Seidel 21 Musculoskeletal System

Most joints are ____-freely moving articulations that are enclosed by a capsule of fibrous articular cartilage, ligaments, and cartilage covering the ends of the opposing bones.

What are the two Synarthrosis types of joints?

What are the two Amphiarthrosis types of joints?

What are the six Diarthrosis (Synovial) types of joints?

Which joint? United by thin layer of fibrous tissue

Which joint? A temporary joint in which the cartilage is replaced by bone later in life

Which joint? Bones are connected by a fibrocartilage disk

Which joint? Bones are connected by ligaments

Which joint? Widest range of motion, movement in all planes

Which joint? Motion limited to flexion and extension in a single plane

Which joint? Motion limited to rotation

Which joint? Motion in two planes at right angles to each other, but no radial rotation

Which joint? Motion in two planes at right angles to each other, but no axial rotation

Which joint? Motion limited to gliding

The ____ joint consists of the articulation between the mandible and the temporal bone in the cranium

In TMJ, The __ action of the joint opens and closes the mouth, whereas the ___ action permits lateral movement, protrusion, and retraction of the mandible

The ___ vertebrae are the most mobile

The ___ and ___ processes and the ligament between them form the arch surrounding and protecting the glenohumeral joint

The elbow is a ___ joint, permitting movement of the humerus and ulna in one plane (flexion and extension).

The ___ joint (wrist) consists of the articulation of the radius and the carpal bones.

The wrist is a __ joint, permitting movement in two planes (flexion and extension movement; radial and ulnar movement).

The metacarpophalangeal joints are ___ type

The ____ ligament protects the knee from hyperextension

The ____ separates the patella, quadriceps tendon, and muscle from the femur.

The knee is a ___ joint, permitting movement (flexion and extension) between the femur and tibia on one plane

The ___ joint (ankle) consists of the articulation of the tibia, fibula, and talus.

The tibiotalar joint is a ___ joint that permits flexion and extension (dorsiflexion and plantar flexion) in one plane

Additional joints in the ankle, the ___ joint (subtalar) and ____ joint, permit a pivot or rotation movement (pronation and supination) of the joint.

Articulations of the foot between the tarsals and metatarsals, the metatarsal and proximal phalanges, and the middle and distal phalanges are ___

Increased length of long bones results from the proliferation of cartilage at the ___.

In the smaller bones, such as the carpals, ___ form in calcified cartilage.

Ligaments are stronger than bone until ___, therefore injuries to long bones and joints are more likely to result in fractures than in sprains

Adolescents, Rapid growth during _____ results in decreased strength in the epiphyses, as well as general decreased strength and flexibility, leading to greater potential for injury.

What age is bone growth completed?

What age is peak bone mass reached?

Increased levels of circulating hormones contribute to the elasticity of ligaments and softening of the cartilage in the pelvis at about ___ weeks of gestation.

What 3 joints have increased mobility during Pregnancy?

In Pregnancy, how does the body compensate to the enlarged uterus?

Painful muscle cramps, usually in the __, __, ___ muscles, occur during the second half of pregnancy in more than 25% of pregnant women.

For menopausal women, decreased estrogen increases ___ and decreases ___, resulting in bone loss and decreased bone density

By 80 years of age, a woman can lose up to __% of her bone mass

What race has the most dense bones?

What happens to muscle mass in older people?

birth injuries may result in ___ or ___

During birth, special ventilator support may result in anoxia leading to ___ disorders

Pregnant women, Type of shoes with heels may ___

What appears to be lumbar lordosis in black women is usually due to a ___.

For example, the ___ is expected to be larger in athletes who play racquet sports and in manual laborers

Fasciculation occurs after injury to a muscle's ___.

___ occurs after injury as a result of pain, disease of the muscle, or damage to the motor neuron.

fluctuation of a joint is associated with ___

___ is an increase in muscle tone.

What can cause Synovial thickening?

___ can be felt when two irregular bony surfaces rub together as a joint moves, when two rough edges of a broken bone rub together, or with the movement of a tendon inside the tendon sheath when tenosynovitis is present.

Passive range of motion often exceeds active range of motion by degrees.

When a joint appears to have an increase or limitation in its range of motion, a ___ is used to precisely measure the angle

Grade of Muscle Strength? Trace of movement

Grade of Muscle Strength? Full range of motion, but not against gravity*

Grade of Muscle Strength? Full range of motion against gravity but not against resistance

Grade of Muscle Strength? Full range of motion against gravity and some resistance, but weak

Grade of Muscle Strength? Full range of motion against gravity, full resistance

When muscle strength is grade __ or less, disability is present; activity cannot be accomplished in a gravity field, and external support is necessary to perform movements.

___ may result from disuse atrophy, pain, fatigue, or overstretching.

Locate the ___ joints by placing your fingertips just anterior to the tragus of each ear.

An audible or palpable snapping or clicking in the temporomandibular joints is not unusual; but ____, ___, ___, __may indicate temporomandibular joint dysfunction.

For temporomandibular joints, Expect a space of ___ cm between the upper and lower teeth when the jaw is open.

For temporomandibular joints, the chin should be able to __ and __

For temporomandibular joints, Laterally move the lower jaw to each side. The mandible should move ___ cm in each direction

Strength of the ___ and ___ muscles is evaluated by asking the patient to clench the teeth while you palpate the contracted muscles and apply opposing force.

asking the patient to clench the teeth while you palpate the contracted muscles and apply opposing force will test what cranial nerve?

The strength of the sternocleidomastoid and trapezius muscles is evaluated with the patient maintaining each of the above positions while you apply opposing force. With rotation, cranial nerve__is simultaneously tested

The curve of the thoracic spine should be __

The curve of the lumbar spine should be __

__ is common in patients who are markedly obese or pregnant.

The appearance of lordosis in black women may result from their more prominent___

__ may be observed in aging adults

A sharp angular deformity, a ___, is associated with a collapsed vertebra from osteoporosis.

The usual number of vertebrae (24) is present in __% or more individuals, but as many as __% of individuals have 23 vertebrae, and up to __% have 25 vertebrae.

Which gender have the 23 variant vertebae more often?

______ have the 25 variant vertebae more often than do other races.

Observe for a winged scapula, an outward prominence of the scapula, indicating injury to the nerve of the ___

Expected carrying angle of the arm, at ___ degrees

Subcutaneous nodules along pressure points of the ulnar surface may indicate___

Variations in carrying angle are ___, a lateral angle exceeding 15 degrees

a medial carrying angle

A boggy, soft, or fluctuant swelling; point tenderness at the lateral epicondyle or along the grooves of the olecranon process and epicondyles; and increased pain with pronation and supination of the elbow should cause you to suspect ___ or ___.

Deviation of the fingers to the ulnar side, and swan neck or boutonniere deformities of the fingers usually indicates ___

A firm mass over the dorsum of the wrist may be a ___

Bony overgrowths in the distal interphalangeal joints, which are felt as hard, nontender nodules usually 2 to 3 mm in diameter but sometimes encompassing the entire joint, are associated with ___

Bony overgrowth along the distal interphalangeal joints, they are called ___

Bony overgrowth along the proximal interphalangeal joints are called ___

Painful, fusiform swelling of the proximal interphalangeal joints causes ____, which are associated with the acute stage of rheumatoid arthritis

Cystic, round, nontender swellings along tendon sheaths or joint capsules that are more prominent with flexion may indicate ___

While supine, place the lateral aspect of the foot on the knee of the other leg; move the flexed knee toward the table (Patrick test). Expect ___

There are two expected variations in leg alignment: ___ and ___.

leg alignment Whites have more ___ than blacks do

Femurs of Native Americans/American Indians are often quite ___, whereas femurs of blacks are usually __

The angle between the femur and tibia is expected to be less than___degrees.

knock-knees

bowlegs

Excessive hyperextension of the knee with weight bearing (genu recurvatum) may indicate weakness of the ___.

An effusion of the knee fills the ___. The usual indentation above the patella is filled out to be convex rather than concave.

Calluses and corns indicate___ or ___

in-toeing

out-toeing

___ should be on the midline of the foot, on an imaginary line from the heel midline to between the second and third toes

Deviations in forefoot alignment (metatarsus varus or metatarsus valgus), heel pronation, and pain or injury often cause a shift in ___

Expect the foot to have a___, although the foot may flatten with weight-bearing

a foot that remains flat even when not bearing weight; flat foot

a foot with a high instep; high arch of sole

___ may be associated with claw toes

Hyperextension of the metatarsophalangeal joint with flexion of the toe's proximal joint is called ___.

A flexion deformity at the distal interphalangeal joint in feet is called a ___.

___ is hyperextension of the metatarsophalangeal joint with flexion of the toe's proximal and distal joints.

___ is lateral deviation of the great toe, which may cause overlapping with the second toe.

A bursa often forms at the pressure point and, if it becomes inflamed, forms a painful ___

Heat, redness, swelling, and tenderness are signs of an ___, possibly caused by rheumatoid arthritis, septic joint, fracture, or tendonitis.

An inflamed metatarsophalangeal joint of the great toe should make you suspect ___

A thickened Achilles tendon may indicate ___

Bending the foot at the ankle, turn the sole of the foot toward and then away from the other foot. Expect ___

Rotating the ankle, turn the foot away from and then toward the other foot while the examiner stabilizes the leg. Expect __________

Leg length is measured from the ___ to ___ of the ankle, crossing the knee on the ___ side

Arm length is measured from the ___ through __ to __.

Condition Detected with: Limb measurement

Condition Detected with: Neer test

Condition Detected with: Hawkins test

Condition Detected with: Katz hand diagram

Condition Detected with: Thumb abduction test

Condition Detected with: Tinel sign

Condition Detected with: Phalen test

Condition Detected with: Straight leg raising

Condition Detected with: Bragard stretch test

Condition Detected with: Femoral stretch test

Condition Detected with: Ballottement

Condition Detected with: Bulge sign

Condition Detected with: McMurray test

Condition Detected with: Anterior and posterior drawer test

Condition Detected with: Varus/valgus stress test

Condition Detected with: Lachman test

Condition Detected with: Apley test

Condition Detected with: Thomas test

Condition Detected with: Trendelenburg sign

The ___ test is performed by having the patient internally rotate the shoulder while the examiner forward flexes the arm up to 150 degrees. This presses the supraspinatus muscle against the anteroinferior acromion. Increased shoulder pain is associated with rotator cuff inflammation or a tear

The ___ test is performed by forward flexing the shoulder to 90 degrees, flexing the elbow to 90 degrees, and then internally rotating the arm to its limit. Increased shoulder pain is associated with rotator cuff inflammation or a tear

For the ____ muscle of the rotator cuff, have the patient abduct the arms 90 degrees and flex the shoulders forward 30 degrees. Apply downward pressure on the distal humerus when the arms are rotated so that thumbs point down or up.

For the ___ muscle, have the patient hold the arm at the side, elbow flexed 90 degrees, and rotate the forearm medially against resistance.

For the ___ and ___ muscles, have the patient hold the arm at the side, elbow flexed 90 degrees, and rotate the arm laterally against resistance.

The ___ test is performed by asking the patient what maneuver is used when symptoms of hand pain, numbness, and tingling are at their worst. If the patient demonstrates a flicking movement of the wrist and hand, similar to that used in shaking down a thermometer, it is a positive sign.

The thumb abduction test isolates the strength of the ___ muscle, innervated only by the median nerve

Weakness on thumb abduction test indicates ____

___ sign is tested by striking the patient's wrist with your index or middle finger where the median nerve passes under the flexor retinaculum and volar carpal ligament

To evaluate ___ test, ask the patient to hold both wrists in a fully palmar-flexed position with the dorsal surfaces pressed together for 1 minute

The ______ test is used to test for nerve root irritation or lumbar disk herniation at the L4, L5, and S1 levels. Have the patient lie supine with the neck slightly flexed. Ask the patient to raise the leg, keeping the knee extended

___ sign is positive when the patient is unable to raise the leg more than 30 degrees without pain.

Positive Bragard stretch test indicates ___

The ____ tests is used to detect inflammation of the nerve root at the L1, L2, L3, and sometimes L4 level. Have the patient lie prone and extend the hip. No pain is expected. The presence of pain on extension is a positive sign of nerve root irritation

When a straight leg raising test performed on the affected extremity reproduces or worsens the patient's radiating pain below the knee, the positive finding is ___ sensitive, but only ___ specific for a herniated disk.

When the straight leg raising test is performed on the contralateral unsymptomatic extremity and sciatic pain is elicited in the affected leg, this positive finding is only ___ sensitive but ___ specific

In Ballottement, what indicates effusion?

Examination for the __ sign is also used to determine the presence of excess fluid in the knee. With the patient's knee extended, milk the medial aspect of the knee upward two or three times, and then tap the lateral side of the patella.

Which meniscus is the McMurray test testing?

The anterior and posterior ___ test is used to identify instability of the anterior and posterior cruciate ligaments.

The Lachman test is used to evaluate____ ligament integrity

varus =

valgus =

When the patient complains of a knee locking, use the ___ test to detect a meniscal tear.

The ___ test is used to detect flexion contractures of the hip that may be masked by excessive lumbar lordosis

The ___ test is a maneuver to detect weak hip abductor muscles.

From about age___ the infant should be able to lift the head and trunk from the prone position, giving you an indication of forearm strength

A ____ extending across the entire palm-is associated with Down syndrome

The ___ maneuver to detect hip dislocation or subluxation should be performed each time you examine the infant during the first year of life.

The test for the ___ sign is also used to detect hip dislocation or a shortened femur.

Tibial torsion, a residual effect of fetal positioning, is expected to resolve after___of weight bearing.

The W or reverse tailor position places stress on the joints of the hips, knees, and ankles. It is commonly seen in children with intoeing associated with___

Bowleg

Genu varum is present if a space of ___ exists between the knees

Genu varum is a common finding of toddlers until ___ of age.

Asymmetry of the tibiofemoral articulation angle or space between the knees should not exceed____.

Knock-knee

Genu valgum is present if a space of ___ exists between the medial malleoli.

Genu valgum is a common finding of children between ___ of age

Generalized muscle weakness is indicated by the ___ sign in which the child rises from a sitting position by placing hands on the legs and pushing the trunk up

pregnant woman can experience pain from the pubic symphysis down into the inner thigh when standing and may have a feeling that the bones are moving or snapping when walking which is due to what hormone?

_____ is experienced by some women during the last trimester because of the associated fluid retention during pregnancy

inflamed intervertebral disks become infiltrated with vascular connective tissue that ossifies, leading to eventual fusion and severe deformity of the vertebral column. The disease begins insidiously with low back pain and progresses to reduced spinal mobility. Uveitis may be present. The disease develops predominantly in males between 20 and 40 years of age

Nerve root: Extension of quadriceps

Nerve root: Squat and rise

Nerve root: Knee jerk diminished

Nerve root: Dorsiflexion of great toe and foot

Nerve root: Heel walking

Nerve root: Plantar flexion of great toe and foot

Nerve root: Walking on toes

Nerve root: Ankle jerk diminished

hypertrophy of the ligamentum flavum and facet joints that results in narrowing of the spinal canal

Signs and symptoms include pain with walking or standing that often seems to originate in the buttocks and may then radiate down the legs, followed by pain relief with sitting. Pain in the lower extremities may be worsened by prolonged standing, walking, bending, or hyperextending the back. The pain is generally relieved by sitting down

Compression on the median nerve caused by thickening of its flexor tendon sheath often results from microtrauma, repetitive motion of the arms and hands, or vibration. It is also associated with rheumatoid arthritis, gout, hypothyroidism, and the hormonal changes of pregnancy and menopause.

___ a form of arthritis, is a disorder of purine metabolism that results from an elevated serum uric acid level. The formation of monosodium urate crystal deposits in joints and surrounding tissues results in acute attacks of arthritis.

____ syndrome is painful jaw movement caused by congenital anomalies, malocclusion, trauma, arthritis, and other joint diseases.

___, an infection in the bone, usually results from an open wound or systemic infection. Purulent matter spreads through the cortex of the bone and into the soft tissues. Blood flow to the affected bone may become blocked, causing necrosis. Signs of infection include edema; erythema; warmth at the site; tenderness; pain with movement; and generalized signs such as spiking fevers, headache, and nausea.

___ is an inflammation of a bursa resulting from constant friction between the skin and tissues around the joint. Common sites include the shoulder, elbow, hip, and knee. Signs include limitation of motion caused by swelling; pain on movement; point tenderness; and an erythematous, warm site. Soreness may radiate to tendons at the site

Excessive bone resorption and excessive bone formation produce a mosaic pattern of lamellar bone. Bowed tibias, misshapen pelvis or skull, shortened thorax, and frequent fractures occur. The bones of the skull are often affected, which can produce symptoms of vertigo, headache, and progressive deafness from involvement of the ossicles or neural elements. While the cause is unknown, a genetic component and a slow-acting virus are suspected.

___ is a painful, nonarticular condition that primarily affects the muscles. Symptoms include widespread pain and aching, persistent fatigue, generalized morning stiffness, multiple tender points (11 or more) at nine bilateral sites (i.e., occiput, low cervical spine, trapezius, supraspinatus, second rib, lateral epicondyle, gluteus, greater trochanter, and knee). The condition may also be accompanied by headaches, irritable bowel, dysmenorrhea, cold sensitivity, Raynaud phenomenon, restless legs, atypical patterns of numbness and tingling, and exercise intolerance and weakness. It more commonly affects women older than 50 years of age.

___ is the deterioration of the articular cartilage covering the ends of bone in synovial joints from inflammatory and noninflammatory causes. The resulting abrasion, pitting, and thinning of the cartilage surface eventually exposes the bone

____ is a chronic, systemic, inflammatory, progressive disorder of joints that can occur between 3 and 80 years of age and affects 1% of the population. The cause is unknown but may be associated with infection, autoimmunity, trauma, stress, or familial pre-disposition. One recent theory is that the immune system is prematurely exhausted, and the existing immune cells clone themselves and begin attacking the body rather than defending it.

A muscle can become ___ from excessive stretching or by forceful contraction beyond its functional capacity.

Stretching or tearing a supporting ligament of a joint by forced movement beyond its normal range can cause a ___

___ is the complete separation of the contact between two bones in a joint, often caused by pressure or force pushing the bone out of the joint. Signs include deformity and inability to use the extremity or joint as usual.

A ___ is a partial or complete break in the continuity of a bone resulting from trauma (direct, indirect, twisting, or crushing). Muscle contractions and spasms lead to shortening of tissues around the bone, thus causing deformity. Other signs include edema, pain, loss of function, color changes, and paresthesia.

An inflammation of the synovium-lined sheath around a tendon, ___ results from repetitive actions associated with occupational or sports activities. Common sites include the shoulder, knee, heel, and wrist. Signs include point tenderness over the involved tendon, pain with active movement, and some limitation of movement in the affected joint.

Signs and symptoms of an acute injury include severe pain in the shoulder and deltoid area, inability to raise the arm sideways due to pain or an inability to maintain a lateral raised arm against resistance, inability to shrug shoulders, tenderness over the acromioclavicular joint, grating sound upon movement, crepitus, and weakness in external shoulder rotation.

Congenital neural tube defects, with incomplete closure of the vertebral column, permit the meninges and sometimes the spinal cord to protrude into a saclike structure

The supplementation with____ of the diets of women who are pregnant and those not yet pregnant but intending pregnancy has reduced the incidence of this MYELOMENINGOCELE, SPINA BIFIDA .

___ is a fixed congenital defect of the ankle and foot. The most common combination of position deformities includes inversion of the foot at the ankle and plantar flexion, with the toes lower than the heel

The most common congenital foot deformity,___can be either fixed or flexible. This defect is caused by intrauterine positioning. Medial adduction of the toes and forefoot results from angulation at the tarsometatarsal joint. The lateral border of the foot is convex, and a crease is sometimes apparent on the medial border of the foot. The heel and ankle are uninvolved.

METATARSUS ADDUCTUS (METATARSUS VARUS) deformity generally resolves within ___ of birth, and fewer than 10% of children require casting or surgery for treatment

____ is a condition present at birth in which the femoral head has an inappropriate relationship with the acetabulum. This term covers a range of severity: frank dislocation, in which the femoral head loses contact completely with the acetabular capsule; subluxation or partial dislocation, in which the femoral head remains in contact with the acetabulum but the joint ligaments allow displacement of the femoral head; and instability.

____ is avascular necrosis of the femoral head resulting from a decreased blood supply to the femoral head. The cause is unknown. It is most commonly seen in males between 3 and 11 years of age. The child may have a limp that is painless or antalgic (painful limp with shortened time on extremity); a loss of internal rotation; a loss of abduction; and decreased range of motion on the affected side. Pain is often referred to the medial thigh, knee, or groin. Muscle weakness of the upper leg may be present if symptoms have been present for a prolonged period. There may be bilateral involvement in 10% of cases.

___ is a traction apophysitis (inflammation of a bony outgrowth) of the anterior aspect of the tibial tubercle in association with inflammation of the anterior patellar tendon. The child presents with a limp, knee pain, and swelling that is aggravated by strenuous activity, especially activity involving the quadriceps muscle. This self-limiting disorder is most common in males between 9 and 15 years of age.

____ is a disorder in which the capital femoral epiphysis slips over the neck of the femur. The child or adolescent presents with knee pain, an antalgic limp, leg weakness, and reduced internal hip rotation. The affected child is commonly obese, taller than most, and between 8 and 16 years of age. Affected girls are often younger than boys. The majority of cases (75%) are unilateral, and the left side is involved more often than the right.

____ is a group of genetic disorders involving gradual degeneration of the muscle fibers. The disorders are characterized by progressive symmetric weakness and muscle atrophy or pseudohypertrophy from fatty infiltrates. Both skeletal muscles and those of organs such as the heart may be involved. Some forms cause mild disability, and these patients can expect a normal life span. Other types produce severe disability, deformity, and death. Early signs may include clumsiness, difficulty climbing stairs, frequent falls, waddling gait, and a positive Gower sign

___is a physical deformity with a concave curvature of the anterior vertebral bodies, convex posterior curves, and lateral rotation of the thoracic spine.

____, is a dislocation injury caused by jerking the arm upward while the elbow is extended. The jerking pulls apart the elbow joint and tears the margin of the annular ligament around the radial head into the joint and allows the torn ligament to become trapped in the joint. This injury is common in children 1 to 4 years of age. The child complains of pain in the elbow and wrist, refuses to move the arm, and holds it slightly flexed and pronated. Supination motion is resisted.

___ is a silent progressive disease in which a decrease in bone mass occurs because bone resorption is more rapid than bone deposition. The bones become fragile and susceptible to spontaneous fractures; the presenting symptom is usually loss of height or an acute, painful fracture

Most common sites for Osteoporosis

____ affects the palmar fascia of one or more fingers and tends to be bilateral. Although the cause is unknown, there appears to be a hereditary component. A gradual increase in incidence occurs with age. It is also seen with increased frequency in patients with diabetes, alcoholic liver disease, and epilepsy

congenital fusion of digits

* Poor physical conditioning
* Failure to warm up muscles adequately
* Intensity of competition
* Collision and contact sports participation
* Rapid growth
* Overuse of joints

* Race (white, Asian, Native American/American Indian); northwestern European descent; blonde or red hair, freckles
* Light body frame, thin
* Family history of osteoporosis, gene for decreased bone density
* Nulliparous
* Amenorrhea or menopause before 45 years of age, postmenopausal
* Sedentary lifestyle; lack of aerobic or weight-bearing exercise
* Constant dieting; inadequate calcium and vitamin D intake; excessive carbonated soft drinks per day
* Scoliosis, rheumatoid arthritis, cancer, multiple sclerosis, chronic illness
* Metabolic disorders (e.g., diabetes, hypercortisolism, hyperthyroidism)
* Drugs that decrease bone density (e.g., thyroxine, corticosteroids, heparin, lithium, anticonvulsants, antacids with aluminum)
* Poor teeth; previous fractures
* Cigarette smoking or heavy alcohol use

* Obesity
* Family history of osteoarthritis
* Hypermobility syndromes
* Aging (older than 40 years of age)
* Injury, high level of sports activities
* Occupation requiring overuse of joints

Ottawa Knee Rules
Age older than ____
Tender at the _______
Isolated tenderness of the _____
Inability to flex the knee to ___

Ottawa Anlkle rules, tenderness at malleolar zone + one of the following
Bone tenderness at distal ___ or ___
Inability to bear weight for ____

Absolute EXCLUSION criteria for Ottawa ankle rule. 6 things