Musculoskeletal Assessment 3/23/09 Assessment o Overall appearance How does the pt look in general?

l? Look at facial expressions, interactions with others, etc. o Posture- look at normal curvature of the spine Kyphosis- increased forward curvature of the spine (usually in the old) Lordosis- swayaback, exaggeration of the L spine (usually in pregnancy) Scoliosis- lateral curving deviation of the spine o Gait & Mobility- Watch them walk (usually from behind) o Bone Integrity- Look for obvious deformities Crepitus- grating sound at the point of the abnormal motion (your knees cracking when you bend them, etc) o Muscle strength & Tone- Look at their ability to change position Clonus- rhythmic contraction of the muscle or muscle groups Fasciculations- any involuntary twitching of the muscles o Skin- Check for edema, temperature, and color o Joint Size & Mobility- Look at ROM (Range of Motion) DJD- Degenerative Joint Disease (Osteoarthritis). Most common form of joint disease Main places are at ankle, knee, wrist, neck, hip, and spine. Contracture- abnormal shortening of the muscle or joint; leading cause is immobility Effusion- the excessive joint fluid that escapes from its natural vessels into a body cavity Sx- causes the joint to be warm and inflamed Most Common Site- knee Subluxation- when your joints our out of their usual spot, like when you dislocate your shoulder ROM Maximum amount of movement available to a joint. Measured in degrees. Assessment- look for stiffness, swelling, pain, limited or unequal movement. Does one arm move more than the other, etc? Diarthroses (synovial)- freely moveable. Hip, knee, ankle Amphiarthrioses- slightly moveable. Pubic bone and vertebrae Synarthroses- not moveable. Skull, distal ends of radius and ulna Joint Motion Flexion- bending Extension- straightning

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Hyperextension- moving beyond normal Abduction- away from the midline Adduction- towards the midline RotationCircumdution- cone like movement (shoulder) Suppination- turning upward. I always remember that to hold soup in your hand, you have to hold your hand like a bowl. Your palm is face up. To hold soup, your hand has to be supine! Pronation- turning downward Inversion- toward Eversion- outward

Pain Neurovascular Status- Sensation of pt CMS (Circulation, Motion, and Sensation) Frequent checks Compartment Syndrome What is it? o Major NV (neurovascular) problem caused by pressure w/i the muscle compartment from swelling mainly due to a crushingtype injury. (LOOK IN BOOK FOR WHAT THIS SAYS) What are the symptoms? o First symptom is pain. Then pain, numbness, tingling, loss of movement in the extremity. Think about what would happen if you were wearing shoes that were too tight. What is the treatment? o Fasciotomy- long surgical incision made in the fascia to relieve the pressure building inside the compartment. Fascia is the coating around the muscles. Gerontological Considerations Osteoporosis- abnormal loss of bone (at 35 you peak and start loosing bone) Metabolic Changes o Menopause- estrogen protects you against bone loss. When you stop making estrogen, you lose that protection against bone loss. o Decreased thyroid Function- Hyperthyroidism causes it. They start off with low levels (hypo) of thyroid hormone and get put on medication that raises it. The medication raises their levels into hyperthyroidism (high), and the high levels cause the osteoporosis. Osteoarthritis- hardening of the bone

Loss of muscle mass and strength. The older you get you lose muscle fibers. Also caused immobility and loss of movement. Nutritional Deficiencies- when they cant eat, cant afford the food, or dont eat a nutritionally balanced diet. Diagnostic Evaluation Imagine Procedures Bone X-Rays- determine the bone density, texture, erosion, and changes. Pt cant move, like when they make you hold your breath in a Chest X-Ray. CT Scan- detect tumors or soft tissue or ligament/tendon injuries MRI- Magnetic Resonance Imaging. You cant have metal, stints, pacemakers. Its better to be safe than sorry. You cant have the pain pumps that go in the spine. They are careful with welders or people around a lot of metal. Also, phones and watches have to be outside of the area. Arthrography- identifies acute or chronic tears of the joint capsule or ligaments. Bone Density Test- X-rays or ultrasound. Determines bone general density at wrist, hip, or spine to estimate the extent of osteoporosis. Tells how crappy your bones are. Nuclear Studies o Bone Scan- performed to detect Metastatic and Primary bone tumors. Also osteomyelitis (inflammation of the bone due to infection), some fractures, and aseptic necrosis ( a condition where poor blood supply to an area of bone leads to bone death). Endoscopic Studies- Physicians can repair tears and defects with this. Also used to assist in major surgeries. o Arthroscopy Other Studies o Arthrocentesis- joint aspiration (getting synovial fluid for evaluation). Looking for inflammatory problems. o Electromyography (EMG)- provides information about the electrical potential of muscles and nerves of an extremity. They put needles down in your muscles and send down electricity to see if your muscles contract. o Biopsy- done to determine structure and identification of certain disease (usually cancer). You have a growth and they cut it out to see what it is. Laboratory Studies

UA- look at pee to see if there is infection and kidney disease and DM (Diabetes Mellitus) CBC (Complete Blood Count)- look for infection and bleeding Blood Chemistry o Serum Calcium- can be altered with bone disease and different conditions a pt may have Thyroid Function- can evaluate bone metabolism Alkaline Phosphates- elevated during early fracture healing and in metastatic disease.

Soft tissue tests- MRI and CT scans Electrolyte altered in bone malignancies- calcium Prevent contractures? Range of motion