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Assignment: Physiology of the Musculoskeletal System Essay

Assignment: Physiology of the Musculoskeletal System Essay

 

The musculoskeletal system encompasses of bones, joints, muscles, ligaments, and tendons. The bony structure protects vital organs, while the bony skeleton provides support to body structures. Joints connect bones and allow body movement. The skeleton is attached to muscles which contract, to enable bone movement also generate heat that is vital in homeostasis. There are three types of bone cells, namely osteoblasts, osteocytes, and osteoclasts (Areeckal & Kocher, 2018). Osteoblasts are involved in bone formation by secretion of bone matrix where mineral salts are deposited. Osteocytes maintain bone functions, while osteoclasts are involved in bone resorption and remolding

Ligaments are fibrous connective tissues that bind articulating bones together and play a role in promoting stable joints. Synovial fluid facilitates the movement of bones, ligaments, and tendons when there is friction (Gross, Fetto & Rosen, 2015). The synovial fluid is mostly found in shoulder, elbow, and knee joints and is contained in a sac known as bursa.

Muscles are attached to bones, soft tissue, skin, connective tissue, and other muscles by tendons, which are cords made of fibrous connective tissues. The body muscles are made up of a group of muscle cells known as fasciculi that are covered in fibrous tissue known as fascia (Malanga & Mautner, 2016). Muscles having specific movements have more fasciculi, and they have various shapes and size based on their function. Besides, skeletal muscles play a role in maintaining posture, body movement, and production of heat.

Subjective Data

Pain: Patients with traumatic disorders of muscles, bones, and joints experience pain. Questions to assess pain should include: How is the pain? Is the pain localized? Does the pain radiate and to which body part? On a scale of 1-10, how severe is the pain? Is the pain dull, sharp, or throbbing? What relieves the pain? What aggravates it? Is there tension on the skin at a pin site? How did the pain start?

Altered sensation: Musculoskeletal problems result in sensation disturbances, which patients define as numbness, tingling, or burning sensations. Questions that the patient should be asked concerning sensation disturbances include: Do you experience any abnormal sensations or numbness? When did the sensations begin? Are they getting worse? Do you also feel pain in the affected part? Can you move the affected part? What is the color of the part next to the affected area?

Joint disorder: Information on whether the patient is experiencing joint difficulties is vital, to identify joint disorders such as arthritis. Questions should include: Are you experiencing joint pain? Do your joints stiffen? Which joints are affected? Do the joints feel warm? What aggravates the symptoms? What relieves the symptoms? Do you experience joints limitation? Do you have a history of joint trauma? (Gross, Fetto & Rosen, 2015)

Bones: History of fractures and surgery should be obtained by asking: Have you ever had a bone fracture? Do you have a history of bone surgery? Do you have any bone deformity? Do you experience pain with or without movement? Have you noticed loss of height?

Objective Data

General appearance: This includes assessment of weight, height, amputated limbs, contractures, discomfort, restricted movements, frequent shifting movements, and facial grimace. Normal findings should consist of: appropriate weight and height as per age, absence of structural anomalies, independent movement no sign of discomfort at rest, distinct relationship between torso, limbs, and pelvis during movement.

Posture: The patient should be observed when standing and feet together and inspected for the relationship between head, torso, pelvis, and limbs (Gross, Fetto & Rosen, 2015). Normal findings include: an upright head and torso, the head is midline and symmetrical to shoulders and the pelvis.

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Gait and mobility: Should be observed when the patient is walking, standing, and sitting. Normal findings are: smooth walking with no

Assignment Physiology of the Musculoskeletal System Essay

Assignment Physiology of the Musculoskeletal System Essay

dragging of feet, the patient remains in an erect position, and balanced, and arms should swing freely when walking.

Bone integrity: The bony skeleton is examined for, and alignment deformities and symmetric parts are compared. Normal findings include: Absence of bone deformities and growths, well-aligned bones and spine and absence of long bones angulation.

Joint function: The joints are assessed for deformity, presence of nodules, and range of motion (Gross, Fetto & Rosen, 2015). Normal findings include the absence of malformations, absence of nodular formation, and a strong range of motion in all joints.

Cervical spine: The neck should flex, hyperextend, rotate, and bend in a lateral position.

Shoulder joint: Normal findings include forward flexion, hyperextension, abduction, and adduction, internal and external rotation of the upper limbs.

Muscle strength and size: Assessment of the muscles is conducted by inspecting the ability of the patient to change position, muscle strength and coordination, and size of muscles (Malanga & Mautner, 2016). Normal findings include a complete range of motion (ROM) against gravity and full manual resistance with a score of 5/5, absence in increase or decrease in muscle size and shape.

Special Physical Assessment Examination Techniques

Trendelenburg Test: Used to assess for hip dysfunction by identifying weaknesses of hip abductors. In the technique, the patient stands on one leg for about 30 seconds without inclining on one side. If he cannot maintain balance, he can support himself by holding onto something. The clinician then inspects if the pelvis is at level when the patient is standing on one leg. If the pelvis drops toward the unsupported limb, it is considered a positive Trendelenburg Test, and if the pelvis remains level, it is negative.

Patrick’s Test: is used to assess defects in the sacroiliac joint. The patient assumes a supine position and places one foot on top of the opposite knee (Gross, Fetto & Rosen, 2015). The clinician presses down the flexed knee firmly while supporting pelvis of the anterior superior iliac spine on the opposite side. If the patient reports pain in the sacroiliac joint, the test is considered positive.

Mcmurray’s Test: Is used to evaluate for the presence of a meniscal tear in the knee. The patient lies on a supine position, and the clinician holds the knee, and one hand palpates the joint line (Malanga & Mautner, 2016). The other hand holds the sole and supports the lower limb and also provide the necessary movement.

Thompson Squeeze Test: Evaluates for the integrity of Achilles tendons and confirms the complete rupture of Achilles tendon. During the test, a patient lies in a prone position with the knee flexed up to 90°. The clinician squeezes the calf muscles, precisely the gastrocnemius – soleus complex, with the hand (Malanga & Mautner, 2016). Normally, squeezing the calf should arouse a contraction of the Achilles tendon, causing a plantar flexion. However, if the Achilles tendon is completely ruptured, there will be no visible plantar flexion.

Adaptation of Physical Assessment Skills and Interviewing Techniques to Accommodate Specific Populations

Pediatric patients: The clinician should enquire from the caregiver if the baby has experienced any trauma, fractures, and if there were any difficulties during birth that affected the bony structure (Duderstadt, 2017). History of rickets and birth defects such as spina bifida, hydrocephalus, or cleft palate should be obtained during history taking. Assessment should be conducted when the child is dressed to a minimum; this is by exposing the feet, upper and lower extremities, and the torso to facilitate the assessment of the spine. During the examination, the clinician should assess for facial grimace, which indicates that the child is in pain or uncomfortable (Duderstadt, 2017). The examiner should also inspect for signs of asymmetry that include a poor range of movement in joints, muscle bulk, and joint swelling.

Pregnant patients: Pregnant women experience musculoskeletal pain and symptoms, particularly in the third trimester including low back pain, back pain, hip pain and symptoms of carpal tunnel syndrome (Malanga & Mautner, 2016). During the assessment, the examiner should inquire if they experience any muscle pain, and if the pain symptoms were present before pregnancy. Poor gait and posture could be a result of the fetal weight exerted on the spine and loosening of the spinal ligaments (Gross, Fetto & Rosen, 2015). The clinician should be careful not to perform techniques that may cause distress to the patient or induce labor.

Geriatrics: In the assessment of geriatric patients, the clinician should obtain information on the history of fractures, back pain, osteoporosis, rheumatoid, and osteoarthritis. The clinician should take a thorough assessment of joints for signs of inflammation, stiffness, and poor range of motion to evaluate for the presence of joint disorders (Carlson, Merel & Yukawa, 2015). In geriatric women, the clinician should inspect for height, alignment of the spine, which may be abnormal due to the loss of vertebrae as a result of bone resorption. Furthermore, physical examination should be conducted to assess for porous bones and signs of bone infections which are prone in the older population.

Major Disease That May Significantly Impact the Musculoskeletal System

Osteoporosis is a common chronic metabolic bone disease that results in bones becoming porous and fragile. It manifests with a low bone mass density and structural decrease in bone tissue resulting in increased bone fragility (Areeckal & Kocher, 2018). Osteoporosis develops when there is a disproportion between bone resorption and bone formation (Carlson, Merel & Yukawa, 2015). Symptoms of Osteoporosis are asymptomatic, and there is a gradual collapse of the vertebra, which results in a slow onset of kyphosis.

Abnormal physical findings that are associated with osteoporosis include: decrease in height and low body mass index less than 19kg/m2 (Areeckal & Kocher, 2018). The patient also has an abnormal posture caused by relaxation of the abdominal muscles that results in a protruding abdomen. The abdominal deformity may result in insufficiency in pulmonary function, and on assessment, the examiner may identify the use of abdominal muscles during respiration. Furthermore, the spine is not well-aligned, and the patient assumes a bending posture which results in back pain.

Summary

In conclusion, the musculoskeletal system is composed of muscles, bones, ligaments, tendons, and bursae, and each plays a role in body movement. In the review of systems, the clinician should inquire on pain, altered sensations, joint pain and stiffness and history of fractures and bone surgery. Physical examination should focus on assessing gait, posture, joint function, and bone integrity and muscle strength. Special physical examination techniques that can be applied in the assessment of the musculoskeletal system include Trendelenburg, Patrick’s, and Mcmurray’s and Thompson tests. The tests are used to evaluate for abnormalities in the muscles, bones, joints, and tendons. Osteoporosis is a common disease that is characterized by porous bones resulting from bone resorption exceeding bone formation. Manifestations of osteoporosis include abnormal posture, height loss, spinal deformity, and thoracic kyphosis.

1. Select a body system relevant to the lesson from the previous week for the topic of this paper. For example, if you are writing this assignment for Week 2, then select the HEENT, Respiratory, or Integumentary system as the focus for the paper (not all three systems). If you are writing this assignment for Week 1, select the Health History as the topic of the paper.
2.Discuss the physiology (structure and function) of the body system including details about the major organ systems (if applicable). If you are writing the assignment for Week 1, provide an overview of interviewing techniques.
3.Construct relevant health history questions (subjective data) pertaining to the body system. If writing the assignment for Week 1, construct relevant health history questions for all body systems as included on the review of systems (ROS).
4.Provide an overview of the objective data and expected normal physical examination findings for this body system. If writing this assignment for Week 1, provide the expected normal subjective findings for each body systems on the ROS.
5.Explain special physical assessment examination techniques or procedures specific to assessing this body system. If writing the assignment for Week 1, explain advanced interview techniques.
6.Analyze and discuss how you might adapt your physical assessment skills or interviewing techniques to accommodate each of the following specific populations:
Infant/pediatric
Pregnancy
Geriatric

7. Identify one major disease or disease process that may significantly impact this body system. If writing the assignment for Week 1, identify one disease process or condition that may significantly hinder conducting a Health History interview.
Synthesis and discuss the expected abnormal physical examination findings that may be associated with this disease or disease process.
8.Summarize the key points

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