HPA MSK

support body position
promote mobility
protect soft organs
mineral storage
produces some blood componenets

midsagittal
sagittal
coronal
transverse

bones
muscles
tendons
bursae

206

long - diaphysis
end - epiphyses

cervical 7
thoracic 12
Lumbar 5
sacral 5 (thought of as 1)
coccygeal 4 (thought of as 1)

cushion between 2 surfaces to reduce friction

1) diarthroses (synovial) - shoulder, elbow, wrist, thumb, knee, hip, ankle, proximal cervical vertebrae - move freely
2)Amphiarthroses - slightly movable - vertebrae, manubriosternal joint, radioulnar joint, symphysis pubis
3) Synarthroses - immovable - epiphyseal growth plate, skull sutres, between distal ends of radius and ulna, between distal ends of tibia and fibula, attachment of root of a tooth

1)hinge - 1 axis, 1 plane (elbow, fingers, knee)
2) pivot - rotary movement in 1 axis, rotates around pivot (radioulnar joint, atlantoodontal joint of C1 and C2)
3) saddle joint - articulating surface of one bone is concave and other is convex (metacarpal bone of thumb, trapezium bone of carpus)
4) condyloid - angular motion in 2 planes, no axial roatation (wrist between distal radius and carpals)
5) ball and socket - round end of bone fits into cup-like cavity of another bone, provides movement around 3 or more axes or in 3 or more planes (shoulder, hip)
6) gliding - gliding movement (vertebrae, tarsal bones of ankle)

secrete fluid for joint lubrication, nourishment, waste removal

-decrease in bone density -> weaker bones
-muscle atrophy -> decreased muscle strength
-decreased overall body mass
-deterioration of articulating cartilage
-vertebral inflexibility
-thoracic kyphosis

XS ETOH, smoking, caffeine, nutrition, exercise, medications - corticosteroids, vasodilators

age, gender, Asian, Caucasian, small frame, family hx

1) illness
2) environmental
3) medications
4) anatomical changes

osteoporosis
cardiovascular
cerebellar
Meuniere
gait changes
visual decrease

avoid:
-scatter or throw rugs
-floors with slippery surface
-dim lighting
-ill-fighting shoes
-clutter
-cords on the floor

10-20
-osteosarcoma
Early adult
-anklosing spondylitis
-bursitis
-rheumatoid arthritis
-systemic lupis
-low back pain
45+
-gout
-osteoporosis
-carpal tunnel
-degenerative joint disease/osteoarthritis
-multiple myeloma
-paget's disease

type I osteoporosis
rheumatoid arthritis
scoliosi
carpal tunnel
SLE
postmenopausal gout
polymyalgia reumatica
scleroderma
myasthenia gravis
MS
senile kyphosis

type II osteoporosis
ankylosing spondylitis
gout
paget's disease
reiter's syndrome
Dupuytren's contracture
psoriatic arthritis
muscular dystrophy
amyotrophic lateral sclerosis (ALS)
low back pain

rheumatoid arthritis
primary osteoarthritis
polymyalgia rheumatica
type I osteoporosis
Paget's disease
Dupuytren's contracture
ALS
ankylosing spondylitis

SLE
rheumatoid arthritis

pain
weakness
limited movement
stiffness
deformity

joint disorders
bone or skeletal disorders
neuromuscular disorders

infections
blood disorders
peripheral vascular disorders

lack of calcium in body

anti-inflammatory
analgesics (narcotic or non-narcotic)
muscle relaxants
steroids
calcium supplements

amputation
use of assistive devices
hemiplagia, paraplegia, quadriplegia

poliolyelitis

poliomyelitis
juvenile arthritis

rheumatoid arthritis
osteoporosis
Paget's disease

arthroscopy
arthroplasty
disectomy or laminectomy
joint aspiration
joint replacement
amputation
reattachment of a limb

1) non weight bearing (doesn't touch floor)
2) touchdown weight bearing (foot may rest on floor but no weight distributed through extremity)
3) partial weight bearing (30-50% of weight)
4) weight bearing as tolerated (bears as much weight as can be tolerated without undue strain or pain)
5) bears weight fully on the extremity

overall appearance
posture
gait and mobility
- gait patterns
- transfer ability
- weight bearing
height and weight
structural abnormalities

hypertrophy
atrophy
involuntary muscle movements
limb circumference

1-3cm difference in limb circumference normal

-joints flat when extended, smooth or rounded during flexion
-no joint enlargement or deformity
-no observable bruising, swelling, erythema, nodules, deformities, masses, skin atrophy, skin breakdown

dislocation - complete dislodgment of one bone out of cavity

sublaxation - partial dislodgment of bone from its place in the joint cavity

1) inspection bilaterally
2) palpate - ask pt to open and close mouth, feel depression, note smoothness and clicks
3) ROM
-open as wide as possible
-push out lower jaw
-move jaw from side to side

-hear or palpate click when mouth opens
-mouth opens 3-6cm with ease
-lower jaw protrudes without deviating to side and moves 1-2cm with lateral motion

Chvostek's sign
-tap side of face just below temple area using middle or index finger
-observe for changes in facial expression
-repeat on other side

should be no changes

1) inspect anteriorly and posteriorly
2) palpate spinous processes
3) ROM
-flexion
-hyperextension
-lateral bending
-rotation
4) Strength - oppose rotation movement

-flexion (45)
-hyperextension (55)
-lateral bending (40)
-rotation (70)

scoliosis
kyphosis
lordosis
list

bursae
tendons
muscles
dislocations

common:
rotator cuff tears, strains, tendinitis, bursitis

1)inspection - anterior and posterior
2) palpate shoulder and surrounding muscles
3) ROM
-forward flexion
-hyperextension
-abduction
-adduction
-internal rotation
-external rotation
-shrug (CN XI)
4) strength - oppose shrug

-forward flexion (180)
-hyperextension (50)
-abduction (180)
-adduction (50)
-internal rotation (90)
-external rotation (90)
-shrug (CN XI)

Drop Arm Test
manually abduct patient's arm and ask them to slowly lower while maintaining extension

normal: will be able to perform

tennis elbow - lateral epicondyle inflamed
pitcher's elbow - medial epicondyle inflamed
bursa may become inflamed

1) inspect flexed and extended
2) palpate with thumb abd middle fingers - olecranon process, olecranon bursa, groove on each side of olecranon process, epicondyles
3) ROM
-flexion
-extension
-supination
-pronation
4) strength - stabilize arm at elbow with non-dominant hand, grasp patient's wrist - ask to flex and extend while you apply opposite pressure

-flexion (160)
-extension (0)
-supination (90)
-pronation (90)

repetitive strain injury
symptoms: pain, numbness, tingling, even at night
Tx: wrist splints, surgery to release the ligament

1) inspection - shape, contour, # of fingers, thenar eminence
2) palpate joints of hand - wrist, metacarpal and interphalangeal
3) ROM
-extension (wrist)
-hyperextension (wrist)
-flexion (wrist)
-hyperextension (fingers)
-flexion (fingers)
-radial deviation
-ulnar deviation
-make fist with thumb on outside
-spread fingers apart
-touch thumb to each fingertip and to base of little finger
4) strength
-wrists: place arm on table with forearm supinated, stabilize, flex and extend wrist while applying resistance
-fingers: spread fingers apart and push together while applying resistance
-hand grasp: grasp dominant and middle fingers in patient's dominant hand and non-dominant in non-dominant and squeeze as hard as possible

-extension (wrist) (0)
-hyperextension (wrist) (70)
-flexion (wrist) (90)
-hyperextension (fingers) (30)
-flexion (fingers) (90)
-radial deviation (20)
-ulnar deviation (55)

Tinel's sign
-tap centre of patient's wrist
-should be no tingling or burning
-abnormal findings = positive test

Phalen's sign
-arms flexed at elbows with backs of hands pressed together
-should be no change in sensation
-abnormal findings = positive test

1) inspect iliac crests, size and symmetry of buttocks and number of gluteal folds
2) observe gait
3)palpate hip joints while patient is supine
4) ROM
-flexion with knee straight
-flexion with knee flexed (thomas test)
-internal rotation
-external rotation
-abduction
-adduction
-hyperextension
5) strength
- flexion with opposing force
-adduction and abduction with opposing force
-extension with opposing force (hand under back of knee)
6) measure limb length (should be within 1-3cm)

-flexion with knee straight (90)
-flexion with knee flexed (thomas test) (120)
-internal rotation (40)
-external rotation (45)
-abduction (45)
-adduction (30)
-hyperextension (15)

medial and lateral collateral
anterior and posterior cruciate

meniscal tears - twisting and bending
cruciate ligament tears/ruptures

1) inspection - in relation to each other and to other joints, contour, suprapatellar pouch and prepatellar bursa, quadriceps
2) Palpate - start above - suprapatellar area and femoral tibial joint
3) ROM
-flexion
-extension
-hyperextension
4) strength - hold flexed knee and ankle and apply resistance against extension

-flexion (130)
-extension (0)
-hyperextension (15)

Bulge sign
-milk medial aspect upward several times, press lateral aspect of knee
-should be no fluid retention

Patellar Ballottement
-firmly grasp thigh just above patella and push patella back toward femur and feel for click
-should be no click

1) inspection - walking, sitting, standing, alignment, shape, position
2)Palpation - calcaneous, medial malleolus, lateral malleolus, anterior aspects, inferior aspect of foor over plantar fascia, achilles tendon, each metatarsophalangeal joint, interphalangeal joints
3) ROM
-dorsiflexion
-plantar flexion
-eversion
-inversion
-flexion (curl toes to floor)
-abduction (toes)
-adduction (toes)
4) strength
-supine position, place hands on tops of patient's feet - ask to dorsiflex
-place hands on soles of feet, ask to plantarflex

-dorsiflexion (20)
-plantar flexion (45)
-eversion (20)
-inversion (30)
-flexion (toes)
-abduction (30)
-adduction (10)

Anterior drawer test
-grasp heel with left hand and place right hand over anterior aspect of tibia, grasp 6cm above joint line
-firmly apply anterior forward motion with left hand
-should be no forward movement of ankle
Talar Tilt Test
-place hands around ankle with thumbs inferior to malleoli, invert and evert ankle
-should be an equal talar tilt through ROM

1) inspection - position and alignment
2) palpate spinous processes with thumb, paravertebral muscles
3) ROM
-flexion
-lateral bending
-hyperextension
-rotation

-flexion (90)
-lateral bending (35)
-hyperextension (30)
-rotation (30)