Composition of the Musculoskeletal System

The skeleton proper (bones & joints)

Skeletal muscles

Tendons

Ligaments

Nutrition & Musculoskeletal Function

Fluoride Aluminum
Magnesium Copper

Zinc

Iron

Manganese
Iodine

Assessment of the musculoskeletal system

History-taking
Inspect & Palpate joints Assess range of motion

Assess muscle strength

Joint motion - a review of terms

Flexion
Extension Dorsiflexion

Inversion
Eversion Internal rotation

Plantar flexion
Adduction Abduction

External rotation
Pronation Suppination

ROM of wrist & hand

Flexion
Extension Hyperextension Ulnar deviation Radial deviation

Lower Extremity ROM

Hip flexion with knee

straight Hip flexion with knee flexed: Internal & External rotation : Abduction : Adduction :

Range of Motion of the Knee

Flexion-extension 1350 Hyperextension - 100

Ballottement
Used to test for joint effusion

If there is an effusion present a palpated tap will be present and the transmitted impulse will be felt by the fingers on either side of the patella

Ankle Range of Motion

Dorsiflexion 20o Plantar Flexion 500 Inversion of hind foot 50 Eversion of hind foot - 50

Phalens test
Ask the person to hold

both hands back to back while flexing the wrists 90 degrees. Acute flexion of the wrist for 60 seconds produces numbness and burning in a person with carpal tunel syndrome

Tinels Sign
In carpal tunnel

syndrome, percussion of the median nerve produces burning and tingling along its distribution, which is a positive Tinels sign

___________________
Dislocation of the hip

functionally shortens and weakens hip and pelvis muscles.

When a child stands on the dislocated hip,

the opposite side of the pelvis drops

The Musculoskeletal system of the elderly

Muscle atrophy Osteoporosis Kyphosis Decreased Osteoarthritis Reduced range of

intervertebral disc space Joint stiffness

motion Degenerative changes

Osteoporosis
Risk Factors
Classification Diagnosis

Prevention
Treatment

Areas of yellow indicate bone loss from osteoporosis

The Musculoskeletal system of the elderly (continued)

Musculoskeletal problems have the most significant

impact on the aged population. More than 1 billion dollars is spent annually by Medicare for hospitalization of elderly patients with these conditions. This represents 20% of all Medicare payments.

Reaching a conclusion
Based on history & physical examination does there

appear to be a musculoskeletal disease or impairment? Do the history and finding suggest a primary musculoskeletal concern or signs & symptoms of a systemic disease? What is the differential diagnosis? What additional tests (labs, diagnostic studies) are indicated?

Differential diagnoses - what is the primary problem

Fracture
Sprain Dislocation or subluxation Joint or muscle inflammation Age specific abnormality Systemic illness (examples) neuropathy myopathy connective tissue disease

Remember...
Diseases of the musculoskeletal system rank first among disease

conditions that alter the quality of lifethe cost of which exceeds 60 billion dollars annually