MUSCULOSKELETAL SYSTEM

- Composed of bones, muscle, and joints - 650 skeletal (voluntary muscles)

- Controlled and innervated by nervous system - Made up of fasciculi (long muscle fibers),
arranged in bundles and joined by
STRUCTURE AND FUNCTION connective tissue.
 Bones - Attach to bones by way of tendons (strong,
- Provide structure and protection fibrous cords)
- Serve as levers - Assist with posture
- Store calcium - Produce body heat
- Produce blood cells - Allow the body to move
- 206 bones: STRUCTURE AND FUNCTION (CONTINUED)
 Axial Skeleton
- 80 bones  Joints
- head and trunk - Also called articulation
 Appendicular Skeleton - Place where two or more bones meet
- 126 bones - Provide a variety range of motion
- extremities, shoulders and - Classifies as:
hips  Fibrous joints
- Composed of osseous tissue, composed by - Ex. Sutures between skulls
osteoblasts(active cells) and degraded by - Joined by fibrous
osteoclasts connective tissue
- Two Types: - Immovable
 Compact Bone  Cartilaginous joints
- hard and dense - Ex. Joints between
- makes up the shaft and vertebrae
outer layers - Joined by cartilage
 Spongy Bone  Synovial Joints
- contains numerous spaces - Ex. Shoulders, wrists, hips,
- makes up the end and knees, ankles
centers of the bones - Contain a space between
- Periosteum: covers the bones bones that is filled with
-contains osteoblasts and blood vessels that synovial fluid, a lubricant
promote nourishment and formation of that promotes a sliding
new bone tissues movement of the ends of
- Bone shapes: the bones.
 Short bones (carpals) - Joined by ligaments (strong,
 Longbones (humerus, femur) dense bands of fibrous
 Flat bones (sternum, ribs) connective tissue)
 Irregular shape (vertebrae, hips) - Enclosed by a fibrous
capsule made of connective
SKELETAL MUSCLES tissue
 3 Types of Muscles: Skeletal, Smooth Cardiac - Contain bursae, small sacs
filled with synovial fluid
 Skeletal
 that serve to cushion the - Progressive loss of total bone mass
joint. - Bones become pourous and fragile
- Susceptible to fractures
MAJOR JOINTS - No symptoms until the first fracture occurs
 Temporomandibular - Bones are densest at 20s
- Temporal bone and mandible - Vitamin D and Calcium deficiency
- Open and closes mouth - Excessive consumption of alcohol or
- Protracts and retracts jaw caffeine, and smoking increases the risk
- Moves jaw from side to side HEALTH ASSESSMENT
 Sternoclavicular
- Manubrium of the sternum and the clavicle  Weight gain
- No obvious movements - Increase physical stress and strain on the
 Elbow musculoskeletal system
- Ulna and radius of the lower arm and the  TMJ dysfunction
humerus of the upper arm - Difficulty chewing
- Flexion and extension of the forearm - Jaw getting locked or stucked
- Supination and pronation of the forearm - Clicking sound
 Shoulder  Bone Pain
- Head of the humerusin the glenoid cavity of - Dull, deep, and throbbing
the scapula  Joint or Muscle Pain
 Wrists, fingers, thumb - Aching
- Distal radius, ulnar bone, carpals, and  Fractures
metacarpals - Sharp, knifelike pain
- Contains ligaments - Pain increases when moved
- Lined with synovial fluid  Osteoarthritis Pain
 Hip - Begins in one set of joints and on one side
- Femur and acetabulum of the body
- Contains fibrous capsule - Deep pain in the joint
 Vertebrae - Worsening in rainy weather
- Thirty-three bones: - Sensation of bone grating together
a. 7 concaved shaped cervical - Stiffness early in the morning
b. 12 convex-shaped thoracic - Relieved with movement
c. 5 concave-shaped lumbar  Rheumatoid Arthritis
d. 5 sacral - Pain and symptoms are varied
e. 3-4 coccygeal - Burning or throbbing on both sides of the
- Cushioned by intervertebral discs body
 Knee - Worsen after sitting long periods
- Femur, tibia, and patella - Inconsistent pattern of pain
- Contains fibrocartilaginous disks and many - Heat and soreness in joints
bursae  Fibromyalgia
 Ankle and Foot - Widespread musculoskeletal pain
- Talus (largeposterior foot tarsal), tibia, and - Accompanied by fatigue, sleep, memory,
fibula and mood changes or cognitive disorders
- Talus articulates with the navicular bones - Genetic or from triggers (infections,
- Heel is connected to the tibia and fibula physical, emotional trauma)
 Osteoporosis –bones demineralize - 3 months pain with no underlying cause
 - Postmenopausal women younger than 65
 Bone Density Screenings
- CBC, Sedimentation Rate, and Thyroid
- All women at age 65
function are performed in diagnosing this.
 Goniometer
 History of Recurrent Fractures
- Device that measures ROM in degrees
- Seen with osteomalacia ( "soft bones”, a
 Rating Muscular Strength
disease that weakens bones and can cause
them to break more easily) Rating Explanation Strength
- Possible physical abuse Classification
 Having type 1 diabetes 5 Active Normal
- Increases risk of low bone density motion
- Fracture risk related to poor vision and against full
resistance
nerve damage
4 Active Slight
 Having type 2 diabetes motion weakness
- Increased bone density against some
- Fracture risk related to poor vision and resistance
nerve damage 3 Active Average
 Late menarche/begin menopause early motion weakness
against
- Risk for osteoporosis due to low estrogen
gravity
levels, decreasing the density of bone mass
2 Passive ROM Poor ROM
 Vitamins 1 Slight flicker Severe
 Vitamin C: of weakness
- healing of tissues and bones contraction
 Vitamin D: 0 No muscular Paralysis
- via sun exposure, absorbs calcium, contraction
4000 IU intake daily
- at least 20 minutes of sun exposure
- deficiency causes osteomalacia  Slumped posture
 High in purine (meat, liver, sardines), and - Result from poor posture or depression
alcohol  Nudge Test
- Increases risk of gouty arthritis, - Assessing for the risk of client falling
inflammatory arthritis that causes pain and backward
swelling in your joints. - Stand behind the client while you gently
 Lactose intolerance nudge the sternum
- Decreased production of lactase enzyme - Falling backward easily is seen with cervical
spondylosis (also known as cervical
 Osteopenia osteoarthritis or neck arthritis, is a
- used to describe a decrease in bone degenerative condition affecting the
mineral density (BMD) below normal cervical spine), and Parkinson disease (a
reference values, yet not low enough to progressive neurological disorder that
meet the diagnostic criteria to be primarily affects movement).
considered osteoporotic  Assessing TMJ
 Sarcopenia - Place your fingers at the external opening
- Degeneration of skeletal muscle fibers of the ear
- Occur with aging - Mouth should open (1-2 in.) and closes
 Bone Density Scans smoothly
 - Jaw moves laterally 1-2 cm  Cervical (continued)
 Abnormal Findings  Lateral Bending
- Arthritis - decreased ROM, - Ear to shoulders
swelling, tenderness, or - 40 degrees each side
crepitus  Rotation
- TMJ dysfunction- decreased - 70 degrees
ROM, clicking, popping, or  ROM of the lumbar spine
grating sound  Flexion: 75-90 degrees
- Test the trigeminal nerve (V) by asking the - Lumbar concavity flattens
client to clench the teeth. Pain or spasms out
occur with myofascial pain syndrome - Spinal process in alignment
 Cervical, thoracic, and lumbar - Structural: increased
- Cervical and lumbar are concave unilateral exaggerated
- Thoracic is convex thoracic convexity
- Spine is straight - Functional: lateral
 Herniated lumbar disk or curvature disappears
ankylosing spondylitis  ROM of thoracic and lumbar spines
- flattened curvature  Lateral bending: 35 degrees
 Scoliosis  Hyperextension:30 degrees
- lateral curvature of the  Rotation: 30 degrees
spine with an increase in  Ankylosing spondylitis
the convexity on the - Is a type of arthritis that causes
curved side inflammation in the joints and ligaments of
 Lordosis the spine.
- exaggerated lumbar curve  Test for back and leg pain (Straight leg test)
- seen in pregnancy or - Perform if the client has lowback pain that
obesity radiates down the back to check for
 Kyphosis hearniated nucleus puposus (referred to as
- Exaggerated thoracic curve a herniated disc or slipped disc, occurs
- Common in aging when the soft inner material (nucleus
 Unequal leg lengths pulposus) of an intervertebral disc in the
- Unequal heights of the hips spine protrudes through the tough outer
 ROM of the Cervical Spine layer (annulus fibrosus), resulting in
 Flexion: 45 degrees compression or irritation of nearby spinal
 Extension: 45 degrees nerves, leading to symptoms such as pain,
 Cervical Spinal Cord Compression numbness, or weakness in the affected
- Neck pain with a loss of sensation in the area.)
legs  Measuring leg length
 Cervical Disk Degenerative Disease and Spinal - Ask the client to lie down
Cord Tumors - Measure the distance between the anterior
- Associated with impaired ROM and pain superior iliac spine and the medial
that radiates to arms, shoulder, or back. malleolus with a measuring tape
 Meningis - Unequal leg lengths are associated with
- Impaire ROM and neck pain scoliosis
- Fever, chills, and headache - Measurements should be equal or within 1
- Serious infection cm
 - If the legs still look unequal, assess the - Supination: 90 degrees
apparent leg length by measuring from a - Epicondylitis: tenderness or pain over
nonfixed point (the umbilicus) to the fixed epicondyles due to repetitive movements
point (medial malleolus) of the forearm or wrists
 Shoulders, arms, elbows  Wrists
 Dislocation - Swelling, tenderness, nodules may be seen
- Flat, hollow, or less-rounded with rheumatoid arthritis
shoulders - Ganglion: nontender, round, enlarged,
 Tenderness, swelling and heat swollen, fluid-filled cyst
- Shoulder strains, sprains, - Wrist Fracture: pain, tenderness, swelling,
arthritis, bursitis, joint inability to hold a grip, pain that goes away
degenerative disease and returns as dull ache.
 ROM
- Flexion: moving arms forward,  Squeeze Test
180 degrees - a clinical test for detecting
- Hyperextension: 50 degrees "stable" syndesmosis injuri
- Adduction: 50 degrees es.
- Abduction: 180 degrees - Extreme pain may indicate
- External and Internal Rotation: rheumatoid arthritis and
90 degrees psoriatic arthritis in hands
- Rotator Cuff Tear: painful and (occurs when your body's
limited abduction immune system attacks
accompanied with muscle healthy cells and tissue.)
weakness and atrophy  Palpating the anatomic snuffbox
- Rotator Cuff Tendonitis: client - Tenderness may indicate a
has sharp catches of pain when scaphoid fracture, result of
bringing hands over head. falling on an outstretched
- Calcified Tendinitis: chronic hand.
pain and severe limitation of  ROM
all shoulder motions - Flexion: 90 degrees
- Lesion of cranial nerve XI: - Hyperextension: 70
inability to shrug shoulders degrees
against resistance - Ulnar deviation: 55 degrees
- Joint or muscle disease: - Radial deviation: 20
decreased ROM against degrees
resistance - Epicondylitis of the lateral side of the elbow:
 Elbows increased pain with extension of the wrist
- Bursitis of the olecranon: redness, heat, against resistance
and swelling due to trauma or arthritis - Epicondylitis of the medial side of the elbow:
- Firm, nontender subcutaneous nodules may increased pain with flexion of the wrist against
be palpated in rheumatoid arthritis or resistance
rheumatoid fever.  Test for carpal tunnel syndrome
 ROM - Perform Phalen Test (help diagnose carpal
- Flexion: 160 degrees tunnel syndrome)
- Extension: 180 degrees  Carpal tunnel syndrome
- Pronation: 90 degrees
 - is a common condition that  Heberden nodes – symptom of
causes numbness, tingling, and osteoarthritis in the hand
pain in the hand and forearm. - small, pea-sized bony growths that
- compression of nerves in the occur on the joint closest to the tip
wrist of the finger, also called the distal
 Thumb weakness interphalangeal joint.
- client cannot raise and stretch the  ROM
thumb - Abduction: 20 degrees
 Flex the wrists at 90 degrees and - Flexion: 90 degrees
place the back of both hands - Hyperextension: 30 degrees
against each other for 1 minute - Thumb flexion: 30 degrees
 If tingling, numbness, burning, or  Dupuytren contracture
pain develop, CTS is suspected - An abnormal thickening of the skin
- Perform Tinel Test (used with imaging tests in the palm of the hand
to find compressed or squeezed nerves and - Inability to extend the ring and
nerve regrowth) little fingers
 Tingling or shocking sensation is  Tenosynovitis
experienced - Inflammation of the fluid-filled
 Median nerve entrapped in carpal synovium within the tendon
tunnel results in pain, numbness, sheath.
and impaired function of hands and - Painful extension of a finger
fingers  Hips
 Flick signal  Fractured Hip
- If the client responds with a - Instability, inability to stand,
motion that resembles deformed hip area
shaking a thermometer,  Strains
CTS is suspected - Stretch or tear of muscle or tendon
 Hands and fingers  Hip disease
 Finger fractures - pain, tenderness, - Inability to abduct hip
swelling, shortened finger,  Osteoarthritis or femoral neck
depressed knuckle, finger crossing stress fracture
on adjacent finger,inability to - Pain and a decrease in internal hip
move the finger rotation
 Acute rheumatoid arthritis -  Bursitis of hip
swollen, stiff, tender finger joints - Pain in palpation of trochanter and
 Boutonniere deformity - finger is pain as the client moves
flexed at the - Do not test ROM if the client had total hip
proximal interphalangeal joint replacement unless given permission by the
(PIP) and hyperextended at the physician
distal interphalangeal joint (DIP)  ROM
- Seen in long term rheumatoid - Flexion with straight knee: 90
arthritis degrees
 Swan-neck deformity - proximal - Flexion with knee bent: 120 degrees
interphalangeal (PIP) joint - Abduction : 45-50degrees
hyperextension and the distal - Adduction: 20-30 degrees
interphalangeal (DIP) joint flexion. - Internal hip rotation: 40 degrees
 - External hip rotation: 45 degrees - Positive Ballotement test: present
- Hip hyperextension: 15 degrees in meniscal tears, occur as a result
 Lasegue Test or Straight Leg Raising of a forceful twist or rotation of
- to assess for irritation or the knee.
compression of the sciatic nerve - Fluid wave or click palpated
and to diagnose conditions such as - Patellofemoral: pain at the front of
sciatica or lumbar disc herniation. the knee, around the kneecap.
 Knees  ROM
- Position of the client upon inspection : - Flexion: 120-130 degrees
client supine, then sitting with knees - Extension: 0 degrees
dangling - Hyperextension:15 degrees
 Abnormal findings - Osteoarthritis(knee): decrease
- Genu valgum: knees turn in with ROM with synovial thickening and
knock knees; crepitation.
- when a child stands up straight and - Flexion contractures: inability to
the knees touch but the ankles are extend knee fully
apart.  Ankles and Feet
- Genu varum: turn out with bowed - Inspect with the client sitting, standing, and
leg; walking
- when the legs curve outward at - They may point in (pes varus)
the knees while the feet and ankles - They may point out (pes valgus)
touch. - Toes and feet are in alignment with lower
- Synovitis: swelling (inflammation) leg
in the synovial membrane that - Longitudinal arch; most of the weight
lines some of your joints; bearing is on the foot midline
- Tenderness and warmth with a  Abnormal Findings
boggy consistency. - Hallux valgus: a laterally deviated
- Atrophy: asymmetric muscular great toe with possible overlapping
development in the quadriceps. of the second toe and possible
 Older Adult Considerations: formation of enlarged, painful,
- Older clients may have a bow- inflamed bursa (bunion)
legged due to decreased muscle - Pes planus: also called flat feet,
control. feet withno arches
 Performing Bulge Test - Pes cavus: feet with high arches
- Used to assess for joint effusion- - Corns: painful thickening of the
presence of increased intra- skin over bony prominences and at
articular fluid in the knee area.; pressure points
- Helps to detect small amounts of - Calluses: not painful thickened skin
fluid in the knee; at pressure points
- Perform if swelling is present. - Verruca vulgaris: painful warts
- No bulge of fluid should appear on - Plantar warts: small, rough
the medial side of the knee. growths on the feet, show up on
 Performing Ballotement Test the balls and heels of the feet, the
- Helps to detect large amounts of areas that bear the most pressure.
fluid in the knee
 - Gouty arthritis: tender, painful,  Bouchard nodes
reddened, hot, and swollen - nodules of the proximal
metatarsophalangeal joint. interphalangeal, typically indicative
- Plantar Fascilitis: irritated and of hand osteoarthritis.
inflamed arch of the foot;  Risk for Osteoarthritis
tenderness of the calcaneus - Hypogonadism: low testosterone in men,
- Hammer toe: hyperextension of loss of menstrual periods in younger
the metatarsophalangeal joint and women
flexion of the proximal
interphalangeal joint.
 ROM
- Dorsiflexion: 20 degrees
- Plantarflexion: 45 degrees
- Eversion: 20 degrees
- Inversion: 30 degrees
- Abduction: 10 degrees
- Adduction: 20 degrees
- Flexion: 40 degrees
- Extension: 40 degrees
 Ottawa Ankle and Foot Rule
- To determine need for x-ray referral
 Abnormal Spinal Curvatures
 Flattening of the Lumbar Curvature
- Seen with a herniated disc or
ankylosing spondylitis
 Lumbar Hyperlordosis
- Hip flexion contracture and hip
extensor weakness
- Increasing lordosis to balance head
over pelvis
 Kyphosis
- Rounded thoracic convexity
 Enthesitis
- Inflammation and tendency for
fibrosis and calcification at sites of
muscle insertion.
 Abnormalities Affecting the Wrists, Hands and
Fingers
 Acute rheumatoid arthritis
- Tender, painful, swollen, stiff joints
 Thenar Atrophy
- Atrophy of the thenar prominence
due to pressure on the median
nerve seen in carpal tunnel
syndrome