Cne Pa: Musculoskeletal

Front 1

purpose of musculoskeletal system

Back 1

1. support the erect body
2. movement
3. encase & protect vital organs
4. produce RBCs in bone marrow
5. storage of certain minerals

Front 2

how many bones in the body?

Back 2

206

(about half are in hands & feet)

Front 3

3 types of joints

Back 3

1. synovial
2. cartilaginous
3. fibrous

Front 4

synovial joints

Back 4

- most common (exs: hip, shoulder, knee)
- freely mobile
- covered by ARTICULAR CARTILAGE
- bones are separated by SYNOVIAL CARTILAGE (don't touch each other) --> cushions joint movement
- SYNOVIAL MEMBRANE lines synovial cavity & secretes small amount of viscous, lubricating synovial fluid
- JOINT CAPSULE surrounds synovial membrane --> strengthened by surrounding ligaments

Front 5

cartilaginous joints

Back 5

- ex: spine
- slightly moveable
- FIBROCARTILAGINOUS DISCS separate bony surfaces
- at the center of discs is NUCLEUS PULPOSUS = fibrocartilaginous material that acts as cushion/shock absorber

Front 6

fibrous joints

Back 6

ex: sutures in skull
- bones are in direct contact
- no appreciable movement

Front 7

types of synovial joints (movements and examples of each)

Back 7

1. spheroidal (ball & socket) --> wide-ranging flexion, extension, abduction, adduction, rotation, circumduction
ex: shoulder, hip

2. hinge --> motion in one plane - flexion, extension
ex: interphalangeal joints, elbows

3. condylar --> movement of 2 articulating surfaces not disocciable
ex: knee, TMJ

Front 8

bursae

Back 8

synovial sacs that allow adjacent muscles or muscles & tendons to glide over each other during movement

Front 9

ligaments

Back 9

ropelike bundles of collagen fibrils that connect BONE TO BONE

Front 10

tendons

Back 10

collagen fibers connecting MUSCLE TO BONE

Front 11

pronation vs supination

Back 11

pronation = turning forearm so palm faces down

supination = turning forearm so palm faces up

Front 12

eversion vs inversion

Back 12

eversion = moving sole of foot outward

inversion = moving sole of foot inward

Front 13

anatomy of temporomandibular joint

Back 13

- most active joint in body
- condylar synovial joint
- articulation of temporal & mandible bones
- can protract, retract, open & close, and move side-to-side
- sometimes tenderness/swelling and decreased ROM is seen in this joint w/ inflammation or arthritis

Front 14

anatomy of glenohumeral joint

Back 14

(shoulder)
- articulation of humerus & scapula
- ball & socket synovial joint
- ROTATOR CUFF = joint enclosed by 4 powerful muscles & lots of tendons that support it
- has lots of & very large bursae --> bursitis may develop (pain when raising arm up)

Front 15

how to palpate shoulder joint

Back 15

- CN 11 test assess muscles surrounding joint
- inspect both anteriorly and posteriorly
- put hand on shoulder & axilla to feel for crepitus
- have pt move arms forward and up (forward flexion), arms behind back (hyperextension), arms to sides and over head (abduction & abduction), touch hands behind head (external rotation)

Front 16

elbow joint

Back 16

- articulation between humerus and radius & ulna
- synovial hinge joint
- has very large bursa
- elbow stabilizes forearm and hand movements
- ulnar nerve runs by medial epicondyle posteriorly --> "funny bone"

Front 17

anatomy of wrist joint

Back 17

3 types of joints:
1. metacarpophalangeal joint
2. PIP
3. DIP

lots of tendons:
- 6 extensor tendons
- 2 flexor tendons
- pass through wrists and attach to fingers

nerves:
- median nerve provides sensation to palmar surface of thumb, 2nd & 3rd digits, most of 4th, and palm of hand

Front 18

phalen's test

Back 18

have pt but backs (dorsal surfaces) of hands together, hold for 60 seconds, and see if they feel any numbness

--> if yes, median nerve is getting compressed in sheath (abnormal finding) - indicates carpal tunnel syndrome

Front 19

tinel's sign

Back 19

tap along median nerve at palmar side of wrist to see if there's any numbness

Front 20

osteoarthritis (aka degenerative joint disease)

Back 20

- cartilage of joints goes through destruction w/ age; begins in middle aged people
- hard, nontender nodules about 2-3 mm in size
- Heberden's nodules & Bouchard's nodes
- effects DIP & PIP (MCP joints are spared)

Front 21

Heberden's nodules vs Bouchard's nodes

Back 21

both seen in osteoarthritis/degenerative joint disease

Herberden's:
- bony nodules over DIP
- very common

Bouchard's:
- nodes on PIP
- less common

Front 22

rheumatoid arthritis

Back 22

- autoimmune disease
- synovial membrane becomes inflamed and there's erosion & overgrowth of fibrous tissue
- joints are reddened, painful, warm to touch
- effects all joints (DIP, PIP, MCP)
- Boutonniere deformity
- Swan neck deformity
- ulnar deviation of MCP (muscle atrophy)

Front 23

boutonniere deformity vs swan neck deformity

Back 23

boutonniere:
- hyperextension in DIP
- flexion of PIP

swan neck:
- flexion of DIP
- hyperextension of PIP

Front 24

anatomy of knee joint

Back 24

- 2 articulations:
a) b/w femur & tibia (NOT fibula)
b) b/w femur & patella
- largest synovial cavity in body --> suprapatellar pouch
- cushioned by medial & lateral menisci (lateral & medial stability)
- stabilized by cruciat ligaments (anterior & posterior stability)

Front 25

ankle joint

Back 25

- articulation of fibia, tibia, and talas
- can do flexion & extension

Front 26

dorsiflexion vs plantar flexion

Back 26

dorsiflexion = flexing feet back w/ toes upward

plantar flexion = pointing toes & feet downward

Front 27

anatomy of spine

Back 27

- cartilaginous joint
- trapezius & latissimus dorsi muscles form lateral muscles of spine
- C7 and T1 are prominent vertebrae felt at base of neck
- scapula hits spine around T7/T8
- 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, 3-4 bones in coccyx

Front 28

Are there more bones in adult or child's skeleton?

Back 28

child's

Front 29

Are ligaments, tendons, or bones stronger in children?

Back 29

ligaments & tendons are stronger than bone until puberty

Front 30

What is responsible for the closure of epiphyseal plates?

Back 30

sex hormones are responsible for closure of epiphyseal plates (this ends longitudinal bone growth)

Front 31

development of spine

Back 31

- at birth spine is a single C-shaped curve
- anterior curve in the CERVICAL region develops at 3-4 months
- posterior curve in the LUMBAR region develops at 12-18 months

Front 32

musculoskeletal assessment in infants

Back 32

- inspect spine for abnormalities/scoliosis
- palpate clavicles
- assess feet for metatarsus adductus (incurving of feet) and/or clubfoot (talipes equinovarus)
- galeazzi test (supine w/ knees bent --> assessing difference in knee height)
- assess hips for congenital hip dislocation