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NurseReview.Org - Muscoloskeletal System

http://NurseReview.Org Muscoloskeletal System

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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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