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Muscoloskeletal System. Musculoskeletal System Consists of:  Bones  Muscles  Joints  cartilage.

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Presentation on theme: "Muscoloskeletal System. Musculoskeletal System Consists of:  Bones  Muscles  Joints  cartilage."— Presentation transcript:

1 Muscoloskeletal System

2 Musculoskeletal System Consists of:  Bones  Muscles  Joints  cartilage

3 function  Support to stand erect  Movement  Protect inner vital organs  Hemopoiesis – Bone marrow produces white & red bld cells and platelets  Reservoir for storage of minerals & energy – Ca. & Phosphorus in the bones.

4 Bones  206  Bones & cartilage are types of Connective tissue  Bone is hard and rigid and dense

5 Joints  2 or more bones connecting  Mobility  Nonsynovial = immovable, skull sutures  Synovial = movable  Synovial joints – ends of bones are covered with cartilage & enclosed in a joint cavity filled with synovial fld.

6  Ligaments are fibrous bands – connect one bone to another. Strengthen joint & prevent movement in the wrong direction  Bursa – enclosed sac filled with synovial fld.& are located in areas of potential friction = shoulder, knee. Help muscles & tendons glide over bone.

7 Muscles  40 – 50 % body weight  Contract & produce movement  Skeletal muscle is voluntary  Composed of Bundles of muscle fibers or fasciculi  Muscle is attached to bones via tendons

8 Skeletal muscles produce the following movements  Flexion – bending  Extension – straightening  Abduction – away from midline  Adduction – toward midline  Pronation – palm down  Supination – palm up  Circumduction - circular

9 Skeletal muscles produce the following movements  Inversion – sole inward  Eversion – sole outward  Rotation – head around central axis  Protraction –forward movement parallel to ground (chin)  Retraction – backward parallel movement  Depression/elevation – Shoulders up & down

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11 Temporomandibular Joint (TMJ)  Articulation of temporal & mandible  Depression anterior to tragus of ear  Jaw function for chewing & speaking  Movements –Hinge – open/close –Gliding – protrusion/retraction –Gliding- side to side

12 Spine  33 Vertebrae  Spinous process posterior midline  7 Cervical  12 Thoracic  5 Lumbar  5 Sacral  3 – 4 Coccygeal

13  C7 & T1 prominent base of neck  Inferior angle of scapula in line with T7 & T8  Highest point iliac crest at L4  Curves Double S – lateral view –cervical & lumbar are concave;(inward) –Thoracic & sacrococcygeal are convex  Intervertebral discs cushion the spine = shock absorber

14 Shoulder  Articulation of humerus & glenoid fossa of scapula  Ball & socket – enclosed by rotator cuff (4 muscles and tendons)  Acromion process – bump at top of shoulder

15 Elbow  Articulation humerus, radius, & ulna  Landmarks are the Medial & lateral epicondyles of the humerus & large olecranon process of the ulna in between  Sensitive ulnar nerve

16 Wrists and Carpals  Wrist –articulation of radius & carpal bones  Permits flexion, extension & side to side deviation  Metacarpophalangeal & interphalangeal joints – permit finger flexion and extension

17 Hip  Acetabulum & femur  Ball & socket joint  Weight bearing function  Landmarks ( IM injections) –Anterior, superior iliac crest –Ischial tuberosity (↓ gluteus maximus, flex hip) –Greater trochanter of femur

18 Knee  Femur, tibia & patella  Largest joint  Hinged joint & largest synovial membrane  2 cartilages – medial & lateral menisci cushion the tibia & femur

19 Ankle & Foot  Ankle joint is the articulation of Tibia, fibula & talus  Hinged joint –Dorsiflexion –Plantar flexion  Landmarks –Medial & lateral malleolus

20 Aging adult  Loss of bone density = osteoporosis  Postural changes  ↓ height due to shortening of the vertebral column

21 Subjective Data  Joints –Pain –Stiffness –Swelling, heat, redness  Muscles –Pain, cramps –weakness

22 Subjective Data  Bones –Pain –Deformity –Trauma  Functional Assessment ( ADL’s )  Self – care behaviors

23 Objective Assessment Physical Exam Musculoskeletal  Purpose –To assess function for ADL’s –Screen for abnormalities

24 Screening Exams  Inspection  Palpation  ROM with movement active or passive if apparent limitations  Age Specific

25 Important to :  Client comfort  Systemic approach  Support joints  Bilateral exam

26 Equipment  Tape measure  Goniometer  Skin marking pen

27 Inspection Size & contour of joint Color, swelling, masses, deformity

28 Palpation Each joint Temperature Muscles Bony articulations joint capsule Tenderness, swelling, masses

29 ROM  Active ROM  Limitation – try passive motion  or in ROM, use a goniometer to measure angles

30 Muscle Testing  Repeat movements for Active ROM  Client flexes & holds against opposing force  = bilaterally, resists opposing force

31 Grade muscle strength (pg. 616)  Values 0- 5  Grade 5= Normal –Full ROM against gravity, full resistance

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33 TMJ  Swelling, tenderness, crepitation  Crepitation = audible & palpable crunching or grating with movement

34 Cervical Spine  Inspection –Head & neck alignment –Spine  Palpation –Spinous processes, Trapezius, Paravertebral muscles –ROM, flexion, extension, hyperextension, lateral flexion, rotation, circumduction –Repeat applying opposing force

35 Shoulders  Inspect –Bilateral comparison  Palpate –Bilaterally for muscle spasms, atrophy, swelling, heat, tenderness –Clavicle to acromioclavicular joint, scapula, greater tubercle of humerus, subacromal bursa, biceps groove & anterior aspect glenohumeral joint

36 Test for Shoulder ROM  Flexion  Extension  Internal rotation  External rotation  Abduction  Adduction  Circumduction Test for strength; shrug shoulders, flex forward, up & abduct against resistance

37 Elbow  Inspect –Size & contour with flexion, extension –Deformity, redness, swelling –Olecranon bursa  Palpate –Flexed 70 degrees Olecranon process, medial & lateral epicondyles of humerus Olecronon bursa for heat, swelling, tenderness, nodules

38 ROM of Elbow  Flexion  Extension  pronation  supination

39 Muscle Strength of Elbow  Flex elbow – then extend against resistance applied just proximal to the wrist

40 Wrist and Hand  Inspect –Palmar & dorsal surface Position, contour and shape –Swelling, redness, deformity or nodules

41 Wrist and Hand  Palpate –Wrist and hand joints –Support hand, use both thumbs to palpate –Metacarpophanlangeal joints –Use thumb and index finger in a pinching motion to palpate interphalangeal joints

42 ROM of Wrists and Hands  Hyperextension  Palmar flexion  Flexion of fingers  Abduction for fingers  Opposition  Ulnar deviation, Radial deviation

43 Muscle Strength for Wrist and Hands  Flex wrist against palm resistance  Phalen’s test – both hands flexed & back to back for 60 secs. Normally no symp. Carpel tunnel syndrome will give a + result of numbness & burning  Tinel’s Sign – direct percussion @ median nerve of wrist. In carpel tunnel + result = burning & tingling

44 Hip  Inspect hip joint with spine when client is standing  Client is supine, palpate the hip joints  ROM

45 Knee  Supine with legs extended ( knees can be flexed or dangling for inspection)  Swelling = ? Soft tissue or ↑ fld in the joint  Bulge Sign – stroke up medial aspect 2-3x. Tap lateral aspect. Watch for a bulge in the medial hollow.  Ballottement of the Patella – lger amt of flds

46 Ankle & foot  Inspect while nonweight- bearing, then standing & walking  ROM  Muscle strength

47 Spine  Standing  Inspect  Palpate spinous processes  ROM of spine is checked by asking to touch toes

48 Leg measurement  True leg length = measure b/t fixed points, the anterior iliac spine cross the medial side of the knee to the medial malleolus


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