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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
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Structure
• 206 bones in the body
– Long bones
– Short bones
– Flat bones
– Irregular bones
• Joints
• Muscles
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Structure of a Long Bone; Composition of
Compact Bone
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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
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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 boneforming 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
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Hinge Joint of the Knee
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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
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Detecting Fluid in the Knee
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Rheumatoid Arthritis—Ulnar Deviation
and “Swan-Neck” Deformity
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Diagnostic Evaluation
• Radiographs
• Arthroscopy
• Computed tomography
• Arthrocentesis
• MRI
• Electromyography
• Arthrography
• Biopsy
• Bone densitometry
• Laboratory studies
• Bone scan
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
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.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins