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what is the 5th most frequent reson for ambulatory visits
- lower back pain
- common and expensive
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types of connective tissue
- bone
- cartilage
- ligaments/tendons
- fascia and bursae
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Muscle
- millions of individual muscle fibers that contract and relax to facilitate movement
- more than 600 in the body
- 2-60cm long
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makeup of muscle
- 75% water
- 20% protein
- 5% inorganic and organic compounds
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types of muscle contraction
- isometric: changes in muscle tension but not length
- isotonic: changes in muscle length but same tension
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2 types of isotonic contraction
- eccentric: extension, muscle lengthens
- concentric: contraction, muscle shortens
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bone
- rigid connective tissue
- gives form to body, supports structures, protects organs
- permits movement with muscles
- a site for blood cell formation
- plays a role in mineral and hormone homeostasis
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how many bones in the human body and the 2 regions
- 206 total
- axial skeleton: 80 bones; skull, vertebrae, thorax
- appendicular skeleton: 126 bones; shoulder, pelvic, upper and lower extremities
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joints
- sites where tow or more bones meet/attach
- provide stability and mobility to the skeleton
- aka areas of articulation
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functions of cartilage
- support
- articulation
- growth
- protection
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tendons
- attach muscle to bone
- transfer forces from muscle to bone
- act as a type of biologic spring for muscles to allow additional stability when moving
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ligaments
- attach bone to bone
- stabilize joints against excessive movement
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fascia
layers of connective tissue with intermeshed fibers that can withstand limited stretching and provides strenght to muscle tissue
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types of fascia
- superficial: lies immediately under the skin
- deep: dense, fibrous tissue that surrounds the muscle bundles, nerves, and blood vessels
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bursae
- small sacs of connective tissue lined with synovial membrane and containing viscous synovial fluid
- typically located at bony prominences or joints to releive pressure and decrease friction between moving parts
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how does aging affect bones joints and muscles
- bones: bone loss, less strong, more brittle. remodel time lengthened
- joints: cartilage becomes more rigid, fragile and susceptible to fraying, decreased ROM
- muscles: sarcopenia (muscle wasting), decrease in mass and strength, reduced o2 intake, reduced BMR and reduced lean body mass
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common accompanying symptoms to musculoskeletal problems
- rash
- fever
- bowel/bladder dysfunction
- fatigue
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what do you palpate the musculoskeletal system for
- muscles and joints for skin temp, tenderness, swelling and crepitus
- look for general contour, abnormal prominances and local landmarks
- palpate superficially to deep- sore areas first
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what do atrophied muscles feel like
- soft and boggy
- kinda like a uterus thats boggy
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muscle strength scale
- 0: no detection of muscle contraction
- 1: a barely detectable flicker or trace of contraction with observation and palpation
- 2: active movement of body part with elmination of gravity
- 3: active movement gainst gravity only but not against resistance
- 4: active movement against gravity and some resistance
- 5: active movement against full resistance with no fatigue (normal)
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joints to pay attention to
- hand and wrist
- elbows
- shoulders
- temporomandibular joint
- cervical, thoracic and lumbar spine
- hips
- legs and knees
- feet and ankles
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planes of movement
- sagittal: divites body into left and right. flexion extension movements (back and forth)
- frontal: divides body into front and back. abduction and adduction movements (lateral and medial)
- transverse: divides body into top and bottom. rotational movements
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what do you start the musculoskeletal assessment after
the romberg test which is last in the neuro exam
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what to do when patient is standing
- look at gait and stance
- look for smooth coordinated movement
- test active ROM of hips (abd, add, flex, exten, internal/ext rot)
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what to do when patient is sitting on end of exam table
- observe muscle bulk symmetry of upper extremities
- test active ROM of shoulders
- assess grade of muscle strength of forearms
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what to test for when patient is lying on the exam table
- observe muscle bulk symmetry of lower extremities
- assess and grade muscle strength of lower extremities
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normal posture
- standing: upright with parallel aligntment of hips and shoulders
- sitting: some degree of rounding of the shoulders is normal
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steps of normal gait
- heal strike
- foot flat
- midstance
- push-off
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average step size
2-4 inches
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