Adventist College

TMJ


• Inspect and palpate the TMJ
• Test ROM
• Test CN V function

Overview

o normal finding:
jaws move laterally 1 to 2 cm
(+) snapping and clicking – may be felt and heard
mouth opens 1-2 inches (distance bet upper and lower teeth)
jaw protrudes and retracts easily
o abnormal finding:
decreased ROM, swelling, tenderness, crepitus – arthritis
decreased muscle strength – muscle and joint dse
decreased ROM, clicking, popping, grating sound – TMJ
dysfunction

Inspect and palpate the TMJ

TMJ palpation

Test ROM

Test CN V function
– contract temporal and masseter
muscle

o normal finding:
full ROM against contraction
contraction palpated with no pain or spasms
o abnormal finding:
lack of full contraction – CN V lesion
Pain or spasms – myofacial pain syndrome

ROM & CN V function

Sternoclavicular joint


• Inspection and palpation
o normal finding:
no visible bony growth, swelling, redness
joint – nontender
o abnormal finding:
swollen, red, enlarged joint or tender
painful joint – joint inflammation

Sternoclavicular joint

http://www.orthoandsportspt.com/media/img/1076/shoulder_anato
my_bones03.jpg

Cervical, Thoracic and Lumbar Spine

o normal finding:
cervical and lumbar spines – concave
thoracic spine – convex
spine –straight; 24 vertebrae
African Americans – large gluteal prominence
– spine appear lumbar lordosis
variation number of vertebrae
•Afr Ame women – 23 vertebrae
•Eskimo, Indian women – 25 vertebrae
Observe the cervical, thoracic, and
lumbar curves from side then from
behind

http://parentingteens.about.com/libr
ary/graphics/normalspine.gif Maria Carmela L. Domocmat, RN, MSN

o abnormal finding:
flattened lumbar curvature – herniated lumbar
disc, ankylosing spondylitis
scoliosis - lateral curvature of thoracic spine
with increase in convexity on curved side
lordosis – exaggerated lumbar curve;
pregnancy, obesity
kyphosis – rounded thoracic convexity
Observe the cervical, –thoracic, lengths
unequal heights of hips unequal leg and

lumbar curves from side then from
behind

.


.
-.


http://www.s-
o.k12.ia.us/teacher_web/wedgem/Sites/ANATOMY/SKELETAL%2
0SY/Axial%20Skeleton.html

Palpate spinous processes and the
paravertebral muscles on both sides of the
spine for tenderness or pain


paravertebral muscles

o normal finding:
nontender spinous processes
well-developed firm and smooth, nontender
paravertebral muscles
no muscle spasms


o abnormal finding:
pain and tenderness of spinal processes and
paravertebral muscles – compression
fractures, lumbosacral muscle strain


o flexion – touch chin; hyperextension –
look up
o lateral bending – touch ear
o rotation
o repeat all against resistance

Test ROM of cervical spine

o normal finding:
flexion - 450; extension - 450
rotation -700
full ROM against resistance


pain and tenderness of spinal processes and
paravertebral muscles compression fractures ad
lumbosacral muscle strain
cervical strain
• impaired ROM and neck pain – form abnormalities soft tissue
(muscles, ligaments, nerves) – due straining or injuring neck
(i.e, sleeping in wrong position, carrying heavy suitcase,
automobile crash)
impaired ROM, pain that radiates to back, shoulder,
arms - cervical disc degenerative dse, spinal cord tumors
neck pain with loss of sensation in legs – cervical spinal
cord compression
impaired ROM, neck pain assoc with fever, chills,
headache – serious infection (e.g., meningitis)

abnormal finding Maria Carmela L. Domocmat, RN, MSN

o flexion – bendforward, touch toes
o lateral bending
o hyperextension
o rotation

Test ROM of thoracic and lumbar
spine

o normal finding:
flexion – 750- 900
smooth movement, lumbar concavity
flattens out, spine remains straight
lateral bending - 350
hyperextension - 300
rotation - 300


o abnormal finding:
lateral curvature disappears- functional scoliosis
unilateral exaggerated thoracic convexity – structural
scoliosis
impaired ROM, pain lumbar and thoracic regions -
low back strain from injury to soft tissues
impaired ROM lumbar and thoracic regions –
osteoarthritis, ankylosing spondylitis, congenital
abnormalities


◦ Lasègue’s test
o Or straight leg raising
o if (+) low back pain that radiates down the back
o to check for herniated nucleus pulposus

o client lie flat and raise each relaxed leg independently to
point of pain
o at point of pain – dorsiflex foot
o note degree of elevation when pain occurs; distribution
and character of pain, results from dorsiflexion

Test for back and leg pain

Lasègue’s test


o normal finding:
able to raise leg to 90 degree angle
mild pain of hamstring


o abnormal finding:
pain that shoots and radiates down one or both
legs (sciatica) below the knees – herniated
intervertebral disc
continuous, aching pain at night not relieved by
rest – metastases
lower back pain with tenderness and limited
ROM – osteoporosis


o leg lengths - if suspect client has 1 leg longer
distance from anterior superior iliac spine and
medial malleolus; cross tape on medial side of
knee
o if still look unequal – assess apparent leg
lengths
measure from nonfixed point (umbilicus) to a
fixed point (medial malleolus) each leg

Measure leg length

o normal finding:
equal or within 1 cm

o abnormal finding:
unequal leg lengths – scoliosis
equal true leg lengths but unequal apparent leg
lengths – abnormalities in structure or position
of hips and pelvis


Shoulders, Arms, and Elbows

o normal finding:
shoulders –symmetrically round, no redness,
swelling, deformity or heat, no tenderness
muscles -fully developed
clavicle and scapulae – even and symmetric

Inspect and palpate shoulders and
arms

.

Range Of Motion


o abnormal finding:
flat, hollow, less rounded shoulders –
dislocation
muscle atrophy – nerve or muscle damage or
lack of use
tenderness, swelling, heat – shoulder stains,
sprains, arthritis, bursitis, degenerative joint dse


o flexion – move arms forward elbows straight ;
hyperextension – move arms backward
o adduction – hands front of body past midline ;
abduction – hands together overhead
o external rotation – hands together behind head,
elbows flexed ;
internal rotation – behind back
o shrug shoulders

Test ROM

o normal finding:
flexion - 1800 ; hyperextension - 500
adduction - 500 ; abduction - 1800
external and internal rotation - 900


o abnormal finding:
painful and limited abduction, muscle weakness &
atrophy – rotator cuff tear
sharp catches of pain when bringing hands overhead –
rotator cuff tendinitis
chronic pain and severe limitation of all shoulder
motions – calcified tendinitis
unable shrug shoulders against resistance - lesion of CN
XI
decreased muscle strength against resistance – muscle
and joint dse


Elbows

• Inspect for size, shape, deformities, redness, or
swelling
o elbows flex and extended
o elbows relaxed and flexed abt 700 – palpate
olecranon process and epicondyles use
thumb and middle fingers

Inspect for size, shape,
deformities, redness, or swelling

o normal finding:
symmetric, without deformity, redness,
swelling
nontender, without nodules


Elbow Palpation


o abnormal finding:
redness, heat, swelling- bursitis of olecranon
process- trauma or arthritis
firm, nontender, subq nodules – rheumatoid
arthritis or rheumatic fever
tenderness or pain over epicondyles –
epicondylitis (tennis elbow) – repetitive
movements of forearm or wrists


o flexion – flex elbow, bring hand to
forehead
o extension – straighten elbow
o pronation – arm out, turn palm down
o supination – turn palm up

Test ROM

o normal finding:
flexion – 1600
extension – 900
pronation – 900
supination – 900
some – lack 5 to 10 0 ; or have
hyperextension


o abnormal finding:
decreased muscle strength against resistance
– muscle and joint dse


Wrists

o palpate anatomic snuffbox
o hollow area on back of wrist at base of fully
extended thumb

o normal finding:
symmetric without redness, swelling
nontender, free of nodules
no tenderness anatomic snuffbox

Inspect and palpate

1. Maintain wrist
flexion while you
try to extend the
wrist.
2. Try to extend
the wrist as you
try to flex it
To assess wrist strength

o abnormal finding:
rheumatoid arthritis – swelling, tenderness,
nodules
ganglion - nontender, round, enlarged,
swollen, fluid-filled cyst ; dorsum of wrist
snuffbox tenderness – scaphoid fracture –
result of falling on outstretched hand


The scaphoid bone is a carpal bone
near the base of the thumb. The
carpal bones connect the two bones
of the forearm, the radius and
the ulna, to the bones of the hand.
Themetacarpal bones are the long
bones that lie underneath the palm.


the metacarpals attach to the phalanges, which are
the bones in the fingers and thumb.
One reason that the wrist is so complicated is
because every small bone forms a joint with the
bone next to it.
This means that what we call the wrist joint is
actually made up of many small joints. Ligaments
connect all the small bones to each other, and to
the radius, ulna, and metacarpal bones.
The scaphoid bone is a small carpal bone on the
thumb side (radial side) of the wrist. It is the most
commonly fractured carpal bone.


The wrist is made up of eight
separate small bones, called the
carpal bones


ganglion

scaphoid fracture

The scaphoid is a
small bone located
on the thumb side
of your wrist. It is
the most commonly
broken bone in the
wrist. Because
symptoms can be
minimal, scaphoid
fractures are
frequently mistaken
as sprained
wrists. Scaphoid
fractures require
casting or surgery.

scaphoid fracture
http://www.vermontorthoclinic-
edu.org/tabid/14407/mid/24836/ContentPubID/108/ContentClassificationGroupID/- Maria Carmela L. Domocmat, RN, MSN
1/ViewIndex/0/Default.aspx

o flexion – bend down ; extension – bend
back
o deviation – client hold wrist straight;
move hand outward and inward

Test ROM

Range Of Motion
Wrists, Hands, and Fingers.

o normal finding:
flexion - 90 0
ulnar deviation - 55 0
radial deviation - 200
Swedes, Chinese – unequal lengths of ulna and
radius


o abnormal finding:
ulnar deviation of wrist and fingers with limited
ROM – rheumatoid arthritis
epicondylitis of lateral side of elbow– increased pain
with extension of wrist and fingers against resistance
epicondylitis of medial side of elbow– increased
pain with flexion of wrist and fingers against
resistance
decreased muscle strength against resistance –
muscle and joint dse


◦ Phalen’s test
◦ Tinel’s sign

Test for Carpal Tunnel Syndrome

Progressive sensory changes including paresthesias
and numbness of the thumb, index finger, and ring
finger of the involved hand; leads to pain waking
the patient up at night.
Motor changes beginning with clumsiness and
progressing to weakness; edema and thenar
atrophy may be noted.
Positive Tinel’s sign: Increased paresthesias on
tapping of tendon sheath (ventral surface of central
wrist).
Positive Phalen test: Increased symptoms with
acute palmar flexion for 1 minute.

Carpal Tunnel Syndrome

http://www.rnpedia.com/home/notes
/medical-surgical-nursing- Maria Carmela L. Domocmat, RN, MSN

notes/carpal-tunnel-syndrome

place backs of both hand against each
other while flexing wrists 900 downward
hold for 60 sec

Phalen’s test

In the first of these
tests, for 1 minute.
The experience of
numbness and
paresthesia over the
palmar surface of the
hand and the first
three fingers and part
of the fourth is called
Phalen’s sign. The
symptoms resolve
quickly after the hand
returns to the resting
Phalen’s test
position.

tapping over the median nerve
(palmar aspect of wrist).
The client’s sensation of tingling or
prickling is known as Tinel’s sign.

Tinel’s sign

http://www.rnpedia.com/home/notes/medical-surgical- Maria Carmela L. Domocmat, RN, MSN
nursing-notes/carpal-tunnel-syndrome

o normal finding:
no tingling, numbness, pain
o abnormal finding:
(+)tingling, numbness, pain – (+) carpal tunnel
syndrome
numbness, pain , impaired function of hand
and fingers - median nerve entrapped in carpal
tunnel


Hands and Fingers

o normal finding:
symmetric, nontender, without nodules
fingers – lie in straight line
no swelling, deformities
rounded protuberance – next to thumb over
thenar prominence
smaller protuberance adjacent small finger

Inspect and palpate

Palpate the joints
between the carpal, meta-
carpal, and phalangeal
bones.
Use your thumbs and index
fingers to palpate each of
these joints.

Interphalangeal joints
Metacarpophalangeal joints
Radiocarpal groove and
wrist

ask the client to
squeeze your first
two fingers as hard
as he or she can.
If you cross your
fingers, you will not
feel as much
discomfort if the
client is exceptionally
To assess grip
strong. strength

o abnormal finding:
swollen, stiff, tender finger joints – acute rheumatoid
arthritis
boutonnière deformity – flexion of proximal
interphalangeal joint and hyperextension of distal
interphalangeal joint
swan-neck deformity - hyperextension of proximal
interphalangeal joint with flexion of distal interphalangeal
joint


swan-neck deformity boutonnière deformity


o abnormal finding:
thenar atrophy (atrophy thenar prominence) – carpal tunnel
syndrome
osteoarthritis
• Heberden’s nodes - hard, painless nodules over distal
interphalangeal joints
• Bouchard’s nodes - hard, painless nodules over proximal
interphalangeal joints


thenar atrophy


o abduction – spread fingers apart ; adduction
– make a fist
o flexion – bend fingers down ; hyperextension
– bend up
o thumb abduction - move thumb away; thumb
adduction – touch thumb base of sml finger

Test ROM

http://www.ncbi.nlm.nih.gov/books/N
BK27290/bin/ch4f4-57.jpg

ROM
http://www.tpub.com/content/armymedical/MD0556/MD05560063i Maria Carmela L. Domocmat, RN, MSN
m.jpg

1. Extend the fingers while you push down on the
dorsal surface
2. Flex the fingers while you push up on the
ventral surface.
3. Spread the fingers as far apart as possible
while you try to push them together.
4. Push the fingers as close together as possible
while you try to pull them apart.

To assess finger strength

http://www.nlm.nih.gov/medlineplus/
ency/images/ency/fullsize/9423.jpgCarmela L. Domocmat, RN, MSN
Maria

http://www.heatedmouse.info/upload
ed_images/hand_finger_joint_causes
01-722880.jpg

o normal finding:
abduction - 20 0
adduction - 900
flexion - 900
thumb flexion/adduction- 500


o abnormal finding:
Dupuytren’s contracture – inability to
extend ring and little fingers
tenosynovitis (infection of flexor tendon
sheathes) - painful extension of finger


Dupuytren’s contracture
http://advanceddynamic.com/Injuries-Conditions/Hand/Hand-Issues/Dupuytren-s-
Contracture/a~285/article.html
http://www.med.und.edu/users/jwhiting/dupdef.html

It is a very common problem and often arises in
the hands of middle aged persons; however, it can
be seen as early as the twenties. This entity does
run in families in some cases. It is seven times
more common in men than women. It has been
associated with diabetes and can be seen in
alcoholics with cirrhosis of the liver. It has also
been associated with epilepsy but may be a result
of the use of anticonvulsant drugs rather than the
presence of epilepsy itself. The underlying cause is
unknown.

Dupuytren’s contracture
http://advanceddynamic.com/Injuries-Conditions/Hand/Hand-Issues/Dupuytren-s-
Contracture/a~285/article.html
http://www.med.und.edu/users/jwhiting/dupdef.html

o abnormal finding:
Tenosynovitis
infection of flexor tendon sheathes
painful extension of finger


When a tendon (a fibrous, non-elastic band of
tissue which attaches a muscle to a bone) and its
surrounding soft tissue (called the tenosynovium)
are injured—either by a direct injury or due to
micro-trauma like excessive repetitive
movements—they become inflamed, swollen, and
painful. This condition is called Tenosynovitis. (A
less accurate and rarely used term to describe this
condition is tendonitis.)
While all of the tendons of the wrist and hand may
become inflamed and painful, the most common
form of tenosynovitis seen in the hand and wrist is
called deQuervain's Tenosynovitis. deQuervain's
Tenosynovitis affects the thumb and wrist.

http://www.ourhealthnetwork.com/conditions/hand/deQuervains
Tenosynovitis.asp Maria Carmela L. Domocmat, RN, MSN

affects two thumb tendons: the abductor pollicis
longus (APL) and the extensor pollicis brevis (EPB).
These tendons connect their respective muscles,
which lie on the back of the forearm, to the thumb.
These tendons are responsible for extending the
thumb backwards, and for moving the thumb away
from the palm of the hand.
On their way to the thumb, the APL and EPB travel
side-by-side along the inside of the wrist. They
pass through a tunnel in the wrist which is covered
by a non-elastic type of fibrous tissue called the
Extensor Retinaculum. The function of this tunnel is
to hold the tendons in place.

deQuervain's
Tenosynovitis

Pathology: Normally, the APL and EPB glide
easily back and forth within this tunnel as they
move the thumb. When the APL and EPB
become inflamed and swollen, however, the
tendons become compressed against each
other because the Extensor Retinaculum (the
non-elastic band of tissue that covers the
tunnel) cannot expand to "make more room for
the swollen tendons." This leads to restricted
and painful tendon and thumb movements.


Hips

• Inspect and palpate
o stand
o normal finding:
buttocks – equally sized
iliac crests – symmetric height
hips – stable, nontender, without crepitus


o abnormal finding:
instability, inability to stand, and/or
deformed hip area – fractured hip
tenderness, edema, decreased ROM,
crepitus – hip inflammation, degenerative jt
dse


o supine
o hip flexion
flexion with knees straight - raise extended leg
flexion with knee flexed - flex knee to chest;
keep other leg extended
Note: if had total hip replacement – do not test
ROM unless physician gives permission; reduce
risk of dislocating prosthesis

Test ROM

o abduction – move extended leg away from
midline of body as far as possible ; adduction –
toward midline of body as far as possible
o internal/ external hip rotation – bend knee and
turn leg inward then outward
o hyperextension – prone, lift extended leg off
table ; or client stand and swing extended leg
backward


http://www.aidmypain.com/muscle/groin-anatomy.php Maria Carmela L. Domocmat, RN, MSN

o normal finding:
flexion with knees straight – 900
flexion with knee flexed -1200
abduction – 45-500 ; adduction – 20 to 300
internal hip rotation - 400 ; external hip rotation -
450


o abnormal finding:
inability to abduct hip – hip dse
pain, decrease internal hip rotation –
osteoarthritis, femoral neck stress fracture
pain or palpation of greater trochanter; pain as
client moves from standing to lying down –
bursitis of hip


evaluates flexion contractures of the
hip
With the client in the supine position,
ask the client to pull one knee up
toward the chest as far as possible.
Approximate the extent of the flexion
contracture by noting the degree of
flexion of the opposite leg (the angle
between the client’s leg and the
table).

Thomas test

normal finding:
◦ when the hip is flexed, the opposite
leg remains flat on the examination
table
abnormal finding
◦ for the individual with an immobile
hip, the opposite hip and leg flex in
response to flexion of the leg.

Thomas test

Knees


• Supine, sitting
• Inspect size, shape, symmetry, swelling, deformities,
alignment, qudricep muscle atropy
• Palpate tenderness, warmth, consistency, nodules
o begin 10 cm above patella
o use fingers and thumb to move downward
the knee


Knee palpation

http://www.sciencephoto.com/image/265069/350wm/M3301436-Swollen_knee-
SPL.jpg


http://www.marvistavet.com/assets/i
mages/knee_meniscus_model.gif


o indication: if (+) swelling to determine cause
of swelling (if due to accumulation of fluid or
soft tissue swelling)
o helps detect small amts of fluid in knee
o client supine – use ball of your hand firmly to
stroke the medial side of knee upward, 3-4x –
to displace any accumulated fluid
o then press lateral side of knee
o look for bulge on medial side of knee

Bulge test

A test for small effusions in the knee joint is
called the bulge sign.
Take the ball of your hand and firmly milk the
medial aspect of the knee upward two to three
times to displace fluid
Then press or tap behind the lateral margin of
the knee.
A positive bulge sign will show a swelling or
bulge of fluid in the hollow area medial to the
patella.
The bulge sign is useful for assessing small
effusions, but
It may be absent in large effusions.

Bulge sign

http://www.hipandkneeadvice.com/index.php/knee-procedures/


1. Quadriceps Tendon
2. Patella
3. Patellar Tendon
4. Tibia
5. Fibula
6. Posterior Cruciate Ligament
7. Anterior Cruciate Ligament
8. Lateral Collateral Ligament
9. Lateral Meniscus
10. Lateral Femoral Condyle
11. Femur

http://www.hipandkneeadvice.com/wp-
content/uploads/2009/07/pic_knee_anatomy__big1.jpg


http://www.trialsightmedia.com/exhibit_store/images/kneeanatomy.jpg Maria Carmela L. Domocmat, RN, MSN

http://static.howstuffworks.com/gif/adam/images/en/knee-arthroscopy-normal-
anatomy-picture.jpg Maria Carmela L. Domocmat, RN, MSN

http://www.healthscout.com/common/images/8/8716_11265_5.jpg


The ligaments which attach the upper leg bone
(femur) to the large lower leg bone (tibia)
create a hinge joint called the knee. The
anterior and posterior cruciate ligaments are 2
short, strong ligaments which criss-cross each
other in the middle of the joint.


o normal finding:
no bulge of fluid appears on medial side of
knee
o abnormal finding:
bulge of fluid on medial side; with sml amt
of joint effusion

Bulge test

When considerable fluid is present in the
suprapatellar pouch, ballottement of the
patella may be possible.
Ballottement involves applying downward
pressure with one hand while pushing the
patella backward against the femur with a
finger of the opposite hand. Examine the
popliteal region with the client in the
prone position or while standing.
Swelling of the joint in the region, which
is called Baker’s cyst, is generally an
extension of the articular cavity.

Ballottement of the
patella

o helps detect large amts of fluid in knee
o client supine
o firmly press nondominant thumb and index
finger on each side of patella
this displaces fluid in suprapatellar bursa located
between femur and patella
o with dominant fingers – push patella down on
femur
o feel fluid wave or a click


o normal finding:
no movement of patella
patella rests firmly over femur
o abnormal finding:
(+) ballottement test – meniscal tears
(+) fluid wave or click – large amts of joint
effusion


o as compress the patella –
slide it distally against
the underlying femur
o normal finding:
no pain
crepitus may be present
o abnormal finding:
(+) pain and crepitus -
patellofemoral disorder

Palpate tibiofemoral space

o flexion
o extension
o hyperextension
o full ROM against resistance

Test ROM

o normal finding:
flexion – 1200 to 1300
extension - 00
full ROM against resistance


o abnormal finding:
decreased ROM with synovial thickening –
osteoarthritis
inability to extend knee fully - flexion
contractures


. To test range of motion of the
knee, ask the client to do the
following:
Straighten and stretch the leg.
Bend the knee.

Range of Motion

To test muscle strength in the
knee, ask the client to do the
following:
Extend the leg as you try to bend
it (quadriceps muscle strength)
Bend the knees as you try to
straighten them(hamstring
muscle strength)

Muscle Strength

McMurray’s test

Test pain and injury

if complains of a “giving in” or “locking” of knee

supine; flex one knee and hip
place your thumb and index finger on 1 hand on
either side of knee
other hand – hold heel of foot up
rotate lower leg and foot laterally
slowly extend knee – note pain or clicking
repeat – rotate leg medially

McMurray’s test

http://3.bp.blogspot.com/_ZWqgYBROGHw/TQx2wAOhcaI/AAAAAAAACAQ/OkboYJC8
Zfk/s1600/p4a04203.jpg

http://www.theshoulderdoc.com/content/assets/mcmurray.gi
f

o normal finding:
no pain or clicking
o abnormal finding:
(+) pain, clicking – torn meniscus of knee


Ankles and Feet

client sit, stand, walk: inspect position,
alignment, shape skin


o normal finding:
toes
• usually point forward and lie flat
• may point in – pes varus
• may point out – pes valgus
toes and feet – in alignment with lower leg
smooth, rounded medial malleolar prominences with
prominent heels and metatarsophalangeal joints
skin – smooth, free of corns and calluses
longitudinal arh – most of weight bearing is on foot
midline


o abnormal finding:
hallux valgus – laterally deviated great toe; possible overlapping of
2nd toe; formation enlarged, painful, inflamed bursa (bunion) on
medial side
pes planus or flat feet – feet with no arches
pes cavus – feet with high arches
corns – painful thickening of skin over bony prominences and at
pressure points
calluses – nonpainful thickened skin that occurs at pressure points
verruca vulgaris- painful warts
plantar warts – warts under a callus; appear as tiny dark spots
hammer toe – hyperextension at metatarsophalangeal joint with
flexion at proximal interphalangeal joint; common 2nd toe


hallux valgus
http://www.rucosm.com/IMAGES/foot1.jpg

pes planus or flat feet
http://www.eorthopod.com/images/ContentImages/child/child_foot_flatfoot_congeni
tal/child_flatfoot_causes01.jpg

pes cavus

Corns are areas of thick, hardened, dead skin. They form to protect the skin and structures
under the skin from pressure, friction, and injury. They may look grayish or yellowish, be less
sensitive to the touch than surrounding skin, and feel bumpy.

Corns
Corns are usually found where toes rub together. A soft corn is found between toes (usually
between the fourth and fifth toes), while a hard corn is often found over a bony part of a toe
(usually on the fifth toe).

http://images.rxlist.com/images/SlideShow/diabetes_foot_probl
ems_s8_corns.jpg

calluses

Corns and calluses form on the skin because of repeated pressure
or friction. A corn is a small, tender area of thickened skin that
occurs on the top or side of a toe. A callus is a rough, thickened
area of skin that appears because of repeated irritation or
Corns & callues
pressure to an area of skin. Calluses usually develop on the palms
of the hand and soles of the feet.

http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/19657.jpg

Warts, also called verrucae, are small benign growths usually
caused by a viral infection of the skin or mucous membrane. The
virus infects the surface layer of skin. The viruses that cause
warts are members of the human papilloma virus (HPV) family, of
which there are many different strains. Warts are not cancerous
but some strains of HPV, usually not associated with warts, have
been linked with cancer formation. Warts are contagious from
person to person and from one area of the body to another on
the same person.
verruca vulgaris

plantar warts

hammertoes are a contracture of the toes as a result of a muscle
imbalance between the tendons on the top and the tendons on
the bottom of the toe.
Hammer toe is a condition where a toe bends downward like a
claw. You can be born with hammer toe or develop it from
wearing short, narrow shoes. Symptoms of hammer toe include
foot pain, calluses on the sole of the foot, or corns on the top of
the toe. Treatment of mild cases and cases in children can include
foot manipulation and splinting of the toe. More severe cases may
need surgery to straighten the toe joint.

http://0.tqn.com/f/p/440/graphics/images/en/9360.jpg

http://images.rxlist.com/images/SlideShow/diabetes_foot_problems_s8_corns.jpg

A hammertoe is a toe that is bent because of a weakened muscle. The weakened muscle makes the tendons (tissues that
connect muscles to bone) shorter, causing the toes to curl under the feet. Hammertoes can run in families. They can also
be caused by shoes that are too short. Hammertoes can cause problems with walking and can lead to other foot problems,

hammer toe
such as blisters, calluses, and sores. Splinting and corrective footwear can help in treating hammertoes. In severe cases,
surgery to straighten the toe may be necessary.


http://feetdoc.com/hammer_toes.ht Maria Carmela L. Domocmat, RN, MSN
m

o normal finding:
no tenderness, heat, swelling, nodules
o abnormal finding:
gouty arthritis- tender, painful, reddened, hot, swollen
metatarsophalangeal joint of great toe
rheumatoid arthritis – nodules of posterior ankle
pain and tenderness metatarsophalangeal joints –
inflammation of joints, rheumatoid arthritis,
degenerative joint dse
plantar fasciitis – tenderness of calcaneus of bottom of
foot

palpate tenderness, heat, swelling,
nodules

o dorsiflexion – point toes upward ;
plantar flexion –downward
o eversion – turn soles outward;
inversion – inward
o abduction – rotate foot outward ;
adduction – inward
o flexion – turn toes under foot ;
extension – upward
o repeat all with resistance

Test ROM

http://t2.gstatic.com/images?q=tbn:ANd9GcTUKOyFEo1NWEb03sa5NBCCpyzzUwyt4 Maria Carmela L. Domocmat, RN, MSN
C8d61SUoBwq6OQqhHMX8g

o abduction– rotate foot outward ;
adduction – inward


o normal finding:
200 dorsiflexion ankle and foot; 45 0 plantar
flexion
200 eversion; 300 inversion
100 abduction; 200 adduction
400 flexion; 400 extension


o abnormal finding:
decreased ROM without or against
resistance – muscle and joint dse
hammer toe – hyperextension of
metatarsophalangeal joint and flexion of
proximal interphalangeal joint


musculoskeletal system

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