Assessment of the Musculoskeletal System

Skeletal System Bone types Bone types –Long bones, such as the femur, are cylindric with rounded ends; they often bear weight. –Short bones, such as the phalanges, are small and bear little or no weight. –Flat bones, such as the scapula, protect vital organs and often contain blood-forming cells. –Bones that have unique shapes are known as irregular bones (e.g., the carpal bones in the wrist). –The sesamoid bone is the least common type and develops within a tendon; the patella is a typical example.

Skeletal System Bone structure Bone structure

Skeletal System

Bone function Bone function –Provides a framework for the body –Supports the surrounding tissues (e.g., muscle and tendons) –Assists in movement through muscle attachment and joint formation –Protects vital organs, such as the heart and lungs –Manufactures blood cells in red bone marrow Provides storage for mineral salts (e.g., calcium and phosphorus)

Skeletal System After puberty, bone reaches its maturity and maximal growth. Bone is a dynamic tissue, however, that undergoes a continuous process of formation and resorption, or destruction, at equal rates until the age of 35 years. In later years, bone resorption accelerates, decreasing bone mass and predisposing clients to injury. After puberty, bone reaches its maturity and maximal growth. Bone is a dynamic tissue, however, that undergoes a continuous process of formation and resorption, or destruction, at equal rates until the age of 35 years. In later years, bone resorption accelerates, decreasing bone mass and predisposing clients to injury. Bone growth and metabolism affected by calcium and phosphorous, calcitonin, vitamin D, parathyroid hormone, growth hormone, glucocorticoids, estrogens and androgens, thyroxine, and insulin Bone growth and metabolism affected by calcium and phosphorous, calcitonin, vitamin D, parathyroid hormone, growth hormone, glucocorticoids, estrogens and androgens, thyroxine, and insulin

Joints Types include synarthrodial, amphiarthrodial, diarthrodial Types include synarthrodial, amphiarthrodial, diarthrodial Structure and function of the diarthrodial or synovial joint Structure and function of the diarthrodial or synovial joint Subtyped by anatomic structure: Subtyped by anatomic structure: –Ball-and-socket –Hinge –Condylar –Biaxial –Pivot

Muscular System Structure Structure Function Function Supporting structures Supporting structures Musculoskeletal changes associated with aging Musculoskeletal changes associated with aging Cultural considerations Cultural considerations

Assessments Family history and genetic risk Family history and genetic risk Personal history Personal history Dietary history Dietary history Socioeconomic status and ability to afford food Socioeconomic status and ability to afford food Current health problems including obesity Current health problems including obesity

Assessments

Physical Assessment  General inspection  Posture  Abnormality in gait such as antalgic gait or lurch Goniometer, which provides a measure of ROM (range of movement) Goniometer, which provides a measure of ROM (range of movement) Head and neck: evaluate the temporomandibular joints Head and neck: evaluate the temporomandibular joints(Continued)

Physical Assessment (Continued) Spine: lordosis, scoliosis Spine: lordosis, scoliosis Upper extremities Upper extremities Lower extremities Lower extremities

Diagnostic Assessement Laboratory tests: serum calcium and phosphorus, alkaline phosphatase, serum muscle enzymes Laboratory tests: serum calcium and phosphorus, alkaline phosphatase, serum muscle enzymes Radiographic examinations: standard radiography, tomography and xeroradiography, myelography, arthrography, and CT Radiographic examinations: standard radiography, tomography and xeroradiography, myelography, arthrography, and CT Other diagnostic tests: bone and muscle biopsy Other diagnostic tests: bone and muscle biopsy

Electromyography EMG aids in the diagnosis of neuromuscular, lower motor neuron, and peripheral nerve disorders; usually with nerve conduction studies. EMG aids in the diagnosis of neuromuscular, lower motor neuron, and peripheral nerve disorders; usually with nerve conduction studies. Low electrical currents are passed through flat electrodes placed along the nerve. Low electrical currents are passed through flat electrodes placed along the nerve. If needles are used, inspect needle sites for hematoma formation. If needles are used, inspect needle sites for hematoma formation.

Electromyography

Arthroscopy Fiberoptic tube is inserted into a joint for direct visualization. Fiberoptic tube is inserted into a joint for direct visualization. Client must be able to flex the knee; exercises are prescribed for ROM. Client must be able to flex the knee; exercises are prescribed for ROM. Evaluate the neurovascular status of the affected limb frequently. Evaluate the neurovascular status of the affected limb frequently. Analgesics are prescribed. Analgesics are prescribed. Monitor for complications. Monitor for complications.

Arthroscopy

Other Tests Bone scan Bone scan Gallium or thallium scan Gallium or thallium scan Magnetic resonance imaging Magnetic resonance imaging Ultrasonography Ultrasonography

Bone scan

Gallium or thallium scan

Magnetic resonance imaging

Ultrasonography