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Outlines
1. Review of Anatomy and physiology of musculoskeletal system 2. Physical Exam 3. Inspection 4. Palpation 5. ROM (Rang of motion)
Objectives
Apply knowledge of Anatomy and physiology of musculoskeletal system Differentiate between normal and abnormal Implement physical assessment
Axial Skeleton
The axial skeleton consists of bones that form the axis of the body and support and protect the organs of the head, neck, and trunk.
The The The The Skull Sternum Ribs Vertebral Column
Appendicular Skeleton
The appendicular skeleton is composed of bones that anchor the appendages to the axial skeleton.
The Upper Extremities The Lower Extremities The Shoulder Girdle The Pelvic Girdle--(the sacrum and coccyx are considered part of the vertebral column)
What do muscles do ?
Muscles simply move you! Without muscles you couldn't open your mouth, speak, shake hands, walk, talk, or move your food through your digestive system. There would be no exploring, running, climbing, smiling, blinking, breathing. You couldn't move anything inside or outside you. The fact is, without muscles, you wouldn't be alive for very long
The skeleton is the name given to the collection of bones that holds our body up. Our skeleton is very important to us. It does three major jobs. 1. It protects our vital organs such as the brain, the heart, and the lungs. 2. It gives us the shape that we have. Without our skeleton we would just be a blob of blood and tissue on the floor. 3. It allows us to move. Because our muscles are attached to our bones, when our muscles move, they move the bones, and we move
Physical Exam
1. Inspection Observe any lack of symmetry and any evidence of trauma or disease. Look for muscle wasting; Inspect the joint contour (shape) and observe any evidence of swelling, deformity or inflammation.
Ask the client to point to, or otherwise identify, any painful areas, including sites of radiation of pain.
Screening questions for musculoskeletal disorders 1. Do you have any pain or stiffness in your arms, legs or back? 2. Can you walk up and down stairs without difficulty? 3. Can you dress yourself in everyday clothes without any difficulty?
Assessment of Gait Ask the patient to walk back and forth across the room . Observe for equality of arm swing , balance and rapidity and ease of turning . Next, ask the patient to walk on his tiptoes ,then on heels . Ask the patient to tandem walk . Test patient's ability to stand with feet together with eyes open and then closed. (Romberg's test .)Reassure patient that you will support him, in case he becomes unsteady . Normal :Person can walk in balance with the arms swinging at sides and can turn smoothly. Person should be able to stand with feet together without falling with eyes open or closed.
heels
tiptoes
tandem
Adduction
Trapezius)
Hand: Grip
Grip
Determine limb tone (resistance to passive stretch). With the patient relaxed Gently move the limb at the shoulder, elbow and wrist joints and note whether tone is normal, increased or decreased
Normal findings
Muscles are symmetrical in size with no involuntary movements. In some, muscles may be slightly larger on the dominant side. Muscle power obviously varies. You should not be able to overpower with reasonable resistance. You have to learn to appreciate the normal tone from practice.
Palpation
Feel each spinous process looking for focal areas of tenderness Joint
Para spinal muscles Active
Feel for crepitus during passive motion
Touch chin
Range of motion
Touch each shoulder with ears for lateral flexion Touch each shoulder with chin for lateral rotation
Passive
Feel for crepitus during passive motion
Normal:
30 degree rotation, able to touch chest with chin, 55 degree extension and 40 degree lateral bend. No resistance during the range of motion.
Hip flexion
Is there evidence of atrophy of the quadriceps, hamstring, or calf muscle groups? Knee problems/pain can limit the use of the affected leg, leading to wasting of the muscles .
While both legs have well developed musculature, the left calf and hamstring are bulkier than the right
Determine limb tone resistance to passive stretch. With the patient relaxed, gently move the limb at the hip, knee and ankle and note whether tone is normal, increased or dicreased. Flex the hip and knee. Support the knee, dorsiflex the ankle sharply and hold the foot in this position checking for clonus .
Knee : Flexion( Hamstrings ,) Extension( Quadriceps ) Ankle : Dorsiflexion( Tibialis anterior), Plantar flexion (Gastronemius .)
Knee extension
Knee flexion
Dorsiflexion
Spine (Bone)
The examiner should stand behind the patient and observe the alignment of the spine in the flexed position to determine scoliosis . View the spine from the side to determine kyphosis .
Ask the patient if he is aware of sore spots. Palpate the spinous process and be gentle with the sore spots .Percuss one vertebra at a time, starting from head . .
Assess range of motion of spine by having patient bend down to pick up an object without bending his legs while you hold his hips . Normal : Gentle concavities in cervical and lumbar regions and a convexity in the thorax . Vertebral line and gluteal cleft align