muscluskeletal assessment...........pptx

muscluskeletal assessment

1. RUSHIKESH HANGE FINAL YEAR BASIC BSC NURSING ASSESSMENT OF MUSCULOSKELETAL SYSTEM

2. Musculoskeletal System A t t h e e n d o f t h e ch a p t e r , t he s t u d e n t w ill be able to: Obtain the primary structures of the musculoskeletal system. Enumerate functions of the musculoskeletal system Assess muscle, bones, and joint of musculoskeletal system. Discuss Joint Movement: Range of Motion (ROM) Document objectives and subjective data of musculoskeletal system.

3. Musculoskeletal System Outlines: Structures of the musculoskeletal system Functions of the musculoskeletal system Assess muscle, bones, and joint Joint Movement: Range of Motion (ROM) Objectives and subjective data of musculoskeletal system

4. Musculoskeletal System The pr i m ary s t ruct u r es o f t he mu s c u l o s k eletal system are Bones Muscles Cartilage Ligaments Tendons Joints.

5. Bones The 206 bones that comprise the human skeleton are classified according to: Location: 80 form the axial skeleton (the vertical axis) which consists of skull, vertebral column, ribs and sternum, 126 form the appendicular skeleton (the free appendages and their attachments to the axial skeleton) that consists of the upper and lower extremities, the shoulders and the pelvis.

6. Bones Shape: Long bones (e.g., femur) Short bones (e.g., metacarpals) Flat bones (e.g., sternum) Irregular bones (e.g., vertebrae) Structure: Cortical or cancellous

7. Musculoskeletal System Muscles : skeletal, cardiac, and smooth Tendons: a strong fibrous cord, attach the skeletal muscle to bone. Ligaments : are fibrous bands running directly from one bone to another that strengthen the joint and help prevent movement in undesirable directions.

8. Joints: are the places of union of two or more bones. Joints are the functional units of the musculoskeletal system because they permit the mobility needed for Activities of Daily Living (ADLs). Cartilage : joints, elastic fi b rocart i lage ( i n tervert e bral (outer discs ) . e a r) , T he c a rtil a ge cushi o ns the b o n e s and gives a smooth surface to facilitate movement.

9. Functions of the musculoskeletal system Support Supports the body Provides framework for the body Gives shape to the body Protection Protects vital organs Protects soft tissues

10. Functions of the musculoskeletal system 3. Movement Provides locomotion (walking, movement) by attachment of muscles, tendons, and ligaments Hematopoiesis Produces red blood cells Produces white blood cells Produces platelets Storage Provides calcium Provides phosphorus

11. Movements of musculoskeletal system (ROM) Flexion : bending a limb at a joint Extension : straightening a limb at a joint Abduction : moving a limb away from the midline of the body Adduction : moving a limb toward the midline of the body P r o n a t i o n : t u rning t h e f o rearm so t h e palm is down Supination: turning the forearm so the palm is up

12. Movements of musculoskeletal system (ROM) Circumduction : moving the arm in a circle around the shoulder Inversion : moving the sole of the foot inward at the ankle Eversion : moving the sole of the foot outward at the ankle Rotation : moving the head around a central axis Protraction : moving a body part forward and parallel to the ground

13. Movements of musculoskeletal system (ROM) part Retraction : moving a body backward and parallel to the ground Elevation : raising a body part Depression : lowering a body part

14. R O M

15. Musculoskeletal Assessment Subjective data Joints: Pain, stiffness, swelling, heat, and limitation of movement. Muscles: Pain (cramps), and weakness Bones: Pain, deformity, and trauma (fractures, sprains, dislocations). Functional assessment (Activity of daily living ADL ): Any self-care deficit in bathing, toileting, dressing, grooming, eating, communicating, mobility, and use of mobility aids. Patient-centered care: Occupational hazards, heavy lifting, repetitive motion to joints, nature of exercise program, and recent weight gain

16. Objective data Inspection and palpation of joints integrated with each body region Observation of range of motion (ROM) as person proceeds through motions necessary for an examination Age-specific screening measures, e.g., scoliosis screening for adolescent

17. Components of Health History: Typical musculoskeletal complaints include pain, loss of function, joint instability or stiffness, loss of sensation, or a newly discovered deformity. An acute condition alerts the provider to a different set of differential diagnoses than a chronic condition. Acute conditions involving trauma are suggestive of a fracture, dislocation, or rupture of tissue. Mechanism of injury (twisting, blunt force, height of fall). Time of when pain occurs. Location or distribution of pain.

18. Perform physical assessment 1. Inspection: Inspection should assess for: Size - Contour - Symmetry - Involuntary movements - Swelling/edema (effusions, (tremors) De f o r m ities (, dislo ca tion) hematoma) Discoloration (vascular insufficiency, bruising, hematoma) Hypertrophy/atrophy of muscles (steroid use, malnutrition) Posture and body alignment Structural relationships Scars indicating any previous surgery or trauma Condition of skin (pressure sores, necrosis, scarring)

19. 2. Palpation: Palpate joints, bursal sites, bones and surrounding muscles. Assess the patient for both verbal and non-verbal cues of pain. Ask the patient, Does the pain radiate elsewhere from the initial region?‘

20. Palpation should assess for the following: Increased temperature (use the back of the hand above, below and on the joint and compare with the other side) Swelling/edema Tenderness Crepitus (osteoarthritis, listen for crepitus as well as feeling) Consistency and tone of muscle

21. Range of movement (ROM) Assess the degree of deviation away from the neutral position. A goniometer should be used to obtain an accurate range of movement (a device that measures the angle of a joint in degrees) Active ROM involves the patient moving the joint himself. Movement should be smooth and pain free. Passive ROM involves you providing motion in order to move the joint.

22. Assessment of Spine Normal curvatures at the spine are concave at the cervical region, convex at the thoracic region and concave at the lumbar region.

23. Palpate along the clavicles and manubrium of the sternum. Observe patient as they go through the range of movements: Chin to chest – flexion Raise the head back to the neutral position – Extension Bend the head backwards – Hyperextension Turn head to each side – Lateral rotation Place each ear to each shoulder – Lateral bending Scoliosis : a lateral curvature of the spine Lordosis : an exaggerated lumbar curvature (can be normal during pregnancy& in obese) Kyphosis : a rounded thoracic; common in osteoporotic women

24. Test for lordosis Have the patient stand against a wall and flatten her or his back against it while you attempt to slide your hand behind patient‘s back. Alternate way t o test f or lor d osi s : W ith and patient instruct supine p a ti e nt to knees fla t ten slight l y back f l exed, aga i nst m a t t ress while you attempt t o slide hand under back.

25. Assessment of Muscles: 1. Inspect the muscles for size. Compare the muscles on one side of the body (e.g., of the arm, thigh, and calf) to the same muscle on the other side. For any discrepancies, measure the muscles with a tape. Normal : Equal size on both sides of body Abnormal: Atrophy (a decrease in size) or hypertrophy (an increase in size), asymmetry

26. Assessment of Muscles: 2. Inspect the muscles and tendons for contractures (shortening). Normal : No contractures Abnormal: Malposition of body part, e.g., foot drop (foot flexed downward)

27. Assessment of Muscles: 3. Inspect the muscles for tremors, for example by having the client hold the arms out in front of the body. Normal: No tremors Abnormal: Presence of tremor

28. Assessment of Muscles: 4.Test muscle strength . Compare the right side with the left side: Sternocleidomastoid : Client turns the head to one side against the resistance of your hand. Repeat with the other side. Trapezius : Client shrugs the shoulders against the resistance of your hands . Deltoid: Client holds arm up and resists while you try to push it down.

29. Assessment of Muscles: Biceps : Client fully extends each arm and tries to flex it while you attempt to hold arm in extension. Triceps : Client flexes each arm and then tries to extend it against your attempt to keep arm in flexion. Wrist and finger muscles : Client spreads the fingers and resists as you attempt to push the fingers together. Client grasps your index and middle fingers while you try to pull the fingers out.

30. Assessment of Muscles: Hip muscles : Client is supine, both legs extended; client raises one leg at a time while you attempt to hold it down. • Hip a b d ucti o n : Cli e nt is su p ine, b o th legs extended. Place your hands on the lateral surface of each knee; client spreads the legs apart against your resistance. Hip adduction: Client is in same position as for hip abduction. Place your hands between the knees; client brings the legs together against your resistance.

31. Assessment of Muscles: Hamstrings : Client is supine, both knees bent. Client resists while you attempt to straighten the legs. Quadriceps : Client is supine, knee partially extended; client resists while you attempt to flex the knee. Muscles of the ankles and feet : Client Resists while you attempt to dorsiflex the foot and again resists while you attempt to flex the foot.

32. Assessment of Skeleton: Inspect the skeleton for structure. Palpate the bones to locate any areas of edema or tenderness.

33. Assessing for knee deviation: Note position of knees, and draw an imaginary line from the anterior superior iliac crest through the knees to the feet. Imaginary line should transect patella.

34. Tinel’s Test: Percu s s lightly o v e r t h e m edian n e r v e, locat e d on wri s t. If n u m b n ess tingling occur on t h e i n ner aspect o f t h e and the palmar aspect of the wrist and th u m b extend f r om t h e to the se c o n d finger, the test is positive for carpal tunnel syndrome

35. Phalen’s Test Have the patient flex the hands back to back at a 90-degree angle and hold this position for about 1 minute; if the patient complains of numbness or tingling anywhere t h e t h u m b to t h e f r om ri n g fi n ge r , t h e test is positive tu n n e l for carpal syndrome

36. Definitions Hy p e r t r o p h y : refe r s to a n in c rease in m u s cle size and shape due to an increase in muscle fiber. At r o p h y : refers to t h i n , flabby m u s cles du e to a reduction in muscle size and shape. Hy p er t o nici t y : Incre a sed m u s cle t o ne, c a u s es resistance with joint movement. Hypo tonicity refers to a flabby muscle with poor tone. Arthrit i s is a n i n flam m ation o f t h e j o i n ts th a t causes pain and swelling.

37. Thank Y ou