Term
| Components of musculoskeletal system |
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Definition
bones
muscle
ligaments
tendons
cartilage
joints |
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Term
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Definition
| moving a body part away from the midline (jumping jacks - first move) |
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Term
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Definition
| moving a body part toward the center or toward the median line (jumping jack - second move) |
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Term
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Definition
| immobility consolidation, and fixation of a joint because of disease, injury, or surgery; most often due to chronic rheumatoid arthritis |
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Term
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Definition
| inability to perform coordinated movements |
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Term
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Definition
| enclosed sac filled with synovial fluid located in the joint areas of potential friction; helps muscles and tendons glide over bone |
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Term
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Definition
| moving the arm in a circle around the shoulder |
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Term
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Definition
| dry crackling sound or sensation due to grating of the ends of damaged bone |
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Term
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Definition
| directed toward or located on the surface |
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Term
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Definition
| flexion contracture of the fingers due to chronic hyperplasia of the plantar fascia |
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Term
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Definition
| moving the sole of the foot outward at the ankle |
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Term
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Definition
| straightening a limb at a joint (point your toe) |
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Term
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Definition
| bending a limb at a joint (bending knee) |
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Term
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Definition
| round, cystic, nontender nodule overlying a tendon sheath or joint capsule, usually on dorsum of wrist |
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Term
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Definition
| round, cystic, nontender nodule overlying a tendon sheath or joint capsule, usually on dorsum of wrist |
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Term
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Definition
| lateral or outward deviation of the great toe |
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Term
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Definition
| moving the sole of the foot inward at the ankle |
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Term
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Definition
| outward or convex curvature of the thoracic spine; hunchback |
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Term
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Definition
| inward or concave curvature of the lumbar spine |
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Term
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Definition
| center of the intervertebral disk |
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Term
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Definition
| bony projection of the ulna at the elbow |
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Term
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Definition
| surface of the sole of the foot |
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Term
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Definition
| turning the forearm so the palm is down |
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Term
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Definition
| moving a body part forward adn parallel to the ground |
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Term
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Definition
| extent of movement of a joint |
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Term
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Definition
| moving a body part backward and parallel to the ground |
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Term
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Definition
| chronic systemic inflammatory disease of joints and surrounding connective tissue |
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Term
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Definition
| nerve pain along the course of the sciatic nerve that travels down from the back or thigh through the leg and in to the foot |
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Term
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Definition
| s-shaped curvature of the thoracic spine |
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Term
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Definition
| turning the forearm so the palm is up |
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Term
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Definition
| clubfoot - congenital deformity of the foot in which it is plantar flexed and inverted |
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Term
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Definition
| strong fibrous cord that attaches a skeletal muscle to a bone |
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Term
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Definition
| wryneck - contraction of the cervical neck muscles, producing torsion of the neck |
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Term
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Definition
provide support
protect tissues and organs |
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Term
| Principle organ of movement |
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Definition
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Term
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Definition
smooth: visceral, involuntary
cardiac
skeletal: striated, voluntary |
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Term
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Definition
connective tissue that join bones to one another
add strength and stability
allow movement |
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Term
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Definition
strong, dense bands of connective tissue at ends of muscles
attach muscles to periosteum
enable bones to move when skeletal muscles contract |
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Term
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Definition
gel-like supporting tissue at ends of bones
protects/supports bones during weight bearing activities |
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Term
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Definition
| area whee two surfaces of bone come together |
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Term
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Definition
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Term
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Definition
may be immovable (cranial sutures)
may be slightly movable (manubriosternal joint) |
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Term
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Definition
freely movable joint filled with synovial fluid and covered with cartilage (knee)
diathrotic are the most common joint |
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Term
| Types of joint movement (7) |
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Definition
flexion
extension
abduction
internal rotation
external rotation
circumduction |
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Term
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Definition
| turning of a body part inward toward the central axis (move head from left or right back to neutral) |
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Term
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Definition
| turning of a body part away from midline (move head to right or left) |
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Term
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Definition
| turning of a body part inward toward the central axis |
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Term
| Purpose of muscular skeletal system |
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Definition
1. support to stand erect
2. movement
3. encase and prtect the inner vital organs
4. produce red blood cells in bone marrow (hematopoiesis)
5. reservoir for storage of essential minerals (calcium and phosphorus) |
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Term
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Definition
hard, rigid and dense connective tissue
gives us support to stand and move
bones are able to remodel and turnover as needed |
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Term
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Definition
| the place of union of two or more bones - the functional unit of the musculoskeletal system as they permit the mobility needed for daily living |
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Term
| Musculoskeletal System Sequence of Exam |
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Definition
1. inspection
2. palpation
3. range of motion
4. muscle strength |
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Term
MS: Inspection
Normal finding |
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Definition
Normal:
joints and muscles symmetrical
no fasiculations
no deformities or masses
no swelling, edema
posture upright
gait smooth and even |
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Term
MS: General Inspection
What is involved in inspection of the joint |
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Definition
Symmetry:
Rheumatoid arthritis - typically involves several joints, symmetrical
osteoarthritis - typically involves one or two joints, asymmetrical
Gross Deformities
Heberdon & Bouchard nodes
ankylosis - stiffness or fixation of joint
Swelling - edema (fluid in joint)
Posture - patient favor one side or joint more than others? |
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Term
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Definition
pain/tenderness
swelling (may be evident only with palpation)
temperature
masses
crepitation |
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Term
MS: Palpation
Normal Findings |
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Definition
| no pain or tenderness, no swelling, no masses or crepitation |
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Term
MS: Range of Motion
Normal Findings |
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Definition
full, active ROM without pain
when palpating, may normally feel crepitations
active ROM should be about the same as passive
passive > active associated with muscle weakness or joint instability. Seen with tendonitis, bursitis |
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Term
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Definition
| After inspection and with range of motion test |
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Term
| How do you perform range of motion tests? |
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Definition
1. range of motion alone
2. range of motion with palpation |
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Term
| Why do we test range of motion prior to muscle strength? |
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Definition
| Muscle strength test have more marked contraction which may cause pain and skew ROM testing |
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Term
| Why might a patient have decreased ROM |
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Definition
pain
inflammation of tissues around joint
ankylosis
foreign body
fluid due to swelling |
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Term
| Why might a patient have increased range of motion |
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Definition
| hypermobility. May be benign or associated with ligament / fracture |
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Term
MS: Muscle Assessment
general |
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Definition
| assess muscle groups for coordination, pain and resistance to opposing force |
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Term
MS: Muscle Assessment
Normal Findings |
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Definition
Coordinated, painless
Greater in dominant arm and leg
May use scale to grade 0-5 (0 = no contraction)
may use descriptive terms: paralysis, severe weakness, moderate weakness |
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Term
MS: Muscle Assessment
Specific Muscle Assessment - when and how? |
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Definition
-used if general assessment is not normal
- muscle tone: N=firm (at rest)
- muscle mass: measure limbs at max circumference. difference of < 1cm not significant. dominant muscle usually greater
- length of extremities (if suspected asymmetrical) - measure between fixed points. anterior iliac spine to medial malleolus crossing medial side of knee |
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Term
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Definition
-repeat motions elicited for active ROM.
-flex and hold and opposing force is applied.
-should be bilaterally equal and should fully resist force |
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Term
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Definition
| just anterior to ear and parallel to external auditory meatus |
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Term
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Definition
Normal:
Open and close mouth: 3-6 cm between upper and lower incisors with mouth open
Project lower jaw: 1-2 cm deviation of lower lip
Move jaw side to side: 1-2 cm from midline of lower lip deviation |
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Term
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Definition
bite down while palpating masseter muscle
clench teeth while applying downward pressure on chin |
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Term
Sternoclavicular Joint
ROM |
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Definition
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Term
Sternoclavicular Joint
Landmarks |
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Definition
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Term
Sternoclavicular Joint
Muscle Strength |
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Definition
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Term
Cervical Spinal Joint
landmarks |
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Definition
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Term
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Definition
flexion - chin to chin
hyperextension - head back
lateral bending - ear to shoulder
rotation - turn head side to side |
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Term
Cervical Spinal Joint
Muscle strength |
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Definition
Rotation against resistance
flexion, hyperextension against resistance |
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Term
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Definition
| clavicle, acromium process of scapula, greater tubercle of humerus, coracoid process of scapula, acromioclavicular joint, glenoid fossa of scapula, glenohumeral joint |
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Term
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Definition
forward flexion
hyperextension
internal rotation
external rotation
abduction, adduction |
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Term
Shoulder Joint
muscle strength |
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Definition
deltoid: abduction against resistance
biceps: flexion against resistance
triceps: extension against resistance
trapezius: shrug shoulders against resistance |
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Term
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Definition
| medial and lateral epicondyles of humerus, olecranon process of ulna |
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Term
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Definition
flexion & extension
supination
pronation |
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Term
Elbow Joint
Muscle strength |
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Definition
| flexion and extension against resistance |
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Term
Wrist, hands, fingers Joints
landmarks |
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Definition
bony tips of radius & ulna
carpal bones
metacarpal bones
metocarpophalangeal joint
proximal interphalangeal joint
distan interphalengeal joint |
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Term
Wrist, hands, fingers Joints
Inspect and palpate |
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Definition
swelling of wrists most easily seen on dorsal aspect
asses for Bouchards (PIP) & Asses for Heberdons (DIP): hard, nontender nodules associated with OA
Palpate using two hands with patient's hand between thumb and index finger, palpate entire finger |
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Term
Wrist, hands, fingers Joints
ROM |
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Definition
-spread fingers apart (abduction) and back together again (adduction)
-touch thumb to each fingertip and base of little finger (finger flexion)
-bend fingers up (hyperextension) & down (flexion) at MCP joint
-bend hand up (extension) and down (flexion) at wrist
-turn hand to right and left (radial & ulner deviation) |
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Term
Wrist, hands, fingers Joints
Muscle strength |
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Definition
wrists: flexion and extension against resistance
fingers: flexion and extension against resistance; abduction and adductin against resistance
Also assess grip strength |
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Term
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Definition
greater trochanter of femur
iliac crest |
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Term
Hip Joint
Inspect and palpate (general) |
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Definition
-assess anterior and posterior while client stands
-assess for symmetry in iliac crest height, gluteal folds, buttocks
-assess gait and posture
-palate hips/pelvis for stability, tenderness, crepitus while supine
-palpate of hip joint - difficult |
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Term
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Definition
assess in supine, prone & standing depending on movement required
-hip flexion with leg extended (supine)
-hip hyperextension with knee extended prone or standing)
-hip flexion with knee flexed (supine)
Abduction (supine or standing)
Adduction (supine or standing)
Internal rotation (supine) - flex knee and rotate leg so flexed knee moves inward toward opposite leg
-external rotation (supine) - place side of foot on opposite knee and move flexed knee toward end of exam table/bed |
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Term
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Definition
-flexion against resistance (supine) - patient raises extended leg while you attempt to hold down
Abduction and adduction against resistance (supine) - put hands on either side of patient's knees. Patient pushes both legs against hands (abduction), place hands between knees and patent brings both legs together (adduction) |
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Term
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Definition
| patella, femur, tibia, fibula, tibial tuberosity, medial condyle of tibia, lateral condyle of tibia, quadriceps |
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Term
Knee Joint
Inspect and palpate |
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Definition
-note gait and psture
-palpate sitting or supine
-apply downward pressure on suprapatellar pouch to localize fluid
-palpate joint where femur articulates with tibia, not patella |
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Term
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Definition
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Term
Knee Joint
Muscle strength |
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Definition
| flexion & extension against resistance |
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Term
Ankles / feet Joints
Landmarks |
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Definition
-tibiotalor joint
achilles tendon
calcaneous
tarsals
metatarsals
phalanx
tarsometatarsal joint
metatarsophalangeal joint
interphalangeal joint |
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Term
Ankles / feet Joints
inspect and palpate |
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Definition
assess patient standing, sitting, walking
palpate anterior surface, toes as you would with palpation of the hand |
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Term
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Definition
dorsifleion, plantar flexion
inversion
eversion |
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Term
Ankles / feet Joints
Muscle strength |
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Definition
| dorsiflexion and plantar flexion against resistnace |
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Term
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Definition
spinus process of vertebrae
paravertebral muscles
iliac crest
base of neck = C7-T1, inferior angle of scapulae = T7-T8
L4 - hghest point ofiliac crest
S2 - dimples over posterior iliac spine |
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Term
Spine
Inspection: normal findings |
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Definition
-concave at cervical
convex at thoracic/sacrococcygeal area
concave at lumbar area
spinous process aligned straight |
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Term
Spine
Normal aging changes |
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Definition
-intervertebral discs thin and vertebral bodies shorten / collapse
-ROM diminishes
-skeletal muscles decreases in bulk and power
-kyphosis is common |
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Term
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Definition
paravertebral muslces, spinous process for tenderness
N = firm, nontender, spinous processes straight |
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Term
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Definition
Flexion, extension
lateral bending
rotation |
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Term
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Definition
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Term
| Treat musculoskeletal injuries how? |
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Definition
RICE
Rest
Ice
Compression
Elevation
Ice for 72 hours than heat to enhance circulation |
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Term
| Organs in upper right abdominal quadrant |
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Definition
liver
gallbladder
duodenum
head of pancreas
right kidney and adrenal
hepatic flexure of colon
part of ascending/ transverse colon |
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Term
| Organs in right lower quadrant of abdomen |
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Definition
cecum
appendix
right ovary and tube
right ureter
spermatic cord |
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Term
| Organs in left upper quadrant of abdomen |
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Definition
stomach
spleen
left lobe of liver
body of pancreas
left kidney and adrenal
splenic lexure of colon
part of transverse and descending colon |
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Term
| Organs in lower left quadrant |
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Definition
part of descending colon
sigmoid colon
left ovary and tube
left ureter
left spermatic cord |
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Term
| What quadrant has the highest number of active bowel sounds? |
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Definition
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Term
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Definition
inspect
auscultate
percuss
palpate |
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Term
Abdominal Inspection
Normal findings |
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Definition
contour: flat, round
symmetry: symmetric bilaterally
unbilicus: midline, inverted
skin: smooth, even, homogeneous color, no lesions
pulsation or movement: pulsations over aorta
hair distribution: (lower abdomen/pubic area)diamond shape, inverted triangle
demeanor - relaxed, benign facial expression |
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Term
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Definition
3 cylindrical columns of erectile tissue: Corpora cavernosa (dorsal) & corpus spongiosum
glans/foreskin
corona
urethra, meatus |
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Term
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Definition
Testes
Epididymis - sperm mature and are stored
Ductus deferens - extends from epididymis in either scrotum to ejaculatory duct |
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Term
Male GU Anatomy
spermatic cord |
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Definition
| from testes to abdomen up through inguinal canal. consists of nerves, vessels and vas deferens |
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Term
Male GU Anatomy
seminal vesicles |
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Definition
| secrete fructose to provide an energy source for sperm |
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Term
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Definition
| muscular gland, surrounds first inch of urethra as it emerges from bladder. secretes milky, alkaline fluid that makes up 30% of semen |
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Term
Male GU Anatomy
Subjective Assessment |
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Definition
-self-care behaviors
-urinary symptoms: frequency, urgency, dysuria, nocturia, hesistancy and straining
-patient reported discharge / lesions
-past history
-sexual history
-STD/I contact |
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Term
| GI Subjective Data to collect |
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Definition
pain
appetite
dysphagia
food intolerance
nausia
vomiting
bowel movement
past abdominal history
medications
nutrition |
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Term
Female GU Anatomy
Subjective Assessment |
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Definition
menstrual history
obstetric history
menarch/menopause
self-care behaviors
urinary symptoms
vaginal discharge
sexual history
contraceptive use
STD history and risk reduction |
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Term
| GI Auscultation procedure |
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Definition
lower right quadrant
upper right quadrant
upper left quadrant
lower left quadrant
In each quadrant listen to three spots. Close to unbilicus, then two other points of the triangle.
Listen for bowel sounds in each of the three spots in each quadrant. DO NOT MOVE STETHOSCOPE UNTIL SOUNDS ARE PRESENT. Listen for 5-30 seconds per spot. Typically this will take 1-5 minutes to auscultate the entire abdomen. If sounds are present this is abnormal, have another nurse check listen, pronto. |
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Term
| GI Auscultation findings - normal |
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Definition
Bowel sounds present times 4 quadrants. Wide range of sounds, very active
No vascular sounds present |
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Term
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Definition
| percuss each of the same spots you auscultated. percuss lightly |
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Term
| GI percussion findings - normal |
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Definition
General tympany in all 4 quadrants. Upper right quadrant, may have dull in top most spot due to liver.
* dullness over distended bladder, adipose tissue, fluid, mass
*hyperresonance with gaseous distention |
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Term
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Definition
| light palpation in 4 quadrants. Using rolling notion of flat hand, palmer side. |
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Term
| GI palpation findings - normal |
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Definition
| no pain, tenderness or guarding. |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
Female GU inspection
normal findings |
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Definition
Objective:
External genitalia: skin color, lesions, discharge, hair distribution.
Separate labia majoria, then minora to inspect clitoris, uretheral meatus, vaginal opening.
Inspect perineum and anus |
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Term
| Male GU objective data - normal |
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Definition
Inspect and palpate:
-hair distribution, sexual maturity, lesions, etc
inguinal lymph nodes
inguinal hernia
Normal:
Penis - glans smooth, without lesions. skin wrinkled, hairless, without lesions. urethral meatus is positioned centrally. pubic hair distribution is consistent with age, without pest inhabitants. meatus pink, smooth without discharge.
Scrotum - asymmetrical (left side lower than right), no scrotal lesions, testes feel oval, firm, rubbery, smooth and equal bilaterally and are freely movable. Epididymis feels softer than testis, smooth, nontender. Spermatic cord - smooth, nontender cord. |
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Term
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Definition
Subjective: pain, lump, discharge, rash, swelling, medications, trauma, history, surgery
Objective:
Visual inspection: arms at side, arms over head, hands on waist, flexing hands forward, leaning forward.
Note symmetry, color, dimpling, contour and nipple
Lymph node palpation:
supra and infraclavicular, central axillary, anterior pectoral
Palpation of the breasts:
vertical strip method
march fingers, don't leave skin surface
always check other breast if variation in tissue noted |
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Term
| Male GU palpation - hernia |
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Definition
Assessment:
have patient shift weight to opposite side than examining
use index finger, locate and follow spermatic cord to external inguinal ring
follow through and have patient bear down
normal = no change
do other side |
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Term
| Female GU palpation - normal |
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Definition
bartholian and Skene's glands N = nonpapable
vaginal wall tone
posterior labia majoia and perineum with index finger inside and thumb outside |
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Term
| Female GU abnormal findings |
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Definition
External genitalia: pigmented nevus or lesion that woman can't see, swelling, excoriation, nodules, rash, lesions, foul smelling discharge, polyp, tenderness, induraion along urethra, painwith palpation.
Internal genitalia:
Cervix: redness, inflammation, pallor with anemia, cyanotic (other than with pregnancy), lateral position may be due to adhesion or tumor, reddened, granular, asymmetric, bleeds easily, lesions, white patch on cervix, cervical polyp
Vaginal Wall: inflammation or lesions, nodule, tenderness |
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Term
| Male GU abnormal findings |
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Definition
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Term
| Recommendations for testicular self exams |
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Definition
USPSTF: does not recommend self or clinical exams
AMC: no recommendation on self, but recommends clinical exams upon yearly physical |
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Term
| Recommendations for breast self exams |
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Definition
ACS: acceptable to chose not to do BSE or do BSE occasionally
If you do not do BSE know how breasts normally look and feel
USPSTF: recommends against teaching BSE |
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