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163 Cards in this Set
- Front
- Back
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Functions of bones and joints |
Movement & support Protection Production of RBCs Storage of minerals |
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Minerals stored in bones |
Calcium Iron |
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Production of RBCs |
Flat bones in adults Produced in marrow |
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Nonsynovial joints |
Nonmobile |
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Synovial joints |
Moveable Contains: cartilage, ligaments, bursa |
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Cartilage |
Covers surface of the bone |
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Ligaments |
Connects bone to bone Provide joint stability |
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Bursa |
Sac of viscous synovial fluid for friction free movement of joint |
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Bursitis |
Inflammation of bursa May be caused by overuse or infection Infection: septic bursitis Consider Xray anytime there is infection over bone to r/o osteomyelitis |
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Osteomyelitis |
Bone infection |
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Muscles |
Fasiculi Tendons |
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Fasiculi |
Bundles of muscle fibers |
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Tendons |
Attach muscle to bon |
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Tendonitis |
Inflammation of tendon |
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Flexion |
Forward and lateral bending Opposite: extension |
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Extension |
Straightening Opposite: flexion |
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Abduction |
Away from midline Opposite: Adduction |
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Adduction |
Toward midline Opposite: abduction |
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Pronation |
Palm down Opposite: supination |
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Supination |
Palm up Opposite: pronation |
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Inversion |
Sole in Opposite: eversion |
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Eversion |
Sole out Opposite: inversion |
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Protraction |
Body part forward Opposite: retraction |
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Retraction |
Body part backward Opposite: protraction |
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Internal rotation |
Shoulder, hip Opposite: External rotation |
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External rotation |
Shoulder, hip Opposite: internal rotation |
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Radial deviation |
Move hand inward Opposite: ulnar deviation |
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Ulnar deviation |
Move hand outward Opposite: radial deviation |
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Rotation |
Moving head around central point |
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Subjective data: pain |
Muscles, joints, nerves Boring, dull, tearing, burning, cramping |
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Subjective data: joint pain, bone pain |
Location, loss of function |
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Rheumatoid arthritis |
RA Inflammation of synovium/joint lining Systemic, symmetric joint involvement Worse in am, morning stiffness Movement decreases pain |
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Osteoarthritis |
Degenerative joint disease Cartilage wears away May affect unilateral joint Very common Worse in pm: wear and tear Causes: obesity, overuse, sports injury |
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Subjective data: decreased ROM |
Changes in mobility or function |
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Subjective data: Weakness |
Suggests motor nerve involvement Look for muscle atrophy r/t decreased innervation of the muscle |
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Subjective data: Bone or joint deformities |
R/t genetics, injury |
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Subjective data: accidents/trauma |
MOI Treatment Sequela Were they able to bear wt immediately after injury |
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MOI |
Method of injury |
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Low back pain |
LBP Localized Specific |
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Localized LBP |
Pain over lumbar spine Possibly osteoarthritis |
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Herniated nucleus pulposus |
HNP Herniated intervertebral disc: puts pressure on spinal nerves Motor changes: weakness Sensory changes: numbness of LE, tingling, saddle anesthesia, loss of bowel/bladder |
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Saddle anesthesia |
Numb inner thigh, loss of bowel and bladder continence Red flag: immediate ortho/neuro consult |
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Subjective data: Aging adult |
Functional assessment Mobility, exercise, eating, grooming, dressing, toileting Decreased functional ability may preclude independent living |
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Objective Data |
Assess function and screen for abnormalities |
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How a person moves |
Rises from chair Takes off jacket - rotator cuff Manipulates small objects |
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Malingering |
May be secondary gain from ortho/neuro complaints such as workman's comp Exaggerate or fake illness to avoid work/duty |
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Examine each joint |
Inspect Palpate ROM Strength |
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Historical information |
Assess symptoms to single or multiple joints Symptoms acute or progressive Systemic symptoms, ie. fever Were there prior problems with the affected area For injuries, ask about MOI |
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Examination technique |
Cephalocaudal Proximal to distal Support the joint being examined Compare corresponding joint: examine unaffected joint first |
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Cephalocaudal |
Head to toe |
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Inspection |
Size and contour of joint Skin color, swelling, deformity |
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Skin color |
Redness, swelling, heat, pain Suggests inflammation or infection of joint |
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Joint swelling |
Effusion: excess of joint fluid Inflammation of surrounding soft tissue: bursa, tendon |
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Deformities |
Dislocation Subluxation Contracture Ankylosis Bony enlargements |
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Dislocation |
Bone out of joint position |
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Subluxation |
Partial dislocation Bone moves in and out of position Damage to ligament, decreased stability |
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Contracture |
Shortening of muscle leading to limited ROM Associated with BR and immobility |
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Ankylosis |
Stiffness or fixation of a joint |
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Ankylosis Spondylitis |
Stiffening of vertebra limiting motion Genetic condition characterized by chronic inflammation of the spine |
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Bony enlargements |
Gouty tophi Heberden's nodes Bouchard's nodes |
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Palpate each joint |
Note any heat, tenderness, swelling, masses or pain |
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ROM |
Test active ROM Gentle passive ROM if active ROM fails Goniometer to measure joint angle Crepitation: noise or palpable crunching with motion |
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Strength/Motor testing |
Test active ROM against resistance Grade strength on 5 point scale |
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Strength 5 |
FROM against full resistance Normal |
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Strength 4 |
FROM against some resistance Slight weakness |
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Strength 3 |
FROM without resistance Moderate weakness Can move against gravity but not resistance |
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Strength 2 |
Full passive ROM Severe weakness Only roll extremity |
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Strength 1 |
Slight muscle contraction Can't move extremity |
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Strength 0 |
No muscle contraction |
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Temporal Mandibular Joint |
Articulation of mandible and temporal bone ROM: open/close, glide forward/retract, side to side Palpate during ROM, palpate masseter muscles Assess CN V |
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Shoulder |
Scapula, humerus, clavicle |
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Glenohumoral Joint |
Articulation of the humerus with glenoid fossa of scapula |
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Subacromial bursa |
Cushioning pad Allows humerus to move under acromion process of scapula during abduction of arm |
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Rotator Cuff |
4 muscles: supraspinatus, infraspinatus, teres minor, subscapularis Tendons |
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Palpable landmarks of Shoulder |
Acromion process of scapula Greater tubercle of the humerus Coracoid process of the scapula |
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ROM of shoulder |
Forward flexion Hyperextension Internal rotation: reach up back, should be equal External rotation: reach behind neck Abduction Adduction |
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Arm Drop test |
Test for rotator cuff tears Supraspinatous Abduct arms past 90 degrees and lower slowly Sudden arm drop: supraspinatus muscle weakness May see deltoid muscle attempting to compensate |
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Elbow |
Articulation of humerus, radius, ulna Inspect olecranon bursa Palpate landmarks for tenderness: medial and lateral epicondyles |
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Olecranon bursa |
Between olecranon process and skin |
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Olecranon bursitis |
Look for an entrance wound May be septic |
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Olecranon nerve |
Between medial apicondyl and olecranon process AKA: ulnar nerve "Funny bone" |
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ROM of elbow |
Flexion and extension Supination and pronation: radioulnar joint at elbow |
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Epicondylitis |
Tendonitis Occurs with repetitive movement Assess for pain with flexion and extension |
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Medial epicondylitis |
Golfer's elbow Pain over medial epicondyle |
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Lateral epicondylitis |
Tennis elbow - affected by backhand swing Pain over lateral epicondyle |
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Wrist and hand |
Inspect for deformities |
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Osteoarthritis |
DJD Hard, tender nodules on fingers |
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Heberden's nodes |
At DIP joint R/t osteoarthritis |
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Bouchard's nodes |
At PIP joint R/t osteoarthritis |
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Rheumatoid Arthritis |
RA Flexion contracture of MCP Called Swan's neck or boutonniere deformity |
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ROM of wrist and fingers |
DIP, PIP, MCP Radiocarpal joint: flexion, extension, radial and ulnar deviation Fingers: flexion, extension |
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Post wrist injury |
Test for snuff box tenderness Seen with radial fx: navicular fx |
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Snuff box test |
If positive/tenderness, assume fx present (may not be seen on Xray for a couple of days) Splint wrist This area has poor blood supply and may result in bone necrosis and disability if not splinted properly |
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Carpel Tunnel Syndrom |
Common in pregnancy Median or Ulnar nerve distribution |
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Median nerve distribution |
Phalen's: 90 degree flexion of wrist x 60 sec - positive paresthesia of fingers on median side Tinel's: Percuss median nerve - positive if numbess and tingling Thenar eminence atrophy - round mound proximal to thumb |
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Ulnar nerve distribution |
Phalen's: 90 degree flexion of wrist x 60 sec - positive paresthesia of fingers on ulnar side Hypothenar atrophy: palmar area distal to wrist on ulnar side |
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DeQuervain's Tendonitis |
Tenosynovitis of wrist Caused by overuse of wrist resulting in hypertrophy of surrounding tissue and pressure on tendon Pain on radial side of wrist Finkelstein's test Pain in wrist when resisting extension of thumb |
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Finkelstein's test |
Make fist with thumb tucked into palm Positive if ulnar flexion of wrist causes pain |
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Depeytren's contracture |
Palmar aspect AKA trigger finger Flexion contrature secondary to chronic hyperplasia of palmar fascia Affects 3, 4, 5th digits: alters function DM Need injectable steroids or surgery to relieve fascia |
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Hip |
Acetabulum and head of femur 3 bursa help movement |
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Inspect hip |
While standing Note symmetry of iliac crest and gluteal fold Palpate landmarks |
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Gluteal fold |
Fold between buttock and articulation of leg |
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Palpate hip landmarks |
Anterior superior iliac crests Ischial tuberosity Greater trochanter |
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Ischial tuberosity |
What you sit on |
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Greater Trochanter |
Lateral hip Pain over this site often indicates greater trochanteric bursitis Treat with NSAIDS Not hip pain |
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Actual hip joint pain |
Deep in crease of groin |
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ROM of hip |
Flexion: knee to chest Abduction Adduction Hyperextension: while standing Internal rotation External rotation |
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Knee |
Articulation of femur, tibia, patella Largest joint of the body |
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Medial and lateral menisci |
Cushion tibia and femur Cartilage |
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Medial and lateral knee stability |
Ligaments Medial collateral Lateral collateral Prevents subluxation to side |
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Anterior and posterior knee stability |
Ligaments Anterior cruciate: crosses in middle, lose stability anteriorly if damaged Posterior cruciate: lose stability posteriorly if damaged |
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Knee landmarks |
Quadriceps: anterior, look here for symmetry Tibial tuberosity: bump under patella |
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Inspect knees |
Shape and contour: normal hollows beside patella Note inflammation or deformities (absence of hollows) Assess quadriceps for atrophy, r/t decreased nerve innervation |
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Palpate knees |
While supine Start high above patella Medial and lateral joint lines |
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Meniscus tear |
Tenderness at medial and lateral joint lines |
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ROM of knee |
Flexion and extension Note pain with movement Crepitus may be present in some asymptomatic knee |
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Effusions of knees |
Bulge sign Ballotment of patella |
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Bulge sign |
Push on one side of knee and see fluid bulge on other side Detects 4-8 ml of fluid |
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Ballotment of patella |
Effusion Milk fluid toward knee Push down on patella Positive test if you hear the patella tap against femur |
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Assess meniscus |
McMurray's test: flex and externally rotate hip, push the leg into full extension, a snap may be heard or felt if meniscus tear present Assess for medial or lateral joint line tenderness |
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Assess ACL |
Drawer test Lackman's test |
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Anterior drawer |
Try to pull lower leg outward while knee is in flexed position Positive if laxity is present |
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Posterior drawer |
Push lower leg backward while nee in flexed position Positive if laxity is present |
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Lackman's test |
Test while leg is in extension Push down on thigh as you pull up on lower leg Positive is laxity is present |
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Ankle and foot |
Tibiotalar joint Articulation of tibia, fibula, talus |
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Ankle landmarks |
Bony prominence on each side of ankle Medial malleolus Lateral malleolus Most feet have a longitudinal arch |
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Inspect ankles |
While sitting, standing, walking Toes should lie flat |
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Hammer toes |
Hyperextension of MTP and flexion of POP More common with high arch Aggrivated by narrow toe box |
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Claw toes |
Curl underneath, overlap Causes pressure points |
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Hallux valgus |
Bunion Lateral deviation of toes Caused by narrow shoes Need surgery to correct |
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Weight bearing of feet and ankles |
Should fall on the middle of the foot Supinated or pronated |
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Pronated |
Strike of heel on ground is concentrated on inside of the foot Ankles appear to turn inward |
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Supinated |
Strike of heel on the ground is concentrated on the outside of the foot Andles appear to turn outward |
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ROM of ankle |
Inversion, eversion Dorsiflexion, plantar flexion |
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Dorsiflexion |
Foot up |
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Plantar flexion |
Food down AKA foot drop |
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Ankle sprain |
Typically caused by inversion of ankle/foot |
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Examine spine |
Examine while standing Note symmetry of shoulders, scapulae, iliac crests, gluteal folds when knees and feet are together |
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Spine landmarks |
C7 T7 L4 S2 |
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C7 |
Vertebral prominens Base of skull |
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T7 |
Inferior angle of scapula Lower shoulder blade |
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L4 |
Crosses the highest point on each iliac crest |
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S2 |
Crosses two symmetric dimples over posterior superior iliac spines |
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Curves |
Four curves Cervical Thoracic Lumbar Sacral |
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Scoliosis |
Lateral curvature of thoracic and lumbar spine Note asymmetry of shoulders, scapulae, iliac crests when bending forward |
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Kyphosis |
Enhanced thoracic curve Hunch back Women > men Osteoporosis |
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Lordosis |
Enhanced lumbar curve Sway back |
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Asymmetric gluteal folds |
Uneven leg length Measure leg length anterior iliac spine to medial malleolus |
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Palpate spine |
Palpate processes and paravertebral muscles Should be no tenderness or spasm |
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ROM of spine |
Flexion: bending forward Extension: bending backward Lateral bending Rotation |
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Straight leg raise |
Pt raises leg without resistance Positive sign: pain shoots down buttcks and leg past knee Indicates herniated nucleus pulposus or L4, L5, S1 nerve root irritation |
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Children |
Grow at epiphyses (growth plates) Trauma here can cause growth or bone deformity |
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Long bones |
Continue to grow until age 20 |
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Preschool |
Lordosis common Observe for genu varum or genu valgum Appear flat footed: fat pad along arch until 3 Walks with broad based stance: until age 3 Toeing in: common until age 3 Check for trendelenburg sign |
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Genu varum |
Bow legs |
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Genu valgum |
Knock knees |
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Adolescents |
Scoliosis screening at age 12 |
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Pregnancy |
Progressive lordosis Anterior cervical flexion, kyphosis, shoulder slumping of shoulder girdle by third trimester May cause median and ulnar nergve impingement in upper extremities |
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Aging adult |
Osteoporosis Height decreases Loss of subcutaneous fat from bony prominences Loss of muscle mass |
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Osteoporosis |
Loss of bone matrix Women > men White > black |
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Height loss |
Decreases up to 2 inches Discs thin and collapse between 6 and 7th decade Kyphosis of spine occurs with backward head tilt Hips and knees flex |
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Black population |
Longer, denser bones Less incidence of osteoporosis |
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Asians/Eskimo population |
Lower bone density than white or black population |
