3Functions What are the functions of the………… Bones (206) Structure; protection; produce red blood cell; act as levers; stores calciumMuscles (650)Allow for movement and position; produce heat
4Functions What are the functions of the………… Joints: Point of articulation of two bones; provide ROMTendons:Connect muscle to bone
5Functions What are the functions of the………… Ligaments: Connect bone to boneCartilage:Support and shapes; acts as a shock absorber
6Functions What are the functions of the………… Bursae: Sacs filled with synovial fluid; cushions and reduce friction between joints
7Movements Range of Motion: (ROM) The degree of movement of a joint is called the range of motion. Diarthrotic, or freely movable, joints are the only joints that have one or more ranges of motion.
8MovementsFlexion: Is the bending forward of the joint to decrease the angle between the bones that it connects.Extension: Is the straightening of a limb to increase the joint angle.Abduction: Is the movement of the limb away from the midline of the body.Adduction: Is the movement of the limb toward the central axis of the body.
9MovementsInternal Rotation: Is the turning of the body part inward toward the central axis of the body.External Rotation: Is the turning of the body part away from the midline
10HistoryWhat can a history tell you about the musculoskeletal system?Health HistoryOccupational or recreational activityPrevious occurrence of the following: Musculoskeletal or systemic disease, Injury, Difficulty with joint movement, Tenderness, Erythema, Difficutly with ADL
11History Family History Developmental Considerations Health promotion and protection patternsAbilities to perform ADLs
12History Subjective Data *For any symptom the person has you should ask about ………….LocationQualityQuantityTimingAggravating Factors
13History Subjective Data *For any symptom the person has you should ask about ………….Relieving FactorsAssociated SymptomsEffects on ADLs
14SymptomsWhat symptoms would signal a problem with the musculoskeletal system?Joints: pain, stiffness, heat or limitation of movementBones: pain, deformity, or traumaMuscles: pain, weaknessBalance and coordination problems
16Physical AssessmentPosture: The position the body parts assume in relationship to other body parts. The client/patient posture is upright with good alignment of the head, shoulders, and hips.Spine: Includes having the person stand up straight and then bend forward at the waist.
17Physical Assessment Common Abnormalities: Lordosis (swayback): exaggerated concave curvature of the lumbar spine.Kyposis (hunchback): excessively convex (backward curvature of the thoracic spine).Scoloiosis: abnormal lateral curvature of the spine. Best detected when a person bends at the waist.
22Physical Assessment Palpate the bones, joints and spine for….. TemperatureTendernessSwellingMassesCrepitus: Grating feeling or sound in joint during ROM
23Physical Assessment Palpate joint during ROM Active ROM is voluntary movement of the joints by the person. Should be done first, before testing for muscle strength.Passive ROM is movement of the relaxed joint of the patient by the examiner through the limits of its movement.
24Physical Assessment Hand grips Foot push/leg raise Muscle Strength (0-5)Muscle Tone
25Physical AssessmentMuscle strength is tested against resistance of the examiner.Grade DescriptionFull ROM against gravity with extreme resistanceFull Rom against gravity with some resistanceFull ROM against gravity with no resistanceFull Rom with gravity eliminatedSlight contraction visible0 No contraction
27Physical Assessment Musculoskeletal Muscles developed without atrophy/ hypertrophy. Arms and legs symmetrical. No edema, varicosity’s, or tenderness. Joints non-tender, without swelling, and with full ROM. Muscle tone and strength 5/5 bilaterally. Spine has full Rom and is without tenderness or deformities.
31Remember Safety Review health status Assess V/S Assess level of orientationAssess ROMAssess environmentAssess level of understanding
32Cane Assisted Ambulation 1. Used with partial weight bearing2. Assess balance, strength, and confidence3. Usually used unilaterally4. Instruct client to hold cane on uninvolved side.The cane and weaker leg work together while ambulatingAllow 15‑30 degrees elbow flexion with the cane
33Cane Assisted Ambulation 5. Move cane forward 6‑10 inches, while keeping weight on both legs6. Move affected leg forward so it is even with the cane7. Bring the unaffected leg past the cane8. Move affected leg even with the unaffected leg9. Repeat stepsDo not use words like good or bad; instead, use involved/uninvolved, affected/unaffected, right/left
34Crutches Assisted Ambulation What disorders necessitate the use of crutches?REMEMBER SAFETYAssess arm and shoulder strengthAssess balanceAssess enduranceProper measurement is important
35Crutches Assisted Ambulation Standing measurements:Two or three fingers should fit between the top of the crutch and the axilla and/orCrutch pads should be 1 1/2‑ 2 inches below axillaRubber tips on crutch should reach 4 ‑ 6 inches to side of client's feet(Handgrip) Elbow should be flexed 15‑30 degrees
36Ambulation-4 Point Gate 1. Begin with feet comfortably apart and crutches 6 inches in front and 6 inches to side of each foot. (Be sure body is in alignment) [tripod position]2. Keeping feet together, move right crutch forward 4‑6 inches3. (Crutch and foot move in opposition)Move left foot forward to be equal level with left cane
37Ambulation-4 Point Gate 4. Move left crutch forward 4‑6 inches5. (Crutch and foot move in opposition)Move right foot forward to be equal level with right crutch6. Repeat
38Ambulation-3 Point Gate 1. Begin in tripod position (above)2. Bring both crutches and affected leg forward3. Move unaffected leg forward4. Repeat
39Ambulation-2 Point Gate 1. Begin in tripod position (above)2. (Crutch and foot move together in opposition)Move left crutch and right foot forward (together)3. Move right crutch and left foot forward (together)4. Repeat
40Swing‑to gait 1. Move both crutches forward 2. Lift and swing legs to crutches3. Repeat
41Swing‑through gait 1. Move both crutches forward 2. Lift and swing legs through and past the crutches3. Repeat
42Walker Assisted Ambulation 1. Position‑ Upper bar of walker is slightly below client's waist.Elbows are flexed 15‑30 degrees (with hands on hand grips)2. Lift walker and move forward 6‑8 inches. Step forward. Follow‑throughwith opposite foot. (If one side is affected, step forward with affected leg first)3. Repeat
43Guidelines for ROM 1. Wash hands 2. Explain/teach 3. Use proper body mechanics4. Provide privacy5. ROM‑ Support joint and limb6 Move smoothly, slowly, rhythmically7. Move to resistance (not pain)8. Return joint to neutral alignment9. Perform 2‑3 times per day10. Assess client11. Document
44Suggested order for performing ROM 1. Wash hands2. Explain ROM3. Raise bed (body mechanics)4. Position client close to side of bed5. Neck‑ flexion, extension, rotation, hyperextension6. Shoulder‑ flexion, extension, hyperextension, abduction, adduction external rotation, internal rotation, circumduction
45Suggested order for performing ROM 7. Elbow‑ flexion, extension8. Forearm‑ supination, pronation9. Wrist‑ flexion, extension, hyperextension, radial deviation, ulnar deviation10. Hands/fingers‑ flexion, extension, hyperextension, abduction, adduction11. Thumb‑ flexion, extension, abduction, adduction, opposition