Chapter 22Review Anatomy: Structure and Function: BonesStructure and FunctionReview Anatomy: Structure and FunctionTypes of Joint MotionJoint Motion cont’dJoint Motion cont’d.Slide 8JointsSlide 10JointsSubjective Data: Health HistorySubject Data: Age ConsiderationsSlide 14Subjective Data: Aging AdultBack PainCultural ConsiderationsPhysical Exam SequenceBegin with InspectionPalpate Each JointExamine Specific JointsPalpation of TMJNeck: Inspect and PalpateShoulder JointSlide 25Abnormalities of the ShoulderDifferentiating Shoulder PainElbowAbnormalities: ElbowWrist and HandSlide 31Assessing Muscle Strength in ArmAbnormalities of the Wrist and HandSlide 34Slide 35HipTo Measure Leg Length DiscrepancyLaSeque’s Test for Herniated DiskKneeSlide 40Abnormalities of the KneeAnkle and FootAbnormalities: Ankle and FootSpine and BackSpine/BackAge ConsiderationsAbnormalities of Lower ExtremitiesSlide 48Abnormalities of the SpineAge Considerations: Pregnant FemaleAge Considerations: Aging AdultSlide 52Inspecting MusclesAssessing Muscles: ToneGrading Muscle StrengthCommon Muscle and Skeletal Abnormalities5 P’s of Musculoskeletal InjuryGeneralized Inflammatory ConditionsAbnormalities: Degenerative Conditions of Bone and CartilageOsteoarthritis Risk FactorsOsteoporosis Risk FactorsCommon Congenital AbnormalitiesDVT’s and PE’s from Trauma, Pelvic and Extremity FracturesNursing DiagnosesSample ChartingAssessment for Nsg 326 clinicalChapter 22Chapter 22Musculoskeletal Musculoskeletal AssessmentAssessmentReview Anatomy: Structure Review Anatomy: Structure and Function:and Function:BonesBones206 bones206 bonesAxial versus appendicular skeletonAxial versus appendicular skeletonLong bones (ex: femur) versus short Long bones (ex: femur) versus short bones (in hands and feet)bones (in hands and feet)Flat bones (skull and parts of the Flat bones (skull and parts of the pelvis) versus rounded (ex. patellar)pelvis) versus rounded (ex. patellar)Structure and FunctionStructure and FunctionMusclesMusclesTendonsTendonsCartilageCartilageLigamentsLigamentsReview Anatomy: Structure Review Anatomy: Structure and Functionand FunctionBursaBursaJointsJointsTypes of Joint MotionTypes of Joint MotionRetraction vs. ProtractionRetraction vs. ProtractionFlexion vs. ExtensionFlexion vs. ExtensionJoint Motion cont’dJoint Motion cont’dCircumductionCircumductionAbduction vs. AdductionAbduction vs. AdductionJoint Motion cont’d.Joint Motion cont’d.Internal Rotation vs. External Internal Rotation vs. External RotationRotationPronation vs. SupinationPronation vs. SupinationJoint Motion cont’d.Joint Motion cont’d.Eversion vs. InversionEversion vs. InversionPlantar vs. dorsiflexionPlantar vs. dorsiflexionJointsJointsTemporomandibular JointTemporomandibular JointShoulder JointShoulder JointJointsJointsSpineSpine Wrist WristElbowElbowHipHipJointsJointsKnee jointKnee jointAnkle and FootAnkle and FootSubjective Data: Health Subjective Data: Health HistoryHistoryJointsJointsMusclesMusclesBonesBonesSelf-care behaviorsSelf-care behaviorsSubject Data: Age Subject Data: Age ConsiderationsConsiderationsInfants and ChildrenInfants and ChildrenAny trauma during L & D? Head first? Any trauma during L & D? Head first? Need for forceps?Need for forceps?Were the motor milestones achieved about Were the motor milestones achieved about the same time as siblings or age-matesthe same time as siblings or age-matesAny broken bones? Dislocations? How Any broken bones? Dislocations? How treated?treated?Any bone deformity? Spinal curvature? Any bone deformity? Spinal curvature? Unusual shape of toes or feet? Any Unusual shape of toes or feet? Any treatment for thesetreatment for theseSubject Data: Age Subject Data: Age ConsiderationsConsiderationsAdolescent and AdultsAdolescent and AdultsInvolvement in sports? How often?Involvement in sports? How often?Use of any special equipment?Use of any special equipment?Nature of daily warm-up?Nature of daily warm-up?What do you do for injury?What do you do for injury?Subjective Data: Aging Subjective Data: Aging AdultAdultAssess for functional abilityAssess for functional abilityADL’sADL’sAny loss of functionAny loss of functionAny self-care deficitAny self-care deficitAny safety risks d/t aging processAny safety risks d/t aging processAny change in weakness over the past Any change in weakness over the past months or years?months or years?Any increase in falls or stumbling in past few Any increase in falls or stumbling in past few months or years?months or years?Any mobility aids to help get aroundAny mobility aids to help get aroundi.e. cane, walkeri.e. cane, walkerBack PainBack PainTenderness of the costovertebral Tenderness of the costovertebral angle can indicate a musculoskeletal angle can indicate a musculoskeletal problem or a kidney problem. problem or a kidney problem.Cultural ConsiderationsCultural ConsiderationsAfrican AmericansAfrican AmericansGreater bone densityGreater bone densityAmish: Dwarfism syndrome commonAmish: Dwarfism syndrome commonChinese-AmericansChinese-AmericansShorter than WesternersShorter than WesternersBone structure differentBone structure differentFilipino-Americans/Vietnamese-Filipino-Americans/Vietnamese-Americans: shorter in statureAmericans: shorter in statureIrish-AmericansIrish-AmericansTaller and broaderTaller and broaderHip width greaterHip width greaterBone density less than African AmericansBone density less than African AmericansNavajo Native AmericansNavajo Native AmericansTaller and thinner than other American Taller and thinner than other American tribestribesPhysical Exam SequencePhysical Exam SequenceGeneral AssessmentGeneral AssessmentOverallOverallPosturePostureGait and mobilityGait and mobilityInspectionInspectionMuscle size & shapeMuscle size & shapeJoint contourJoint contourPalpationPalpationMuscle toneMuscle toneJointsJointsRange of MotionRange of MotionMuscle strengthMuscle strengthAdvanced TechniquesAdvanced TechniquesUsing a goniometerUsing a goniometerTinel’s signTinel’s signPhalen’s signPhalen’s signMeasuring limb lengthMeasuring limb lengthBulge signBulge signPatellar ballottementPatellar ballottementMcMurray’s signMcMurray’s signBegin with