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Musculoskeletal System
Chapter 22
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 22: Musculoskeletal System

Structure and Function

Subjective Data—Health History Questions

Objective Data—The Physical Exam

Abnormal Findings
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-2
Chapter 22: Musculoskeletal System
Structure and Function


Joints

Nonsynovial or synovial joints

Cartilage

Ligament

Bursa
Muscles

Fasciculi

Tendon

Skeletal muscle movements
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-3
Chapter 22: Musculoskeletal System
Synovial Joint
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-4
Chapter 22: Musculoskeletal System
Skeletal Muscle Movements
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-5
Chapter 22: Musculoskeletal System
Skeletal Muscle Movements
(cont.)
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Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-6
Chapter 22: Musculoskeletal System
Structure and Function
(cont.)

Temporomandibular joint

Spine


Vertebrae

Landmarks of the spine

Intervertebral disks
Shoulder

Glenohumeral joint

Rotator cuff

Subacromial bursa

Acromion process

Greater tubercle of the humerus

Coracoid process
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-7
Chapter 22: Musculoskeletal System
Landmarks of the Spine
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-8
Chapter 22: Musculoskeletal System
Shoulder
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-9
Chapter 22: Musculoskeletal System
Structure and Function
(cont.)


Elbow

Medial and lateral epicondyles

Olecranon process of ulna
Wrist and carpals

Radiocarpal joint

Midcarpal joint

Metacarpophalangeal joints

Interphalangeal joints
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-10
Chapter 22: Musculoskeletal System
Right Elbow
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-11
Chapter 22: Musculoskeletal System
Bones of the Hand
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-12
Chapter 22: Musculoskeletal System
Structure and Function
(cont.)

Hip






Acetabulum and head of femur
Anterior superior iliac spine
Ischial tuberosity
Greater trochanter of femur
Ankle and foot



Tibiotalar joint
Medial and lateral
malleolus
Metatarsals
Knee






Femur, tibia, and patella
Suprapatellar pouch
Medial and lateral menisci
Cruciate ligaments
Prepatellar bursa
Quadriceps muscle
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-13
Chapter 22: Musculoskeletal System
Hip Joint
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-14
Chapter 22: Musculoskeletal System
Landmarks of the Knee
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-15
Chapter 22: Musculoskeletal System
Ankle and Foot
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-16
Chapter 22: Musculoskeletal System
Subjective Data—
Health History Questions

Joints

Pain

Stiffness
Swelling, heat, and redness

Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-17
Chapter 22: Musculoskeletal System
Subjective Data—
Health History Questions
(cont.)

Muscles

Pain (cramps)

Weakness
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-18
Chapter 22: Musculoskeletal System
Subjective Data—
Health History Questions
(cont.)

Bones



Pain
Deformity
Trauma (fractures, sprains, dislocations)
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-19
Chapter 22: Musculoskeletal System
Subjective Data—
Health History Questions
(cont.)

Functional assessment
(activities of daily living)

Self-care behaviors
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-20
Chapter 22: Musculoskeletal System
Objective Data—The Physical Exam

Preparation



Screening
musculoskeletal
examination
Complete
musculoskeletal
examination

Order of the examination

Inspection
• Size and contour of joint
• Skin and tissues over joint

Palpation
• Skin temperature
• Muscles, bony articulations,
Equipment needed
area of joint capsule

Tape measure

Range of motion

Goniometer, to measure
joint angles

Muscle testing

Skin marking pen
• Apply opposing force
• Grading muscle strength
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-21
Chapter 22: Musculoskeletal System
Objective Data—The Physical Exam
(cont.)
Temporomandibular joint

Inspect joint area

Palpate as person opens mouth

Motion and expected range


Open mouth maximally

Protrude lower jaw and move side to side

Stick out lower jaw
Palpate muscles of mastication
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-22
Chapter 22: Musculoskeletal System
Objective Data—The Physical Exam
(cont.)
Cervical spine



Inspect alignment of head
and neck
Palpate spinous processes
and muscles
Motion and expected range

Chin to chest

Lift chin

Each ear to shoulder

Turn chin to each shoulder
Shoulders

Inspect joint

Palpate shoulders and axilla

Motion and expected range

Arms forward and up

Arms behind back and hands up

Arms to sides and up
over head

Touch hands behind head
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-23
Chapter 22: Musculoskeletal System
Objective Data—The Physical Exam
(cont.)
Elbow
Wrist and Hand

Inspect joint in flexed and
extended positions

Inspect joints on dorsal and
palmar sides

Palpate joint and bony
prominences

Palpate each joint

Motion and expected range

Motion and expected range

Bend hand up, down

Bend and straighten elbow

Bend fingers up, down

Pronate and supinate hand

Turn hands out, in

Spread fingers, make fist

Touch thumb to each finger

Phalen’s test

Tinel’s sign
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-24
Chapter 22: Musculoskeletal System
Objective Data—The Physical Exam
(cont.)
Hip
Knee

Inspect as person stands

Inspect joint and muscle

Palpate with person supine

Palpate

Motion and expected range

Bulge sign

Ballottement of patella

Motion and expected range

Raise leg

Knee to chest

Flex knee and hip;
swing foot out, in

Swing leg laterally, medially

Stand and swing leg back


Bend knee

Extend knee

Check knee during ambulation
McMurray’s test
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-25
Chapter 22: Musculoskeletal System
Objective Data—The Physical Exam
(cont.)
Ankle and foot

Inspect with person sitting,
standing, and walking

Palpate joints

Motion and expected
range
Spine

Inspect while person stands

Palpate spinous processes

Motion and expected range

Bend sideways, backward

Twist shoulders to each side

Point toes down, up

Straight leg raising

Turn soles out, in


Flex and straighten toes
Measure leg length
discrepancy
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-26
Chapter 22: Musculoskeletal System
Sample Charting
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-27
Chapter 22: Musculoskeletal System
Abnormal Findings
Abnormalities Affecting Multiple Joints


Inflammatory conditions

Rheumatoid arthritis

Ankylosing spondylitis
Degenerative conditions

Osteoarthritis (degenerative joint disease)

Osteoporosis
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-28
Chapter 22: Musculoskeletal System
Abnormal Findings
Abnormalities of the Shoulder

Atrophy

Dislocated shoulder

Joint effusion

Tear of the rotator cuff

Frozen shoulder—adhesive capsulitis

Subacromial bursitis
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-29
Chapter 22: Musculoskeletal System
Abnormal Findings
Abnormalities of the Elbow

Olecranon bursitis

Gouty arthritis

Subcutaneous nodules

Epicondylitis—tennis elbow
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-30
Chapter 22: Musculoskeletal System
Abnormal Findings
Abnormalities of the Wrist and Hand

Ganglion cyst

Ulnar deviation or drift

Colles’ fracture


Carpal tunnel syndrome
Degenerative joint
disease or osteoarthritis

Acute rheumatoid
arthritis

Syndactyly

Polydactyly

Ankylosis

Dupuytren’s contracture

Swan-neck and
boutonniere deformities
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-31
Chapter 22: Musculoskeletal System
Abnormal Findings
Abnormalities of the
Knee
Abnormalities of the
Ankle and Foot

Mild synovitis

Achilles tenosynovitis

Prepatellar bursitis

Chronic/acute gout

Swelling of menisci


Osgood-Schlatter
disease
Hallux vagus with bunion
and hammer toes

Callus

Plantar wart

Ingrown toenail

Chondromalacia
patellae
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-32
Chapter 22: Musculoskeletal System
Abnormal Findings (cont.)
Abnormalities of the
Spine
Common Congenital or
Pediatric Abnormalities

Scoliosis

Congenital dislocated hip

Herniated nucleus
pulposus

Talipes equinovarus
(clubfoot)

Spina bifida

Coxa plana (Legg-CalvéPerthes syndrome)
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-33
Chapter 22: Musculoskeletal System
Ankylosis is…
A. one or more bones in a joint being out
of position
B. partial dislocation of a joint
C. shortening of a muscle leading to limited
range of motion of joint
D. stiffness or fixation of a joint
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-34
Chapter 22: Musculoskeletal System
Why would the examiner ask a high school
athlete “what do you do when you get hurt?”
A. Because so many young athletes are injured that it
is important to plan ahead.
B. Because many athletes are reticent to report injuries
because they think it will limit their playing time.
C. Because it is important for young athletes to
understand the risks involved in playing sports.
D. Because it is important for the athlete to report an
injury to a clinician, rather than a coach, who may
not take the injury seriously.
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 22-35