Transcript musculoskeletal/motor assessment

ASSESSING
THE MOTORMUSCULOSKELETAL
SYSTEM
Structures
 Bones
 Joints
 Ligaments
 Bursae
 Muscles
 Tendons
 Cartilage
Functions
Bones (206):
Structure; protection; act as levers;
produce blood cells; store
calcium
Muscles (650):
Allow for movement and position;
produce heat
(Continued)
Functions
Joints:
Point of articulation of two bones;
provide ROM
Tendons:
Connect muscle to bone
Ligament:
Connects bone to bone
(Continued)
Functions
Cartilage:
Supports and shapes; acts as a shock
absorber
Bursae:
Sacs filled with synovial fluid;
cushion and reduce friction between
joints
Types Of
Joints
 Pivot
 Hinge
 Condyloid
 Plane/gliding
 Ball and socket
 Saddle
Movements
 Extension Flexion  Hyperextension
 Abduction Adduction  Circumduction
 Internal rotation  External rotation
 Pronation
 Supination
 Protraction
 Retraction
 Depression
 Elevation
 Opposition
 Reposition
 Inversion
 Eversion
 Ulnar deviation  Radial deviation
Ulnar Deviation: a progressive malformation of the
joints at the bottom of the fingers. The knuckles begin
to become malformed and tend to make the fingers
shift toward the outside of the hand, toward the
pinkie. Often seen in patients with rheumatoid
arthritis.
Radial Deviation: malformation in other direction
“club hand”
Relationship to
Other Systems
 Genitourinary
 Lymphatic
 Neurological
 Cardiovascular  Endocrine
 Hematological  Gastrointestinal
 Integumentary  Respiratory
Developmental
Variations
 Older Adults
Osteopenia
Osteoporosis
Kyphosis
Atrophy
Cultural Variations
New text: 694
Old text: Pg 597
 African Americans
 Asians
 Native Americans
 Whites
Case Study
Maria O’Malley, 68year-old, widow,
parish housekeeper
Post-menopausal
Concerned about
osteoporosis; feel she
is “shrinking”
“Aching joints in
evening after
working all day” for
several years
Symptoms
What symptoms would signal a problem
with the musculoskeletal system?
 Pain
 Weakness
 Stiffness
 Balance and coordination problems
 Other related symptoms
Pertinent History
Findings
 Aching joints after working all day for
past several years; back and neck
 Some relief with OTC analgesics
 + HTN treated with Zestril
 + Fractured wrist r/t fall; 2 adult
children; hysterectomy at age 35
 + Family history of HTN & osteoporosis
(Continued)
Pertinent History
Findings
 Yearly physical exam; B/P checked every
3 months; hasn’t had gynecological
exam since hysterectomy
 No formal exercise program
 Lives alone; children, sister, and friends
are supports
 Polish; Catholic; Medicare/Medicaid
Physical
Assessment
Approach: inspection, palpation,
percussion
Position: Standing, sitting, supine
Tools: tape measure, goniometer
General Survey and head-to-toe scan
Inspection
Posture: head position, alignment
Normal spinal curves: cervical,
thoracic, lumbar, sacral,
Spinal deformities: kyphosis, scoliosis,
lordosis
Gait: phase, cadence, arm swing,
toeing, base of support, stride length
Assessing for kyphosis
& scoliosis
Cerebellar Function
Balance:
 Gait
 Tandem walk (heel to toe)
 Toe and heel walking
 Deep knee bend
 Hop on one foot
 Romberg Test
(Continued)
Cerebellar Function
Coordination:
 Rapid alternating movements
 Finger thumb opposition
 Toe tapping
 Heel down shin
Accuracy of movements:
 Finger to nose
 Point to point localization
Abnormal Gaits
Propulsive
Scissors
Spastic Stepping Waddling
Palpation
Muscle tone: upper and lower extremities
Muscle strength: upper & lower extremities
 Hand grips
 Foot push/leg raise
 Grade strength 0 to 5
Joint Assessment
For all joints note:
 ROM
 Condition of skin
 Deformity
 Swelling
 Crepitus
 Redness
 Warmth
 Stability
 Pain
Pertinent Physical
Findings
 1 1/2 inch loss since menopause
 Mild kyphosis
 Mild atrophy in quadriceps
 Full ROM joints, muscle strength
+5/5
 + S4
Nursing Diagnosis
What actual or
potential
problems can
you identify for
Mrs.O’Malley?