health assessment exam: MS

• - long bones
• - short bones
• - flat bones
• - irregular bones

• attach bone to bone
• - strong bands
• - elastic
• - maintain joint in normal ROM

• - attach muscle to bone and muscle to muscle to muscle
• - muscle contraction- tendon pulls on bone

covers the tendon

Inflammation of the tendon

• fluid-filled cavities located at tissue sites where tendons or muscle pass over bony prominences near joints
• - facilitates movement
• - reduces friction

• inflammation of the bursa. which can cause
• - limitation of movement
• - pain upon movement

• also called articulations
• - point where two bones meet
• - three types of joints

• - fibrous
• - cartilaginous
• - synovial

skull sutures

vertebrae

• - mast majority of out bones
• - ankle, shoulder, knee
• - contains synovial fuid

- acts as a cushion and protects from wear and tear

• - pain 
• - weakness
• - limited movement
• - stiffness
• - deformity

pain

• chronic 
• - what have they been doing? long term

• acute
• - caused by trauma? came without external forces?

• - joint disorder 
• - bone or skeletal disorders: fractures
• - neuromuscular disorders

multiple sclerosis, multiple muscular dystrophy

osteo arthritis or rheumatoid arthritis

• Infections
• Blood disorders
• Peripheral vascular disorders

limes disease(cutaneous manifestations that can cause muscular problems if left untreated)

hemophilia - injury casing bleeding into the joint which could cause pain

cancers that metastasize

• Arthroscopy
• Arthroplasty
• Diskectomy or Laminectomy
• Internal fixation
• External fixation
• Amputation
• Reattachment of a limb

Joint examination

Joint repair/reconstruction

surgical fixation

• 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

• Injuries/accidents
• Special needs
• Childhood illnesses
• Family history
• Social history
• Hobbies/leisure activities
• Exercise – Is it F. I. T. ??
• Diet Intake

• Amputation
• Use of assistive devices
• Hemiplegia, quadriplegia, paraplegia

• - Post Polio Syndrome
• - Juvenile Arthritis

• Rheumatoid arthritis
• Paget’s disease
• Osteoporosis

softens, thickens, and deforms bone

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

bones can become “spongy,” weak, and more likely to break with even the slightest twist or bump

• Alcohol or tobacco use
• Work environment: role of repetitious movements
• Home environment: physical layout/barriers

• Goniometer (measure joint range of motion )
• Tape measure and felt tip marker
• Sphygmomanometer (measure blood pressure)

• Patient comfort
• Compare non-affected to affected - symmetry
• Proceed in cephalocaudal (head to toe) order

• Overall appearance
• Posture
• Gait and mobility

• Weight-bearing status
• Gait patterns
• Transfer ability

• able to 
• Sitting to standing
• Sitting to sitting
• Laying to sitting

• 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

• - muscle size and shape
• - joint contour and peri-articular tissue

• Hypertrophy (increase in mass or girth)
• Atrophy (partial or complete wasting away of a part of the body)
• Involuntary muscle movements (tics, tremors)

• 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

- muscle tone and strength

- slight resistance to passive stretch

• - Spasticity (stiff or rigid muscles) 
• - Hypotonicity (Having less than normal tone or tension)

• 0: no muscle contraction is detected
• 1: 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

• 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

performed independently by the patient

performed by the examiner

• Articulation between mandible and temporal bone
• Open and close jaw
• Protraction and retraction
• Side to side movement

• (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.

• Flexion
• Extension
• Lateral flexion (bending)
• Rotation

• 33 Irregular bones--vertebrae
• 7 Cervical
• 12 Thoracic articulate with ribs
• 5 Lumbar
• Sacrum shapes the posterior wall of the pelvis
• Coccyx

• Note curvature
• Check symmetry
• Check alinement byPalpating spinousprocesses

• - hyper-extension 
• - lateral left to right
• - rotation 
• - flexion

An exaggerated posterior curvature of the thoracic spine (humpback) that causes significant back pain and limited mobility.

A genetic disorder in converting cartilage to bone results in normal trunk size, short arms and legs, and short stature

A lateral S-shaped curvature of the thoracic and lumbar spine, usually with involved vertebrae rotation

• Ball and socket joint
• Abduction 
• Adduction
• Horizontal forward Flexion
• Horizontal Backward Flexion(hyperextension)
• Circumduction
• External and internal rotation

• Shoulders =in height
• No swelling
• No tenderness
• No crepitus
• Full ROM

• Arm extended and abducted from the body
• Instruct patient to slowly lower the arm while maintaining arm extended
• Arm quickly drops
• Severe pain

• 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

• Palpate for warmth, swelling, tenderness, nodules, crepitus
• Tennis Elbow:Lateral epicondylitis
• Golfer’s ElbowMedial epicondylitis

• 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

• Metacarpophalangeal and Interphalangeal joints
• Abduction - 20 º
• Extension
• Hyperextension - 30 º
• Flexion - 90 º
• Circumduction

•  Extension
•  Flexion-80 º
•  Opposition

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

• Roll B/P cuff up
• Inflate to 20 mm Hg
• Have patient squeeze
• Normal: 150 mm Hg
• Check for symmetry

• - tinel's sign 
• - phalen's sign

Ball and socket joint between head of femur and acetabulum

• - flexion 
• - flexion with knee flexion 
• - internal and external rotation 
• - abduction 
• - adduction 
• - hyperextention

• Pain
• Inability to bear weight
• Affected leg is shorter
• Affected leg:Internal rotation and External rotation

• Complex joint!!
• Patella, femur and tibia
• Extension
• Flexion - 130 º

• Ligament tears
• Traumatic
• Athletes – female (?)

• Osteoarthritis
• Wear and Tear

• Hinge Joint
• Tibia, Fibula and Talus

• - doriflexion 
• - planter flexion
• - eversion
• - inversion

• Extension
• Flexion
• Abduction - 10 º
• Adduction - 20 º

• Height/Weight
• Waist to Hip Ratio
• Body Proportions
• Growth Patterns in Children
• Changes in Nutritional Status in Adults

• 100 Lb for 5 feet then add 5 Lb for every inch above 5 feet.
• + or – 10% for small or large frame

• 106 Lb for 5 feet then add 6 Lb for every inch over 5 feet
• + or – 10% for small or large frame

Actual Wt ÷ IBW x 100

70-80% IBW

< 70% IBW

110% IBW

>120 % IBW

Waist to Hip Ratio

>1.0

>0.8

• < 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

• Determines Body Fat Stores & Nutritional Status
• - use triceps skin fold (TSF) to determine

• Skeletal Muscle Mass
• Measure in mm
• Normal: 5-95th% tilebased on age/gender
• Used to calculate the Mid-Arm Muscle Circumference