Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 40 Assessment of Musculoskeletal Function

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question What is atrophy? A.Shrinkage-like decrease in the size of the muscle B.Fluid-filled sac found in connective tissue C.Rhythmic contraction of muscle D.Grating or crackling sound or sensation

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer A.Shrinkage-like decrease in the size of the muscle. Atrophy is shrinkage-like decrease in the size of the muscle. Bursa is a fluid-filled sac found in connective tissue. Clonus is rhythmic contraction of muscle. Crepitus is a grating or crackling sound or sensation.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Functions of the Musculoskeletal System Protection of vital organs Mobility and movement Facilitate return of blood to the heart Production of blood cells (hematopoiesis) Reservoir for immature blood cells Reservoir for vital minerals

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Structure 206 bones in the body –Long bones –Short bones –Flat bones –Irregular bones Joints Muscles

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Structure of a Long Bone; Composition of Compact Bone

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Bone Cells Osteoblasts –Function in bone formation Osteocytes –Mature bone cells that function in bone maintenance –Located in the lacunae Osteoclasts –Multinuclear cells function in destroying, resorbing, and remodeling bone –Located in Howship’s lacunae

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Bone Formation and Maintenance Osteogenesis: process of bone formation –Ossification: the process of formation of the bone matrix and deposition of minerals Bone is in constant state of turnover Regulating factors –Stress and weight bearing –Vitamin D –Parathyroid hormone and calcitonin –Blood supply Role of calcium

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Bone Healing Hematoma and inflammation Angiogenesis and cartilage formation Cartilage calcification Cartilage removal Bone formation Remodeling

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Epiphysis is the bone-forming cell.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Epiphysis is the end of a long bone. Osteoblast is a bone- forming cell.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Joints (Articulation): Junction of Two or More Bones Synarthrosis: immovable joints Amphiarthrosis: allow limited movement Diarthrosis: freely movable –Ball and socket –Hinge –Saddle –Pivot –Gliding

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Hinge Joint of the Knee

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Muscles Attached to bones and other structures by tendons Encased in a fibrous tissue—fascia Contraction of muscle causes movement Sarcomere: the contractile unit of skeletal muscle that contains actin and myosin Muscle cell fibers react to electrical stimulation Contraction uses energy in the form of ATP Anaerobic pathways using glucose metabolized from stored glycogen provide energy for more strenuous muscle activity

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Muscle Maintenance Muscle tone Muscle actions Exercise, disuse, and repair

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Bone is in a constant state of turnover.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Bone is in a constant state of turnover.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment of the Musculoskeletal System Include data related to function ability; ADLs, IADLS, and ability to perform various activities; note any problems related to mobility Health history: family history, general health maintenance, nutrition, occupation, learning needs, socioeconomic factors, and medications (include OTC) Assessment of pain and altered sensations Physical assessment: posture, gait, bone integrity, joint function, muscle strength and size, skin, neurovascular status

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Normal Spine and Three Abnormalities

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Detecting Fluid in the Knee

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Rheumatoid Arthritis—Ulnar Deviation and “Swan-Neck” Deformity

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Diagnostic Evaluation Radiographs Computed tomography MRI Arthrography Bone densitometry Bone scan Arthroscopy Arthrocentesis Electromyography Biopsy Laboratory studies

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Which statement is false about magnetic resonance imaging? A. Credit cards with magnetic strips may be erased. B. Nonremovable cochlear implant devices can become inoperable. C. Transdermal patches that have a thin layer of aluminized back must be covered with gauze. D. Jewelry and hair clips must be removed before the MRI is performed.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C.Transdermal patches that have a thin layer of aluminized back must be covered with gauze. True statements are credit cards with magnetic strips may be erased. Nonremovable cochlear implant devices can become inoperable. Jewelry and hair clips must be removed before the MRI is performed. Transdermal patches that have a thin layer of aluminized back must be covered with gauze is false. Transdermal patches that have a thin layer of aluminized back must be removed before the MRI is performed because they can cause burns.