MUSCULOSKLETAL.pptx for bsn students year 1

Bsn

1. PROF. ROBERTO B. AGRAVANTE JR RN. Class Instructor ASSESSMENT OF THE SKELETAL SYSTEM

2. At birth the human skeleton is made up of around 300 bones . By adulthood , some bones have fused together to end up with 206 bones . Human bones grow continually from birth till our mid 20's. Our skeleton's bone mass is at its maximum density around the age of 30. The longest bone in the human body is the thigh bone called the femur. elc

3. What is a Skeleton? Greek Word: “Skeletos” = Dried Up It is the supporting structure (framework) of the human body SKELETAL SYSTEM elc

4. Functions of Skeletal System Support Protection Movement Storage Blood Cell Production Triglyceride (fat) storage Hormone production Osteocalcin

5. Gross Anatomy of the Skeletal System elc

6. How many bones does an average adult has? Head 22 Ears 6 Neck 1 Spine 26 Chest 25 Upper limb +Girdle 64 Lower Limb + Hips 62 Total 206

7. Bone Classification: accdg to SHAPE Long Flat Irregular Short elc

8. Divisions of the Skeletal System elc

9. Axial Skeleton consists of the bones of the head and trunk of a vertebrate In the human skeleton, it consists of 80 bones in total composed of six parts the skull bones the ossicles of the middle ear he hyoid bone the rib cage sternum and, the vertebral column

10. Appendicular Skeleton

11. Appendicular Skeleton The appendicular skeleton is the portion of the skeleton of vertebrates consisting of the bones that support the appendages / limbs.  composed of 4 regions of bones pectoral girdle (clavicle and scapula) Upper limbs (arm, forearm, hand) pelvis Lower limbs (thigh, leg, foot)

12. Pectoral Girdle Girdle Something that surrounds or circles around something else Pectoral Girdle Shoulder girdle It supports your shoulder, encourages a full range of motion, and protects your nerves and blood vessels that pass between the trunk of your body and your upper limbs. Your clavicle provides the only direct connection between your pectoral girdle and axial skeleton. elc

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14. Upper Limbs / Upper Extremities Humerus Radius and Ulna Carpal,Metacarpals and Phalanges Function: Movement Composed of three parts: Brachium (Arm) Antebrachium (Forearm) Manus (Hand) elc

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16. Pelvis the entire structure formed by the two hip bones, the sacrum, and, attached inferiorly to the sacrum, the coccyx Function: protects the delicate organs of the abdominopelvic cavity while anchoring the powerful muscles of the hip, thigh, and abdomen elc

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18. Male Pelvis Female Pelvis (Android) (Gynecoid) elc

19. Difference of Male and Female Pelvis elc

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22. Lower Limbs / Lower Extremities Function: Movement, Weight Bearing, Support Composed of: Thigh Knee Leg Foot Femur Patella Fibula and Tibia Tarsals, Metatarsals and Phalanges elc

23. In Summary… The appendicular skeleton is the portion of the skeleton of vertebrates consisting of the bones that support the appendages / limbs.  composed of: pectoral girdle (clavicle and scapula) Upper limbs (Humerus, Radius, Ulna, Carpal, Metacarpal, Phalanages) Pelvis Lower limbs (Femur, Patella, Tibia and Fibula, Tarsal, Metatarsal and Phalanges) elc

24. Joints elc

25. Joints Articulation / Arthrosis is the connection made between bones in the body which link the skeletal system into a functional whole. Function: connect bones within the body bear weight enable mobility Provides stability elc

26. Joint Classification Function based on the amount of movement allowed at the joint Synarthrosis Amphiarthrosis Diarthrosis Structure Classified according to the type of connective tissue that binds the bones together and if there is a fluid Fibrous Cartilaginous Synovial elc

27. Joint Classification accdg to FUNCTION Synarthrosis syn = together, arthro = joint Immovable joint Amphiarthrosis amphi = on both sides Slightly movable joint Diarthrosis dia = through, apart Movable joint elc

28. Joint Classification accdg to Structure: FIBROUS JOINT Bones are joined by the collagen fibers of connective tissue. No joint cavity is present. The amount of movement allowed depends on the length of the connective tissue fibers. Most fibrous joints are immovable, a few are slightly movable. elc

29. Joint Classification accdg to Structure: CARTILAGINOUS JOINT Unite two bones by means of cartilage lacks a joint cavity not highly movable elc

30. Joint Classification accdg to Structure: SYNOVIAL JOINT are joints in which the articulating bones are separated by a fluid-containing cavity This arrangement permits substantial freedom of movement Most joints of the appendicular skeleton are synovial joints elc

31. Types of Synovial Joint elc

32. 6 types of Synovial Joints Plane Joint (Gliding) Hinge Joint Pivot Joint Saddle Joint Ellipsoid Joint (Condyloid) Ball-and-socket Joint elc

33. Plane Joint Gliding Joint Consists of two articular surfaces that glide over each other. Movement: Uniaxial (Gliding) Slipping movement only, no axis around which movement can occur.   Examples: Vertebral Articular Surfaces Intercarpal Joints Intertarsal Joints elc

34. Hinge Joint Consists of a convex cylinder of one bone applied to a corresponding concavity of the other bone Movement: Uniaxial (Flexion and Extension) Occuring around one axis, movement only in one plane. Examples: Elbow and Knee joint Interphalangeal joint elc

35. Pivot Joint Consists of a cylindrical bony process that rotates within a ring composed partly of bone and ligament Movement: Uniaxial (Rotation) Occuring around one axis, movement only in one plane. Examples: Proximal Radioulnar joints Antlantoaxial joint elc

36. Saddle Joint Consists of two saddle-shaped articulating surfaces oriented at right angles to each other Movement: Biaxial (Adduction, abduction, flexion and extension) Occuring around 2 axes at right angles to each other. Examples: Carpometacarpal joint of the thumb Intercarpal joints elc

37. Ellipsoid Joint Condyloid Joint Articular surfaces are ellipsoid instead of spherical; range of motion limited almost to hinge and restricts rotation  Movement: Biaxial (Adduction, abduction, flexion and extension) Examples: Metacarpophalageal Joint Wrist Joint elc

38. Ball-and-Socket Joint Consists of a ball (head) at the end of one bone and a socket in an adjacent bone into which a portion of a ball fits Movement: Multiaxial (Adduction, abduction, flexion and extension) Examples: Shoulder (glenohumeral) Joint Hip (coxal Joint elc

39. Types of Movement elc

40. Types of Movement Gliding Angular Rotation Special Movements Gliding occurs when one flat, or nearly flat, bone surface glides or slips over another without appreciable angulation or rotation. Gliding occurs at the intercarpal and intertarsal joints, and between the flat articular processes of the vertebrae elc

41. Types of Movement Gliding Angular Rotation Special Movements Flexion Dorsiflexion Plantar Flexion Extension Hyperextension Abduction Adduction Circumduction elc

42. Types of Movement Gliding Angular Rotation Special Movements The turning of a bone around its own long axis. elc

43. Types of Movement Gliding Angular Rotation Special Movements Supination and Pronation Inversion and Eversion Protraction and Retraction Elevation and Depression Opposition and Reposition Excursion elc

44. Types of Movement Supination and Pronation Inversion and Eversion Protraction and Retraction Elevation and Depression Opposition and Reposition Excursion - Unique to the fingers - Unique to the mandible elc

45. Types of Movement Supination and Pronation Inversion and Eversion Protraction and Retraction Elevation and Depression Opposition and Reposition Excursion - Unique to the fingers - Unique to the mandible elc

46. Major Joints of the Human Body Temporomandibular Joint (TMJ) Sternoclavicular Joint Elbow Joint Shoulder Joint Wrist, Fingers and Thumb elc

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48. Major Joints of the Human Body Temporomandibular Joint (TMJ) Sternoclavicular Joint Elbow Joint Shoulder Joint Wrist, Fingers and Thumb Vertebrae Hip Knee Ankle and Foot elc

49. In Sumarry… Articulation / Arthrosis is the connection made between bones in the body which link the skeletal system into a functional whole. Function: connect bones within the body bear weight enable mobility Provides stability elc

50. In Summary… Classified in 2 ways Function: Synarthrosis, Amphiarthrosis, Diarthrosis Structure: Fibrous, Cartilaginous, Synovial Fibrous: Sutures, Syndesmoses, Gomphoses Cartilaginous: Synchondroses, Symphises Synovial: Plane, Hinge, Pivot, Saddle, Ellipsoid, Ball-and-socket Joints allow variety of movements elc

51. Muscular System elc

52. Muscles came from the Latin word “ mus” = little mouse Muscles make up about 40-50% of body weight Muscles are distinguished by their ability to transform chemical energy (ATP) into directed mechanical energy. elc

53. Functions Movement Maintenance of Posture Respiration Production of Body Heat elc

54. Characteristics Excitability Contractility Extensibility Elasticity elc

55. Skeletal Muscle - Voluntary - Striated - Attached to bones Cardiac Muscle - myocardium - unique to the heart - involuntary - striated - connected by intercalated disks Smooth Muscle - visceral - non-striated - involuntary - autorhythmic elc

56. Muscles of Facial Contraction Mastication and Swallowing Eye Respiration Muscles important to nursing elc

57. Facial Muscles elc

58. Facial Muscles Occipitofrontalis Corrugator Supercilii Orbicularis Oculi Orbicularis Oris Buccinator Zygomaticus Levator Labii Superioris Depressor Anguli Oris Eyebrows and scalp Eyebrows (angry) Eyelids and surrounding structure Lip movement Cheeks (blowing/whistling) Smiling and laughing Upper lip movement Depresses the corner of the mouth elc

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60. Mastication Temporalis Masseter Lateral Pterygoid Medial Pyerygoid elc

61. Swallowing Tongue Muscles Intrimsic and Extrinsic Hyoid Muscles Suprhyoid and Infrahyoid Soft Palate Pharangeal Muscles Elevators, Constrictors Superior, Middle Inferior elc

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63. Muscles of the Eye Superior Rectus Inferior Rectus Medial Rectus Lateral Rectus Superior Oblique Inferior Oblique Upward Downward Medial Lateral Rotates on its axis Rotates on its axis elc

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65. Muscles of Respiration External Intercostal Muscles Internal Intercostal Muscle Diaphragm Pulls / elevates the ribs Retracts / depresses the ribs Prime mover of inspiration elc

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67. Muscles Important to Nurses Deltoid Vastus Lateralis Ventrogluteal Gluteus Medius Dorsogluteal elc

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69. Interaction of Muscles for Movement Agonist muscle that accomplishes certain movement Antagonist Muscle acting opposition to an agonist Syngergist Group of muscles working together to create a movement Prime mover – the primary muscle for movement Fixators Muscles that holds the bone in place elc

70. Collection of Subjective Data Present Health History Pain (i.e joint pain) Weight gain Past Health History Existence of Co-morbidities History of trauma/fall/injury Immunization Medications Previous Diagnostic/Lab Results Family Health History History of Arthritis/osteoporosis Lifestyle Diet Smoke Exposure to environemental hazards Activity, exercise, rest and sleep pattern Use of other complimentary therapies elc

71. Assessment of Musculoskeletal System: Objective Data Posture and Gait Appearance and Symmetry (Inspect and Palpate) Pain Muscle Strength Range of Motion elc

72. Muscle Strength Against applied resistance Against gravity Move passively Inspect and feel for a palpable contraction of the muscle while the client attempts to move it. Compare bilateral findings elc

73. Range of Motion Demonstrate how. Ask client to redemonstrate Measure ROM using goniometer Compare bilateral findings elc

74. Focus Assessment Posture and Gait Temporomandibular Joint Sternoclavicular Joint Cervical Thoracic and Lumbar Shoulder Elbow Wrists Hands and Fingers Hips Knees Ankle and Foot elc

75. Focus Assessment: Posture and Gait Nudge Test elc

76. Focus Assessment: TMJ and Sternoclavicular Joint Inspect Assess for Pain ROM elc

77. Focus Assessment: Cervical Thoracic and Lumbar Inspect Curvatures Palpate for pain, bulges, etc ROM elc

78. Focus Assessment: Cervical Thoracic and Lumbar Inspect Curvatures Palpate for pain, bulges, etc ROM elc

79. Focus Assessment: Shoulder, Arms, Elbow Inspect for appearance Assess for Pain ROM elc

80. Focus Assessment: Shoulder and Arms Inspect for appearance Assess for Pain ROM elc

81. Focus Assessment: Elbow Inspect for appearance Assess for Pain ROM elc

82. Focus Assessment: Wrist Inspect for appearance Assess for Pain Squeeze Test Palpate Anatomic Stuff Box ROM elc

83. Focus Assessment: Wrist, Carpal Tunnel Syndrome Carpal Tunnel Syndrome A condition when one of the major nerves to the hand — the median nerve — is squeezed or compressed as it travels through the wrist resulting to pain, numbness, and tingling in the hand and arm. elc

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85. Test of Carpal Tunnel Syndrome Phalen Test Tinel Test Flick Signal Thumb Weakness elc

86. Focus Assessment: Hands and Wrist Inspect Assess for Pain ROM elc

87. Focus Assessment: Hips Inspect symmetry Assess for Pain ROM elc

88. Focus Assessment: Hips Inspect symmetry Assess for Pain ROM elc

89. Focus Assessment: Knees Inspect appearance Assess for Pain Bulge Test Ballotement Test McMurray Test ROM elc

90. Focus Assessment: Ankles and Feet Inspect appearance Assess for Pain Squeeze Test ROM elc

91. Disease in Focus Abnormal Spinal Curvatures Bone Cancer Fracture Osteoporosis Rickets Rheumatoid Arthritis Ostearthritis Gouty Arthritis elc

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93. What happens when there is a fracture? elc

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95. Fracture Broken Bone Can be: Closed or Open (Compound) Simple or Comminuted Complete or Incomplete Impacted elc

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97. Osteoporosis  is a bone disease that occurs when the body loses too much bone, makes too little bone, or both. As a result, bones become weak and may break from a fall or, in serious cases, from sneezing or minor bumps. Osteoporosis  means “porous bone.” elc

98. Calcium Homeostasis elc

99. Vitamin D Deficiency Vitamin D is a fat-soluble vitamin Vitamin D is commonly known as ergocalciferol (Vitamin D2) and cholecalciferol (Vitamin D3).Vitamin D2 and D3 are broken down to their active form, calcitriol, in the body. Calcitriol works by increasing absorption of calcium and phosphorus in the body. It is produced by the body in response to skin being exposed to sunlight. It is also occurs naturally in a few foods -- including some fish, fish liver oils, and egg yolks -- and in fortified dairy and grain products. elc

100. Vitamin D Deficiency: Rickets Rickets  is the softening and weakening of bones in children due to poor bone mineralization, usually because of an extreme and prolonged vitamin D deficiency. elc

101. Joint Problems Arthritis Osteoarthritis (OA) Rheumatoid Arthritis (RA) Gout/Gouty Arthritis (GA) elc

102. Joint Problems Arthritis Osteoarthritis (OA) Rheumatoid Arthritis (RA) Gout/Gouty Arthritis (GA) elc

103. Joint Problems Arthritis Osteoarthritis (OA) Rheumatoid Arthritis (RA) Gout/Gouty Arthritis (GA) elc

104. Arthritis Osteoarthritis (OA) Rheumatoid Arthritis (RA) Gout/Gouty Arthritis (GA) elc

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110. Prepare your 1/4 sheet of paper and your pen for a quiz. Write your name, section and date today. Erasure means wrong. Wrong spelling is wrong. elc