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1、AssessmentoftheMusculo SkeletalSystem Dr EssmatGemaey230NUR Outlines ReviewofAnatomyandphysiologyofmusculoskeletalsystemPhysicalExamInspectionPalpationROM Rangofmotion Objectives ApplyknowledgeofAnatomyandphysiologyofmusculoskeletalsystemDifferentiatebetweennormalandabnormalImplementphysicalassessme
2、nt Whatdomusclesdo Musclessimplymoveyou Withoutmusclesyoucouldn topenyourmouth speak shakehands walk talk ormoveyourfoodthroughyourdigestivesystem Therewouldbenoexploring running climbing smiling blinking breathing Youcouldn tmoveanythinginsideoroutsideyou Thefactis withoutmuscles youwouldn tbealive
3、forverylong Theskeletonisthenamegiventothecollectionofbonesthatholdsourbodyup Ourskeletonisveryimportanttous Itdoesthreemajorjobs 1 Itprotectsourvitalorganssuchasthebrain theheart andthelungs 2 Itgivesustheshapethatwehave Withoutourskeletonwewouldjustbeablobofbloodandtissueonthefloor 3 Itallowsustom
4、ove Becauseourmusclesareattachedtoourbones whenourmusclesmove theymovethebones andwemove PhysicalExam InspectionObserveanylackofsymmetryandanyevidenceoftraumaordisease Lookformusclewasting Inspectthejointcontour shape andobserveanyevidenceofswelling deformityorinflammation Asktheclienttopointto orot
5、herwiseidentify anypainfulareas includingsitesofradiationofpain Screeningquestionsformusculoskeletaldisorders1 Doyouhaveanypainorstiffnessinyourarms legsorback 2 Canyouwalkupanddownstairswithoutdifficulty 3 Canyoudressyourselfineverydayclotheswithoutanydifficulty AssessmentofGaitAskthepatienttowalkb
6、ackandforthacrosstheroom Observeforequalityofarmswing balanceandrapidityandeaseofturning Next askthepatienttowalkonhistiptoes thenonheels Askthepatienttotandemwalk Testpatient sabilitytostandwithfeettogetherwitheyesopenandthenclosed Romberg stest Reassurepatientthatyouwillsupporthim incasehebecomesu
7、nsteady Normal Personcanwalkinbalancewiththearmsswingingatsidesandcanturnsmoothly Personshouldbeabletostandwithfeettogetherwithoutfallingwitheyesopenorclosed tiptoes heels tandem UpperExtremityMuscles Inspectthemusclesoftheshoulder arm forearmandhand Notemusclesize bulk Lookforasymmetry atrophyandfa
8、sciculation Lookfortremorandotherabnormalmovementatrestandwitharmsoutstretched Determinemusclepowerby Gentlytryingtooverpowercontractionofeachgroupofmuscles Shoulder Abduction Deltoid Adduction Shrug Trapezius Abduction Adduction Trapezius Elbow flexion Biceps Elbowextension Triceps Wrist Flexion an
9、dextension Hand Gripoppositionofthumbandindexfingeroppositionofthumbandlittlefingerandfingerabductionandadduction Grip Determinelimbtone resistancetopassivestretch WiththepatientrelaxedGentlymovethelimbattheshoulder elbowandwristjointsandnotewhethertoneisnormal increasedordecreased Normalfindings Mu
10、sclesaresymmetricalinsizewithnoinvoluntarymovements Insome musclesmaybeslightlylargeronthedominantside Musclepowerobviouslyvaries Youshouldnotbeabletooverpowerwithreasonableresistance Youhavetolearntoappreciatethenormaltonefrompractice Neck RangeofMotionof FixtheheadwithonehandwhileyouexamineneckIns
11、pectionNotethenormalconcavityofcervicalspineIdentifyTransverseprocessofC7ObserveTrapeziusandSternomastoidmusclesPalpationFeeleachspinousprocesslookingforfocalareasoftendernessJointFeelforcrepitusduringpassivemotionParaspinalmusclesRangeofmotionActiveTouchchinforflexionThrowheadbackforextension Touch
12、chin Throwheadback ToucheachshoulderwithearsforlateralflexionToucheachshoulderwithchinforlateralrotationPassiveFeelforcrepitusduringpassivemotionNormal 30degreerotation abletotouchchestwithchin 55degreeextensionand40degreelateralbend Noresistanceduringtherangeofmotion MusclesofLowerExtremity Inspect
13、themusclesofthehip kneeandankle Notemusclesize bulk Lookforasymmetry atrophyandfasciculation Lookforabnormalmovement Determinemusclepowerbygentlytryingtooverpowercontractionofeachgroupofmuscles Hip Flexion Iliopsoas Extension Gluteusmaximus Abduction Adduction Hipflexion TheKneeExam InspectionMakesu
14、rethatbothkneesarefullyexposed Thepatientshouldbeineitheragownorshorts Rolleduppantlegsdonotprovidegoodexposure Watchthepatientwalk Dotheylimporappeartobeinpain Whenstanding isthereevidenceofbowing varus orknock kneed valgus deformity Thereisapredilectionfordegenerativejointdiseasetoaffectthemedical
15、aspectoftheknee acommoncauseofbowing varusKneedeormity moremarkedontheleftleg Isthereevidenceofatrophyofthequadriceps hamstring orcalfmusclegroups Kneeproblems paincanlimittheuseoftheaffectedleg leadingtowastingofthemuscles Whilebothlegshavewelldevelopedmusculature theleftcalfandhamstringarebulkiert
16、hantheright Knee Flexion Hamstrings Extension Quadriceps Ankle Dorsiflexion Tibialisanterior Plantarflexion Gastronemius Determinelimbtoneresistancetopassivestretch Withthepatientrelaxed gentlymovethelimbatthehip kneeandankleandnotewhethertoneisnormal increasedordicreased Flexthehipandknee Supporttheknee dorsiflextheanklesharplyandholdthefootinthispositioncheckingforclonus Dorsiflexion Kneeextension Kneeflexion Spine Bone Theexaminershouldstandbehindthepatientandobservethealignmentofthespineinth
