Musculoskeletal System
Musculoskeletal: consists of bones, joints, muscles
o Needed for movement
o Protect/ incase internal organs
o Produce RBC in BM
o Serve as a reservoir for storage of essential minerals
o 206 bones in the human skeleton
Components
o Synovial joints: also named diarthrosis
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Place of union of two or more bones
o Bursa: enclosed fluid filled sac that serves as a cushion
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Helps muscles to glide and tendons to move (muscular movement)
o Tendons: muscle to bone
o Ligaments: bone to bone
Fibrous Joints
o Bones united by fibrous joints or cartilage
o Do not move (sutures in the skull)
Cartilaginous joints
o Separated by fibrous cartilage
o Slightly moveable (vertebrae)
Synovial joints
o Joints separated by one another, enclosed in a cavity lined with synovial membrane
that secretes fluid
o Freely moveable
o Bursae located in areas of potential
friction  facilitate movement of muscles
and tendons
Spine and Vertebrae
o Vertebrae: 33 connecting bones
o Can feel the spinous process in furrow down midline of the back
Shoulder
o Shoulder girdle consists of
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Humerus, scapula, clavicle, joints, and muscles
o Subacromial bursa
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Assists with abduction of the arm
o Palpable landmarks: scapula/ clavicle form the shoulder girdle
Elbow, Wrist and Carpals
Elbow
o 3 bony articulations: humerus, radius, and ulna of forearm
o Palpable landmarks are medial and lateral epicondyles of humerus and large olecranon
process of ulna between them.
Bones of Hand
o Human hand has: 27 bones, 27 joints, 34 muscles and 100+ ligaments and tendons
Hip
o Ball and socket
o Palpation of bony landmarks guide examination
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Iliac crest: anterior superior spine to posterior
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Ischial tuberosity
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Greater trochanter of femur
Knee
o Articulation of 3 bones: femur, tibia, patella in articular cavity
o Largest joint in body
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Hinge joint
o Synovial membrane is largest in body
Ankle and Foot
o Landmarks = 2 bony prominences on either side
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Helps stability of the ankle
Developmental Competence:
Infants & Children
o By 3mo fetus has formed scale model of the skeleton of the cartilage
o Bone growth occurs in 2 dimensions
o Epiphyses: specialized growth plates at the end of long bones
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Growth continues until closure of epiphyses, last closure at age 20
Pregnant Women
o Increased hormones  increased mobility in joints
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Estrogen, relaxin and corticosteroids
o Maternal posture changes due to increased mobility in sacroiliac, sacrococcygeal and
symphysis pubis joints in the pelvis
o Pressure on the ulnar and median nerves seen in last trimester
Aging Adult
o After age 40, resorption occurs more rapidly than deposition
o Decreased height
o Kyphosis, slight flexion of hips/ knees
o Sedentary lifestyle impact
Culture and Genetics
o Higher bone mineral density (BMD)= denser bone
o Low BMD = hip/ vertebral fractures
o Earlier peak and rapid decline of BMD  increased fracture risk for Caucasian women
Purpose of Musculoskeletal examination
o Assess function for ADLs and screen for abnormalities
Cervical Spine
o Person can normally maintain flexion against full resistance
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Tests integrity of cranial nerve XI (spinal nerve)
Wrist and Hand Examination
o Test for Carpal Tunnel Syndrome
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Phalen test : acute flexion of wrist  numbness and burning
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Tinel sign test: percussion of median nerve  burning and tingling
Knee Examination
o If swelling  test for bulge sign and ballottement of patella to distinguish soft tissue
swelling or increased fluid in joint
Spine Examination
o Kyphosis: Enhanced thoracic curve typically seen in aging people
o Lordosis: Pronounced lumbar curve seen in obese people
o Palpate spinous processes; normally straight and not tender.
o Palpate paravertebral muscles; should feel firm with no tenderness or spasm.
o Spinal curvature clearly seen when person touches toes
Straight Leg Raising / Lasegue’s Test
o Herniated nucleus pulposus
o Raise affected leg until pain, dorsiflex foot
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Positive if sciatic pain present
Developmental Competence: Infants
o Checking hips for congenital dislocation
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Ortolani’s maneuver: should be done at every visit until infant is 1 years old
o Hip dislocation
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Allis test
Adolescents
o Kyphosis common due to poor posture
Abnormalities Affecting Multiple Joints
o Inflammatory conditions
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Rheumatoid arthritis
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Ankylosing spondylitis
o Degenerative conditions
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Osteoarthritis (degenerative joint disease)
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Osteoporosis