Musculoskeletal System

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  1. Important things to know in children and adolescents abt MS?
    When are ligaments stronger?
    Why fractures are more common on children than adolescence?
    What happens in puberty?
    Age to complete bone growth? peak bone mass?
    • Long bones increase in length and thickness throughout childhood. 
    • Ligaments are stronger in children.
    • Ligaments stronger than bone in children until adolescence. Then bone is stronger than ligament.
    • There is decrease of strength in the epiphyses (growth plate) which increases the risk of injury at that site of the bone.
    • Bone growth abt age 20, peak bone mass at 35.
  2. What happens in the MS system of a pregnant women?
    • increased mobility of the pelvic bone. This is due to hormones.
    • Lordosis of the spine.
    • Lowe back pain (40-50%)
    • Muscle cramps.
  3. What changes in older adults?
    • Loss of bone and decreased bone density. (30% loss by age 80)
    • Long bones and vertebrae most vulnerable for fractures.
    • Ligaments and bones are both weaker.
    • Deterioration of the bone cartilage (decreased mobility)
    • Sedentary life worsens degeneration of MS.
  4. chts of joint, muscular, bone, nerve pain/
    • JT: locking, movement disorder, pain w movement (passive and active).
    • MC: pain when movement, soreness.
    • NV: Pain, numbness, tingling, shooting pain.
    • Bone: pint tenderness, and deformity.
  5. what is important to know when taking a history on infants and children? pregnant women? older adults?
    • I & C: type of birth delivery, birth injuries, quality of movement. -- low birth weight, premature, resuscitation efforts, required ventilator support (may result in anoxia leading to muscle tone disorders). -- Milestones (walking, hopping, etc).
    • PW: Muscle cramps, back pain (could be something else besides pregnancy). -- type of shoes?
    • OA: weakness, increase injuries,
  6. What is scoliosis? kyphosis? lordosis?
    Fluctuation? Crepitus?
    • S: curvature to the side.
    • K: front.
    • L: back.

    • F: movement of fluid around the joint.
    • C: grating sound w movement (heard of felt)
  7. In range of motion does active or passive go first in the examination?
    Which one has a bigger ROM usually?
    What is a goiometer?
    what the grading for Muscle strength?
    • Active ROM first, then Passive.
    • Passive ROM is usually a little bit greater than active ROM. 
    • G: it is a tool to measuare ROM.
    • MS: graded from 0 to 5 (0 no resistance, 5 full resistance). Symmetry.
  8. What is assessed in TMJ?
    Cervical Spine?
    • inspect --> palpate (pain, crepitus, locking, and popping) --> ROM (open and close, lateral movement) --> strength (clench teeth, masseter strength).
    • CS: inspect --> palpate (posterior neck, cervical spines, trapezius and sternocleidomastoid.
  9. What is Flexion? Expention?
    Radial vs Ulnar?
    Supination and Pronation?
    adduction and abduction?
    Dorsiflexion and plantar flexion?
    invertion and eversion?
    • Flexion: towards the body.
    • Extension: away from the body.
    • Hyperextension: extention greater than normal -- double joints (degree greater than 0).
    • Radial and Ulnar: Radial thumb, the other one.
    • Supination: palm facing up.
    • Pronation: Palm facing down.
    • Adduction: adding it to the body.
    • Abduction: away from the body.
    • Dorsiflexion: toes pointing up towards body.
    • Plantar flexion: toes down, like a valerina.
    • Inversion: w the toe up rest of the floor .
    • Eversion: w the toe on the floor, rest of the feet of the floor.
  10. Dislocation or wing of scapula?
    What does it mean when palpating down the posterior spine, the pt complaints abt pain?
    • Winged: nerve damage or muscle trauma. Usually occurs only in one side.
    • dislocation: space b/t the humerus and scapula.
    • Point tenderness means fracture, so most likely vertebrae fracture.
  11. what is the Adams test? what is it used for?
    How to check symmetry of hips on babies? adults?
    If a pt. is complaining abt hip pain, what other part of the body should u assess?
    What is the farber test?
    What should u keep an eye when doing hip tests?
    • Adams test is to bend over on the hips.
    • Used for scoliosis.
    • On baby gluteal folds.
    • Adults look when they r standing.
    • Should also assess knee, and vice-verse.
    • Faber: external rotation of the knees to abt 45 degrees.
    • Make sure the pt keeps his/her bud down.
  12. If pt complaints abt pain in hands and u suspect of carpal tunnel in the hands, what tests should u performed?
    • Tinel sign and Phalen test.
    • Tinel: strike the median nerve under the flexor carpal ligament. -- tingling sensation radiating from the wrist is a positive sign.
    • Phalen: forced flexed wrists for 30-60 secs. -- positive test if numbness or tingling developed.
  13. If a pt. comes with a complaint abt maybe a tear rotator cuff, what test should u do?
    • Neer test and Hawkins test.
    • Neer: arm at side, then internally rotate and forward flex arm at the shoulder. -- positive is pain from impingement.
    • Hawkins: Arm straight out, bend at elbow to 90 degrees, and the internally rotate arm to its limit and and drop hand down. -- positive if pain.
  14. If pt is complaining from lower back pain, and u suspect a nerve irritation, what test should u do?
    • Straight leg raising test. -- pt supine, neck slightly flexed, raise leg w knee extended. -- positive if pain.
    • Femoral stretch test. -- same as straight leg test but having the pt prone.
  15. what are hip test assessment?
    • Thomas test: fully extend one leg with flexed knee on the other. Observe the pt's ability to keep the extended leg flat-- tests the degree of flexion, not only pain.
    • Trendelenburg test: it is to detect weak hip muscles. have the pt stand on one leg and flex the knee on the other. observe for any drop from behind the pt. -- A + test is to see a drop on the unsupported leg. 
    • Barlow and Ortolini: they are used together to check for dislocated hips, until age 2 or 3 months.
  16. What test would u do if u suspect excess fluid or effusion on the knee?
    Ligaments of the knee?
    • Ballottement: one hand in the suprapatella and the other one on the patella. Suprapatellar hand pouch with web of thumb and forefinger. Push down on this hand. Push patella downwards towards the femur to look for bogginess (movable fluid).
    • Bulge sign: milk the kneed to try to collect fluid 2 or 3 x.
    • Image Upload 1

    • ACL and PCL: (forward and backward movement) prevent excessive anterior glide of the femur on the tibia.
    • MCL and LCL: are side movement.
    • MCL: prevents excessive abduction of the tibia.
    • LCL: prevents excessive adduction of the tibia.
  17. what test would u performed if suspecting and ACL tear?
    Medial or lateral meniscus?
    • Anterior drawer test: flex knee feet on table, grasp posterior of tibia (upper calf) and pull tibia forward. -- if excessive movement, then the tests is +.
    • Posterior Drawer test: knee flex at 90 degrees, grasp the anterior aspect of the tibia, and push forward or back. -- positive for extra movement.
    • McMurray test: Move knee side to side, knee flexed one hand in knee and the other in the foot, then rotate the tibia. -- pop or click or pain may be a + test.
    • Valgus stress test: abduction stress test. one hand stabilizing the knee, the other on the lower leg. Then push lower leg into abduction. -- if abduction is greater than normal, test if +.
    • Varus stress test: same thing but adduct instead of abduct.
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Musculoskeletal System
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