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types of bones
- - long bones
- - short bones
- - flat bones
- - irregular bones
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Ligament
- attach bone to bone
- - strong bands
- - elastic
- - maintain joint in normal ROM
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tendon
- - attach muscle to bone and muscle to muscle to muscle
- - muscle contraction- tendon pulls on bone
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tendon sheath
covers the tendon
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Tendonitis
Inflammation of the tendon
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Bursa
- fluid-filled cavities located at tissue sites where tendons or muscle pass over bony prominences near joints
- - facilitates movement
- - reduces friction
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bursitis
- inflammation of the bursa. which can cause
- - limitation of movement
- - pain upon movement
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joints
- also called articulations
- - point where two bones meet
- - three types of joints
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what are the three types of joints
- - fibrous
- - cartilaginous
- - synovial
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fibrous joint
skull sutures
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cartilaginous joints
vertebrae
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synovial joints
- - mast majority of out bones
- - ankle, shoulder, knee
- - contains synovial fuid
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synovial fluid
- acts as a cushion and protects from wear and tear
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common chief complaints
- - pain
- - weakness
- - limited movement
- - stiffness
- - deformity
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what is the most common complaint
pain
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chronic vs acute pain
- chronic
- - what have they been doing? long term
- acute
- - caused by trauma? came without external forces?
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medical history: specific musculoskeletal specific
- - joint disorder
- - bone or skeletal disorders: fractures
- - neuromuscular disorders
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neuromuscular disorders
multiple sclerosis, multiple muscular dystrophy
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Joint disorders
osteo arthritis or rheumatoid arthritis
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medical history: Nonmusculoskeletal specific
- Infections
- Blood disorders
- Peripheral vascular disorders
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Nonmusculoskeletal specific: Infections
limes disease(cutaneous manifestations that can cause muscular problems if left untreated)
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Nonmusculoskeletal specific: Blood disorders
hemophilia - injury casing bleeding into the joint which could cause pain
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Nonmusculoskeletal specific: Peripheral vascular disorders
cancers that metastasize
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Surgical History
- Arthroscopy
- Arthroplasty
- Diskectomy or Laminectomy
- Internal fixation
- External fixation
- Amputation
- Reattachment of a limb
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Arthroscopy
Joint examination
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Arthroplasty
Joint repair/reconstruction
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Diskectomy or Laminectomy
surgical fixation
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Common medications
- Anti-inflammatory agents - NSAIDS
- Analgesics: narcotic or non-narcotic
- Muscle relaxants
- Steroids
- Calcium supplements
- Biphosphonates – Fosamax®, - Evista®, Boniva® - inhibit osteoclastic activity
- Hormone therapy – used less for bone health
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health history for bone examination includes?
- Injuries/accidents
- Special needs
- Childhood illnesses
- Family history
- Social history
- Hobbies/leisure activities
- Exercise – Is it F. I. T. ??
- Diet Intake
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Health History: Special needs include
- Amputation
- Use of assistive devices
- Hemiplegia, quadriplegia, paraplegia
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Health Hsitory: Childhood illnesses include
- - Post Polio Syndrome
- - Juvenile Arthritis
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Health History: Family history
- Rheumatoid arthritis
- Paget’s disease
- Osteoporosis
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Paget’s disease
softens, thickens, and deforms bone
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Rheumatoid arthritis
a chronic, systemic inflammatory disease of joints and surrounding connective tissue. Inflammation of synovial membrane leads to thickening; then to fibrosis, which limits motion; and finally to bony ankylosis
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Osteoporosis
bones can become “spongy,” weak, and more likely to break with even the slightest twist or bump
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Health History:
- Alcohol or tobacco use
- Work environment: role of repetitious movements
- Home environment: physical layout/barriers
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Assessment: Equipment
- Goniometer (measure joint range of motion )
- Tape measure and felt tip marker
- Sphygmomanometer (measure blood pressure)
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Assessment: General approach
- Patient comfort
- Compare non-affected to affected - symmetry
- Proceed in cephalocaudal (head to toe) order
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General Assessment includes
- Overall appearance
- Posture
- Gait and mobility
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Gait and mobility includes
- Weight-bearing status
- Gait patterns
- Transfer ability
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what is transfer ability
- able to
- Sitting to standing
- Sitting to sitting
- Laying to sitting
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what are some normal findings for general assessment?
- Height and weight are proportionate
- Full ROM
- Ambulate independently
- No structural defects
- Shoulders and hips are level
- Head and torso are upright
- Stable gait
- Transfers independently
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what should you inspect?
- - muscle size and shape
- - joint contour and peri-articular tissue
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what are some abnormal findings when inspecting patients muscle size and shape?
- Hypertrophy (increase in mass or girth)
- Atrophy (partial or complete wasting away of a part of the body)
- Involuntary muscle movements (tics, tremors)
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what are some normal findings during inspection
- Symmetrical muscle contour
- No involuntary muscle movements
- Bilateral limb circumference is within 1–3 cm of each other
- Joints are flat when extended, and smooth/rounded during flexion
- No joint enlargement or deformity
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we should palpate for what?
- muscle tone and strength
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what should occur during palpation for muscle tone
- slight resistance to passive stretch
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muscle tone abnormal findings
- - Spasticity (stiff or rigid muscles)
- - Hypotonicity (Having less than normal tone or tension)
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muscle strength scale
- 0: no muscle contraction is detected1: a trace contraction is noted in the muscle by palpating the muscle while the patient attempts to contract it
2: the patient is ale to actively move the muscle when gravity is eliminated 3: the patient may move the muscle against gravity but not against resistance from the examiner 4: the patient may move the muscle group against some resistance from the examiner 5: the patients moves the muscle group and overcomes the resistance of the examiner. this is normal muscle strength
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General Joint Assessment
- Check symmetry
- Do painful ones LAST
- Apply light pressure with fingerpads
- Start in the periphery of the joint and move to center of the joint
- Move it through the ROM
- Note swelling, pain, tenderness, warmth, nodules, erythema, ecchymosis
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Active ROM
performed independently by the patient
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Passive ROM
performed by the examiner
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Tempromandibular Joint TMJ
- Articulation between mandible and temporal bone
- Open and close jaw
- Protraction and retraction
- Side to side movement
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TMJ Range of Motion
- (1) hinge action to open and close the jaws;
- (2) gliding action for protrusion and retraction; and
- (3) gliding for side-to-side movement of the lower jaw.
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Neck ROM
- Flexion
- Extension
- Lateral flexion (bending)
- Rotation
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Spine
- 33 Irregular bones--vertebrae
- 7 Cervical
- 12 Thoracic articulate with ribs
- 5 Lumbar
- Sacrum shapes the posterior wall of the pelvis
- Coccyx
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Inspection & Palpation of the Spine
- Note curvature
- Check symmetry
- Check alinement byPalpating spinousprocesses
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Spine ROM
- - hyper-extension
- - lateral left to right
- - rotation
- - flexion
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Kyphosis
An exaggerated posterior curvature of the thoracic spine (humpback) that causes significant back pain and limited mobility.
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Lordosis
A genetic disorder in converting cartilage to bone results in normal trunk size, short arms and legs, and short stature
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Scoliosis
A lateral S-shaped curvature of the thoracic and lumbar spine, usually with involved vertebrae rotation
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Shoulders ROM
- Ball and socket joint
- Abduction
- Adduction
- Horizontal forward Flexion
- Horizontal Backward Flexion(hyperextension)
- Circumduction
- External and internal rotation
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Inspection & Palpation of the Shoulder
- Shoulders =in height
- No swelling
- No tenderness
- No crepitus
- Full ROM
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Rotator Cuff Tear
- Arm extended and abducted from the body
- Instruct patient to slowly lower the arm while maintaining arm extended
- Arm quickly drops
- Severe pain
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Elbow ROM
- Hinge Joint between humerus, radius and ulna
- Flexion of Forearm-160 º
- Extension of forearm-0 º--Flat
- Supination of forearm-90 º: Palm up
- Pronation of forearm-90 °: Palm down
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Palpation of the Elbow
- Palpate for warmth, swelling, tenderness, nodules, crepitus
- Tennis Elbow:Lateral epicondylitis
- Golfer’s ElbowMedial epicondylitis
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Wrist and Hand ROM
- Eight carpal bones connected by ligaments to the metacarpals distal and to the scaphoid and lunate bones proximally
- Hyperextension - 70 º
- Flexion - 90 º
- Radial deviation - 20 º
- Ulnar deviation - 55 º
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Hand and Fingers ROM
- Metacarpophalangeal and Interphalangeal joints
- Abduction - 20 º
- Extension
- Hyperextension - 30 º
- Flexion - 90 º
- Circumduction
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Thumb ROM
- Extension
- Flexion-80 º
- Opposition
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Phalen 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 no symptoms in the normal hand
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Grip Strength
- Roll B/P cuff up
- Inflate to 20 mm Hg
- Have patient squeeze
- Normal: 150 mm Hg
- Check for symmetry
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how can oyu test for carpal tunnel syndrome?
- - tinel's sign
- - phalen's sign
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Hip Joints
Ball and socket joint between head of femur and acetabulum
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Hip ROM
- - flexion
- - flexion with knee flexion
- - internal and external rotation
- - abduction
- - adduction
- - hyperextention
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Fractured Hip
- Pain
- Inability to bear weight
- Affected leg is shorter
- Affected leg:Internal rotation and External rotation
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Knee Joints ROM
- Complex joint!!
- Patella, femur and tibia
- Extension
- Flexion - 130 º
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Common Knee Disorders: Younger adult
- Ligament tears
- Traumatic
- Athletes – female (?)
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Common Knee Disorders: Older adults
- Osteoarthritis
- Wear and Tear
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Ankle
- Hinge Joint
- Tibia, Fibula and Talus
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Ankle ROM
- - doriflexion
- - planter flexion
- - eversion
- - inversion
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Toes ROM
- Extension
- Flexion
- Abduction - 10 º
- Adduction - 20 º
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Anthropometric Measurements
- Height/Weight
- Waist to Hip Ratio
- Body Proportions
- Growth Patterns in Children
- Changes in Nutritional Status in Adults
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Ideal Body Weight: female
- 100 Lb for 5 feet then add 5 Lb for every inch above 5 feet.
- + or – 10% for small or large frame
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Ideal Body Weight: males
- 106 Lb for 5 feet then add 6 Lb for every inch over 5 feet
- + or – 10% for small or large frame
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% IBW = ?
Actual Wt ÷ IBW x 100
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moderate malnutrition IBW
70-80% IBW
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severe malnutrition IBW
< 70% IBW
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Risk for Obesity Related Diseases
Waist to Hip Ratio
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Waist to Hip Ratio: Males
>1.0
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Waist to Hip Ratio: Females
>0.8
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Body Mass Index values
- < 18.5 - Underweight
- 18.5 – 24.9 - Normal
- 25.0 – 29.9 - Overweight
- 30.0 – 34.9 - Obesity Class I
- 35.0 – 39.9 - Obesity Class II
- >40.0 - Obesity Class III
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Skin Fold Thickness
- Determines Body Fat Stores & Nutritional Status
- - use triceps skin fold (TSF) to determine
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Mid-Arm Circumference (MAC)
- Skeletal Muscle Mass
- Measure in mm
- Normal: 5-95th% tilebased on age/gender
- Used to calculate the Mid-Arm Muscle Circumference
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