Musculoskeletal HA Exam #4

support to stand erect
movement
encase and protect inner vital organs (ribs)
produce RCB, WBC, and platelets
reservoir for storage of essential minerals (Vitamin D)

Fibrous
Cartilaginous
Synovial

united by interjacent fibrous tissue or cartilage
immovable

skull -> head injury with swelling, remove bone

separated by fibrocartilaginous discs
only slightly moveable

spine

freely moveable, bones are separated from another

knee
shoulder
hip
fingers
elbow

covers surface of opposing bone
protective cushing

fibrous bands running directly from one bone to another bone
liggy liggy bone bone

attach muscle to bone

enclosed sac filled with synovial fluid

contraction produces movement

composed of muscle fibers (fasciculi) and tendon (attaches muscle to bone)

flex muscles
stretch out

aliens away
add / bring to the body

hand flat palms down
hands up holding bowl of soup

circle around like a pitcher

into middle of body
leaving body
feet

twisting wrist around
shaking head no

chin forward
chin backward

shrug shoulder up and down

side to side with wrist

pain -> worse in the morning or after moving all day, timing is important, unilateral or bilateral
stiffness
swelling, heat, and redness
limitation of movement (document in degrees) if can normally do splits but can't move leg 45 degree

Pain (cramps)
Weakness

Pain
Deformity (stuck like that)
Accidents or trauma (document all history)

something that you do that is part of every day living
Activity of Daily Living

environmental exposure
exercise programs
weight fluctuations

Does the pt have limitations on:
bathing
toileting
dressing
grooming
eating
mobility (unable to get out of bed on own)
communicating

assess function for ADLs and to screen for abnormalities
screening exam is adequate for most patients

if have a history of musculoskeletal issues
appropriate for persons with articular disease, history of musculoskeletal symptoms, or any problems with ADLS

Inspect bilaterally
Palpation
ROM
Muscle Strength Testing = applying opposing force to see if strength difference

ask for Active ROM if patient able to move independently
if patient unable to move independently, perform passive ROM
do not take joint beyond the point of comfort

equal bilaterally and oppose force

reduction in normal distance and direction through which a joint can move
when a joint does not move fully and easily in its normal manner it is considered to have a limited range of motion
can still move but painful = document as limited ROM

temporomandibular joint

area just anterior to ear

open and close mouth
note smooth motion of mandible
audible and palpable snap and click occurs in many normal people as mouth opens

mechanical soft diet
get mouth guard for grinding teeth at night

alignment of head and neck
spine straight, head erect

spinous process and sternomastoid, trapezius, paravertebral muscles
should be firm, no muscle spasm or tenderness

ROM = cup one hand over shoulder to note any crepitus
Muscle Strength = shrug shoulders against resistance

Stabilize arm with one hand
Flex elbow against your resistance applied just proximal to wrist

Inspect hands and wrists
Palpate each joint in wrist and hands
Palpate metacarpophalangeal joints with each thumb
Palpate sides of interphalangeal joints

Forearm supinated
Stabilize
Ask person to flex wrist against resistance at palm

Hold both hands back-to-back while flexing wrist 90 degrees
Acute flexion for 60 seconds produces no symptoms (normal)
Numbeness and burning in carpal tunnel

Direct percussion of median nerve at wrist (tapping wrist)
No symptoms (normal)
Burning and tingling in Carpal Tunnel

Inspection
Palpation
ROM
Muscle Strength

ask person to maintain dorsiflexion and plantar flexion against your resistance

spine straight?
note normal convex thoracic and concave lumbar curve

spinous processes

abnormal gait-one leg higher than other
shoulder higher than other

bottom of the butt