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musculoskeletal system
1. Assessment of the
Musculoskeletal
system
Maria Carmela L. Domocmat, RN, MSN
Instructor, Nursing Health Assessment
School of Nursing
Northern Luzon Adventist College
Maria Carmela L. Domocmat, RN, MSN
4. • Inspect and palpate the TMJ
• Test ROM
• Test CN V function
Overview
Maria Carmela L. Domocmat, RN, MSN
5. o normal finding:
jaws move laterally 1 to 2 cm
(+) snapping and clicking – may be felt and heard
mouth opens 1-2 inches (distance bet upper and lower teeth)
jaw protrudes and retracts easily
o abnormal finding:
decreased ROM, swelling, tenderness, crepitus – arthritis
decreased muscle strength – muscle and joint dse
decreased ROM, clicking, popping, grating sound – TMJ
dysfunction
Inspect and palpate the TMJ
Maria Carmela L. Domocmat, RN, MSN
9. Test CN V function
– contract temporal and masseter
muscle
Maria Carmela L. Domocmat, RN, MSN
10. o normal finding:
full ROM against contraction
contraction palpated with no pain or spasms
o abnormal finding:
lack of full contraction – CN V lesion
Pain or spasms – myofacial pain syndrome
ROM & CN V function
Maria Carmela L. Domocmat, RN, MSN
12. • Inspection and palpation
o normal finding:
no visible bony growth, swelling, redness
joint – nontender
o abnormal finding:
swollen, red, enlarged joint or tender
painful joint – joint inflammation
Sternoclavicular joint
Maria Carmela L. Domocmat, RN, MSN
13. Maria Carmela L. Domocmat, RN, MSN
http://www.orthoandsportspt.com/media/img/1076/shoulder_anato
my_bones03.jpg
15. o normal finding:
cervical and lumbar spines – concave
thoracic spine – convex
spine –straight; 24 vertebrae
African Americans – large gluteal prominence
– spine appear lumbar lordosis
variation number of vertebrae
•Afr Ame women – 23 vertebrae
•Eskimo, Indian women – 25 vertebrae
Observe the cervical, thoracic, and
lumbar curves from side then from
behind
Maria Carmela L. Domocmat, RN, MSN
20. o abnormal finding:
flattened lumbar curvature – herniated lumbar
disc, ankylosing spondylitis
scoliosis - lateral curvature of thoracic spine
with increase in convexity on curved side
lordosis – exaggerated lumbar curve;
pregnancy, obesity
kyphosis – rounded thoracic convexity
Observe the cervical, –thoracic, lengths
unequal heights of hips unequal leg and
lumbar curves from side then from
behind
Maria Carmela L. Domocmat, RN, MSN
32. o normal finding:
nontender spinous processes
well-developed firm and smooth, nontender
paravertebral muscles
no muscle spasms
Maria Carmela L. Domocmat, RN, MSN
33. o abnormal finding:
pain and tenderness of spinal processes and
paravertebral muscles – compression
fractures, lumbosacral muscle strain
Maria Carmela L. Domocmat, RN, MSN
34. o flexion – touch chin; hyperextension –
look up
o lateral bending – touch ear
o rotation
o repeat all against resistance
Test ROM of cervical spine
Maria Carmela L. Domocmat, RN, MSN
38. o normal finding:
flexion - 450; extension - 450
rotation -700
full ROM against resistance
Maria Carmela L. Domocmat, RN, MSN
39. pain and tenderness of spinal processes and
paravertebral muscles compression fractures ad
lumbosacral muscle strain
cervical strain
• impaired ROM and neck pain – form abnormalities soft tissue
(muscles, ligaments, nerves) – due straining or injuring neck
(i.e, sleeping in wrong position, carrying heavy suitcase,
automobile crash)
impaired ROM, pain that radiates to back, shoulder,
arms - cervical disc degenerative dse, spinal cord tumors
neck pain with loss of sensation in legs – cervical spinal
cord compression
impaired ROM, neck pain assoc with fever, chills,
headache – serious infection (e.g., meningitis)
abnormal finding Maria Carmela L. Domocmat, RN, MSN
40. o flexion – bendforward, touch toes
o lateral bending
o hyperextension
o rotation
Test ROM of thoracic and lumbar
spine
Maria Carmela L. Domocmat, RN, MSN
41. o normal finding:
flexion – 750- 900
smooth movement, lumbar concavity
flattens out, spine remains straight
lateral bending - 350
hyperextension - 300
rotation - 300
Maria Carmela L. Domocmat, RN, MSN
42. o abnormal finding:
lateral curvature disappears- functional scoliosis
unilateral exaggerated thoracic convexity – structural
scoliosis
impaired ROM, pain lumbar and thoracic regions -
low back strain from injury to soft tissues
impaired ROM lumbar and thoracic regions –
osteoarthritis, ankylosing spondylitis, congenital
abnormalities
Maria Carmela L. Domocmat, RN, MSN
43. ◦ Lasègue’s test
o Or straight leg raising
o if (+) low back pain that radiates down the back
o to check for herniated nucleus pulposus
o client lie flat and raise each relaxed leg independently to
point of pain
o at point of pain – dorsiflex foot
o note degree of elevation when pain occurs; distribution
and character of pain, results from dorsiflexion
Test for back and leg pain
Maria Carmela L. Domocmat, RN, MSN
46. o normal finding:
able to raise leg to 90 degree angle
mild pain of hamstring
Maria Carmela L. Domocmat, RN, MSN
47. o abnormal finding:
pain that shoots and radiates down one or both
legs (sciatica) below the knees – herniated
intervertebral disc
continuous, aching pain at night not relieved by
rest – metastases
lower back pain with tenderness and limited
ROM – osteoporosis
Maria Carmela L. Domocmat, RN, MSN
48. o leg lengths - if suspect client has 1 leg longer
distance from anterior superior iliac spine and
medial malleolus; cross tape on medial side of
knee
o if still look unequal – assess apparent leg
lengths
measure from nonfixed point (umbilicus) to a
fixed point (medial malleolus) each leg
Measure leg length
Maria Carmela L. Domocmat, RN, MSN
49. o normal finding:
equal or within 1 cm
o abnormal finding:
unequal leg lengths – scoliosis
equal true leg lengths but unequal apparent leg
lengths – abnormalities in structure or position
of hips and pelvis
Maria Carmela L. Domocmat, RN, MSN
51. o normal finding:
shoulders –symmetrically round, no redness,
swelling, deformity or heat, no tenderness
muscles -fully developed
clavicle and scapulae – even and symmetric
Inspect and palpate shoulders and
arms
Maria Carmela L. Domocmat, RN, MSN
52. .
Range Of Motion
Maria Carmela L. Domocmat, RN, MSN
55. o abnormal finding:
flat, hollow, less rounded shoulders –
dislocation
muscle atrophy – nerve or muscle damage or
lack of use
tenderness, swelling, heat – shoulder stains,
sprains, arthritis, bursitis, degenerative joint dse
Maria Carmela L. Domocmat, RN, MSN
56. o flexion – move arms forward elbows straight ;
hyperextension – move arms backward
o adduction – hands front of body past midline ;
abduction – hands together overhead
o external rotation – hands together behind head,
elbows flexed ;
internal rotation – behind back
o shrug shoulders
o repeat all against resistance
Test ROM
Maria Carmela L. Domocmat, RN, MSN
57. o normal finding:
flexion - 1800 ; hyperextension - 500
adduction - 500 ; abduction - 1800
external and internal rotation - 900
Maria Carmela L. Domocmat, RN, MSN
58. o abnormal finding:
painful and limited abduction, muscle weakness &
atrophy – rotator cuff tear
sharp catches of pain when bringing hands overhead –
rotator cuff tendinitis
chronic pain and severe limitation of all shoulder
motions – calcified tendinitis
unable shrug shoulders against resistance - lesion of CN
XI
decreased muscle strength against resistance – muscle
and joint dse
Maria Carmela L. Domocmat, RN, MSN
60. • Inspect for size, shape, deformities, redness, or
swelling
o elbows flex and extended
o elbows relaxed and flexed abt 700 – palpate
olecranon process and epicondyles use
thumb and middle fingers
Inspect for size, shape,
deformities, redness, or swelling
Maria Carmela L. Domocmat, RN, MSN
61. o normal finding:
symmetric, without deformity, redness,
swelling
nontender, without nodules
Maria Carmela L. Domocmat, RN, MSN
63. o abnormal finding:
redness, heat, swelling- bursitis of olecranon
process- trauma or arthritis
firm, nontender, subq nodules – rheumatoid
arthritis or rheumatic fever
tenderness or pain over epicondyles –
epicondylitis (tennis elbow) – repetitive
movements of forearm or wrists
Maria Carmela L. Domocmat, RN, MSN
65. o flexion – flex elbow, bring hand to
forehead
o extension – straighten elbow
o pronation – arm out, turn palm down
o supination – turn palm up
Test ROM
Maria Carmela L. Domocmat, RN, MSN
66. .
Range Of Motion
Maria Carmela L. Domocmat, RN, MSN
67. o normal finding:
flexion – 1600
extension – 900
pronation – 900
supination – 900
some – lack 5 to 10 0 ; or have
hyperextension
Maria Carmela L. Domocmat, RN, MSN
68. o abnormal finding:
decreased muscle strength against resistance
– muscle and joint dse
Maria Carmela L. Domocmat, RN, MSN
70. o palpate anatomic snuffbox
o hollow area on back of wrist at base of fully
extended thumb
o normal finding:
symmetric without redness, swelling
nontender, free of nodules
no tenderness anatomic snuffbox
Inspect and palpate
Maria Carmela L. Domocmat, RN, MSN
71. 1. Maintain wrist
flexion while you
try to extend the
wrist.
2. Try to extend
the wrist as you
try to flex it
To assess wrist strength
Maria Carmela L. Domocmat, RN, MSN
73. o abnormal finding:
rheumatoid arthritis – swelling, tenderness,
nodules
ganglion - nontender, round, enlarged,
swollen, fluid-filled cyst ; dorsum of wrist
snuffbox tenderness – scaphoid fracture –
result of falling on outstretched hand
Maria Carmela L. Domocmat, RN, MSN
74. The scaphoid bone is a carpal bone
near the base of the thumb. The
carpal bones connect the two bones
of the forearm, the radius and
the ulna, to the bones of the hand.
Themetacarpal bones are the long
bones that lie underneath the palm.
Maria Carmela L. Domocmat, RN, MSN
75. the metacarpals attach to the phalanges, which are
the bones in the fingers and thumb.
One reason that the wrist is so complicated is
because every small bone forms a joint with the
bone next to it.
This means that what we call the wrist joint is
actually made up of many small joints. Ligaments
connect all the small bones to each other, and to
the radius, ulna, and metacarpal bones.
The scaphoid bone is a small carpal bone on the
thumb side (radial side) of the wrist. It is the most
commonly fractured carpal bone.
Maria Carmela L. Domocmat, RN, MSN
76. The wrist is made up of eight
separate small bones, called the
carpal bones
Maria Carmela L. Domocmat, RN, MSN
80. The scaphoid is a
small bone located
on the thumb side
of your wrist. It is
the most commonly
broken bone in the
wrist. Because
symptoms can be
minimal, scaphoid
fractures are
frequently mistaken
as sprained
wrists. Scaphoid
fractures require
casting or surgery.
scaphoid fracture
http://www.vermontorthoclinic-
edu.org/tabid/14407/mid/24836/ContentPubID/108/ContentClassificationGroupID/- Maria Carmela L. Domocmat, RN, MSN
1/ViewIndex/0/Default.aspx
82. o flexion – bend down ; extension – bend
back
o deviation – client hold wrist straight;
move hand outward and inward
Test ROM
Maria Carmela L. Domocmat, RN, MSN
86. o normal finding:
flexion - 90 0
hyperextension - 700
ulnar deviation - 55 0
radial deviation - 200
Swedes, Chinese – unequal lengths of ulna and
radius
Maria Carmela L. Domocmat, RN, MSN
87. o abnormal finding:
ulnar deviation of wrist and fingers with limited
ROM – rheumatoid arthritis
epicondylitis of lateral side of elbow– increased pain
with extension of wrist and fingers against resistance
epicondylitis of medial side of elbow– increased
pain with flexion of wrist and fingers against
resistance
decreased muscle strength against resistance –
muscle and joint dse
Maria Carmela L. Domocmat, RN, MSN
88. ◦ Phalen’s test
◦ Tinel’s sign
Test for Carpal Tunnel Syndrome
Maria Carmela L. Domocmat, RN, MSN
89. Progressive sensory changes including paresthesias
and numbness of the thumb, index finger, and ring
finger of the involved hand; leads to pain waking
the patient up at night.
Motor changes beginning with clumsiness and
progressing to weakness; edema and thenar
atrophy may be noted.
Positive Tinel’s sign: Increased paresthesias on
tapping of tendon sheath (ventral surface of central
wrist).
Positive Phalen test: Increased symptoms with
acute palmar flexion for 1 minute.
Carpal Tunnel Syndrome
Maria Carmela L. Domocmat, RN, MSN
91. place backs of both hand against each
other while flexing wrists 900 downward
hold for 60 sec
Phalen’s test
Maria Carmela L. Domocmat, RN, MSN
92. In the first of these
tests, for 1 minute.
The experience of
numbness and
paresthesia over the
palmar surface of the
hand and the first
three fingers and part
of the fourth is called
Phalen’s sign. The
symptoms resolve
quickly after the hand
returns to the resting
Phalen’s test
position.
Maria Carmela L. Domocmat, RN, MSN
93. tapping over the median nerve
(palmar aspect of wrist).
The client’s sensation of tingling or
prickling is known as Tinel’s sign.
Tinel’s sign
Maria Carmela L. Domocmat, RN, MSN
96. o normal finding:
no tingling, numbness, pain
o abnormal finding:
(+)tingling, numbness, pain – (+) carpal tunnel
syndrome
numbness, pain , impaired function of hand
and fingers - median nerve entrapped in carpal
tunnel
Maria Carmela L. Domocmat, RN, MSN
98. o normal finding:
symmetric, nontender, without nodules
fingers – lie in straight line
no swelling, deformities
rounded protuberance – next to thumb over
thenar prominence
smaller protuberance adjacent small finger
Inspect and palpate
Maria Carmela L. Domocmat, RN, MSN
99. Palpate the joints
between the carpal, meta-
carpal, and phalangeal
bones.
Use your thumbs and index
fingers to palpate each of
these joints.
Interphalangeal joints
Metacarpophalangeal joints
Radiocarpal groove and
wrist
Maria Carmela L. Domocmat, RN, MSN
100. ask the client to
squeeze your first
two fingers as hard
as he or she can.
If you cross your
fingers, you will not
feel as much
discomfort if the
client is exceptionally
To assess grip
strong. strength
Maria Carmela L. Domocmat, RN, MSN
101. o abnormal finding:
swollen, stiff, tender finger joints – acute rheumatoid
arthritis
boutonnière deformity – flexion of proximal
interphalangeal joint and hyperextension of distal
interphalangeal joint
swan-neck deformity - hyperextension of proximal
interphalangeal joint with flexion of distal interphalangeal
joint
Maria Carmela L. Domocmat, RN, MSN
102. swan-neck deformity boutonnière deformity
Maria Carmela L. Domocmat, RN, MSN
103. o abnormal finding:
thenar atrophy (atrophy thenar prominence) – carpal tunnel
syndrome
osteoarthritis
• Heberden’s nodes - hard, painless nodules over distal
interphalangeal joints
• Bouchard’s nodes - hard, painless nodules over proximal
interphalangeal joints
Maria Carmela L. Domocmat, RN, MSN
105. o abduction – spread fingers apart ; adduction
– make a fist
o flexion – bend fingers down ; hyperextension
– bend up
o thumb abduction - move thumb away; thumb
adduction – touch thumb base of sml finger
o repeat all against resistance
Test ROM
Maria Carmela L. Domocmat, RN, MSN
109. 1. Extend the fingers while you push down on the
dorsal surface
2. Flex the fingers while you push up on the
ventral surface.
3. Spread the fingers as far apart as possible
while you try to push them together.
4. Push the fingers as close together as possible
while you try to pull them apart.
To assess finger strength
Maria Carmela L. Domocmat, RN, MSN
112. o normal finding:
abduction - 20 0
adduction - 900
flexion - 900
hyperextension - 300
thumb flexion/adduction- 500
Maria Carmela L. Domocmat, RN, MSN
113. o abnormal finding:
Dupuytren’s contracture – inability to
extend ring and little fingers
tenosynovitis (infection of flexor tendon
sheathes) - painful extension of finger
decreased muscle strength against resistance
– muscle and joint dse
Maria Carmela L. Domocmat, RN, MSN
115. It is a very common problem and often arises in
the hands of middle aged persons; however, it can
be seen as early as the twenties. This entity does
run in families in some cases. It is seven times
more common in men than women. It has been
associated with diabetes and can be seen in
alcoholics with cirrhosis of the liver. It has also
been associated with epilepsy but may be a result
of the use of anticonvulsant drugs rather than the
presence of epilepsy itself. The underlying cause is
unknown.
Dupuytren’s contracture
http://advanceddynamic.com/Injuries-Conditions/Hand/Hand-Issues/Dupuytren-s-
Contracture/a~285/article.html
http://www.med.und.edu/users/jwhiting/dupdef.html
Maria Carmela L. Domocmat, RN, MSN
117. o abnormal finding:
Tenosynovitis
infection of flexor tendon sheathes
painful extension of finger
decreased muscle strength against resistance
– muscle and joint dse
Maria Carmela L. Domocmat, RN, MSN
118. When a tendon (a fibrous, non-elastic band of
tissue which attaches a muscle to a bone) and its
surrounding soft tissue (called the tenosynovium)
are injured—either by a direct injury or due to
micro-trauma like excessive repetitive
movements—they become inflamed, swollen, and
painful. This condition is called Tenosynovitis. (A
less accurate and rarely used term to describe this
condition is tendonitis.)
While all of the tendons of the wrist and hand may
become inflamed and painful, the most common
form of tenosynovitis seen in the hand and wrist is
called deQuervain's Tenosynovitis. deQuervain's
Tenosynovitis affects the thumb and wrist.
http://www.ourhealthnetwork.com/conditions/hand/deQuervains
Tenosynovitis.asp Maria Carmela L. Domocmat, RN, MSN
119. affects two thumb tendons: the abductor pollicis
longus (APL) and the extensor pollicis brevis (EPB).
These tendons connect their respective muscles,
which lie on the back of the forearm, to the thumb.
These tendons are responsible for extending the
thumb backwards, and for moving the thumb away
from the palm of the hand.
On their way to the thumb, the APL and EPB travel
side-by-side along the inside of the wrist. They
pass through a tunnel in the wrist which is covered
by a non-elastic type of fibrous tissue called the
Extensor Retinaculum. The function of this tunnel is
to hold the tendons in place.
deQuervain's
Tenosynovitis
Maria Carmela L. Domocmat, RN, MSN
120. Pathology: Normally, the APL and EPB glide
easily back and forth within this tunnel as they
move the thumb. When the APL and EPB
become inflamed and swollen, however, the
tendons become compressed against each
other because the Extensor Retinaculum (the
non-elastic band of tissue that covers the
tunnel) cannot expand to "make more room for
the swollen tendons." This leads to restricted
and painful tendon and thumb movements.
Maria Carmela L. Domocmat, RN, MSN
124. • Inspect and palpate
o stand
o normal finding:
buttocks – equally sized
iliac crests – symmetric height
hips – stable, nontender, without crepitus
Maria Carmela L. Domocmat, RN, MSN
125. o abnormal finding:
instability, inability to stand, and/or
deformed hip area – fractured hip
tenderness, edema, decreased ROM,
crepitus – hip inflammation, degenerative jt
dse
Maria Carmela L. Domocmat, RN, MSN
126. o supine
o hip flexion
flexion with knees straight - raise extended leg
flexion with knee flexed - flex knee to chest;
keep other leg extended
Note: if had total hip replacement – do not test
ROM unless physician gives permission; reduce
risk of dislocating prosthesis
Test ROM
Maria Carmela L. Domocmat, RN, MSN
129. o abduction – move extended leg away from
midline of body as far as possible ; adduction –
toward midline of body as far as possible
o internal/ external hip rotation – bend knee and
turn leg inward then outward
o hyperextension – prone, lift extended leg off
table ; or client stand and swing extended leg
backward
o repeat all against resistance
Maria Carmela L. Domocmat, RN, MSN
132. o normal finding:
flexion with knees straight – 900
flexion with knee flexed -1200
abduction – 45-500 ; adduction – 20 to 300
internal hip rotation - 400 ; external hip rotation -
450
hyperextension - 150
Maria Carmela L. Domocmat, RN, MSN
133. o abnormal finding:
inability to abduct hip – hip dse
pain, decrease internal hip rotation –
osteoarthritis, femoral neck stress fracture
pain or palpation of greater trochanter; pain as
client moves from standing to lying down –
bursitis of hip
Maria Carmela L. Domocmat, RN, MSN
134. evaluates flexion contractures of the
hip
With the client in the supine position,
ask the client to pull one knee up
toward the chest as far as possible.
Approximate the extent of the flexion
contracture by noting the degree of
flexion of the opposite leg (the angle
between the client’s leg and the
table).
Thomas test
Maria Carmela L. Domocmat, RN, MSN
135. normal finding:
◦ when the hip is flexed, the opposite
leg remains flat on the examination
table
abnormal finding
◦ for the individual with an immobile
hip, the opposite hip and leg flex in
response to flexion of the leg.
Thomas test
Maria Carmela L. Domocmat, RN, MSN
138. • Supine, sitting
• Inspect size, shape, symmetry, swelling, deformities,
alignment, qudricep muscle atropy
• Palpate tenderness, warmth, consistency, nodules
o begin 10 cm above patella
o use fingers and thumb to move downward
the knee
Maria Carmela L. Domocmat, RN, MSN
142. o indication: if (+) swelling to determine cause
of swelling (if due to accumulation of fluid or
soft tissue swelling)
o helps detect small amts of fluid in knee
o client supine – use ball of your hand firmly to
stroke the medial side of knee upward, 3-4x –
to displace any accumulated fluid
o then press lateral side of knee
o look for bulge on medial side of knee
Bulge test
Maria Carmela L. Domocmat, RN, MSN
143. A test for small effusions in the knee joint is
called the bulge sign.
Take the ball of your hand and firmly milk the
medial aspect of the knee upward two to three
times to displace fluid
Then press or tap behind the lateral margin of
the knee.
A positive bulge sign will show a swelling or
bulge of fluid in the hollow area medial to the
patella.
The bulge sign is useful for assessing small
effusions, but
It may be absent in large effusions.
Bulge sign
Maria Carmela L. Domocmat, RN, MSN
151. The ligaments which attach the upper leg bone
(femur) to the large lower leg bone (tibia)
create a hinge joint called the knee. The
anterior and posterior cruciate ligaments are 2
short, strong ligaments which criss-cross each
other in the middle of the joint.
Maria Carmela L. Domocmat, RN, MSN
153. o normal finding:
no bulge of fluid appears on medial side of
knee
o abnormal finding:
bulge of fluid on medial side; with sml amt
of joint effusion
Bulge test
Maria Carmela L. Domocmat, RN, MSN
155. When considerable fluid is present in the
suprapatellar pouch, ballottement of the
patella may be possible.
Ballottement involves applying downward
pressure with one hand while pushing the
patella backward against the femur with a
finger of the opposite hand. Examine the
popliteal region with the client in the
prone position or while standing.
Swelling of the joint in the region, which
is called Baker’s cyst, is generally an
extension of the articular cavity.
Ballottement of the
patella
Maria Carmela L. Domocmat, RN, MSN
156. o helps detect large amts of fluid in knee
o client supine
o firmly press nondominant thumb and index
finger on each side of patella
this displaces fluid in suprapatellar bursa located
between femur and patella
o with dominant fingers – push patella down on
femur
o feel fluid wave or a click
Maria Carmela L. Domocmat, RN, MSN
157. o normal finding:
no movement of patella
patella rests firmly over femur
o abnormal finding:
(+) ballottement test – meniscal tears
(+) fluid wave or click – large amts of joint
effusion
Maria Carmela L. Domocmat, RN, MSN
160. o as compress the patella –
slide it distally against
the underlying femur
o normal finding:
no pain
crepitus may be present
o abnormal finding:
(+) pain and crepitus -
patellofemoral disorder
Palpate tibiofemoral space
Maria Carmela L. Domocmat, RN, MSN
161. o flexion
o extension
o hyperextension
o full ROM against resistance
Test ROM
Maria Carmela L. Domocmat, RN, MSN
162. o normal finding:
flexion – 1200 to 1300
extension - 00
hyperextension - 150
full ROM against resistance
Maria Carmela L. Domocmat, RN, MSN
163. o abnormal finding:
decreased ROM with synovial thickening –
osteoarthritis
inability to extend knee fully - flexion
contractures
decreased muscle strength against resistance
– muscle and joint dse
Maria Carmela L. Domocmat, RN, MSN
164. . To test range of motion of the
knee, ask the client to do the
following:
Straighten and stretch the leg.
Bend the knee.
Range of Motion
Maria Carmela L. Domocmat, RN, MSN
165. To test muscle strength in the
knee, ask the client to do the
following:
Extend the leg as you try to bend
it (quadriceps muscle strength)
Bend the knees as you try to
straighten them(hamstring
muscle strength)
Muscle Strength
Maria Carmela L. Domocmat, RN, MSN
168. if complains of a “giving in” or “locking” of knee
supine; flex one knee and hip
place your thumb and index finger on 1 hand on
either side of knee
other hand – hold heel of foot up
rotate lower leg and foot laterally
slowly extend knee – note pain or clicking
repeat – rotate leg medially
McMurray’s test
Maria Carmela L. Domocmat, RN, MSN
175. o normal finding:
toes
• usually point forward and lie flat
• may point in – pes varus
• may point out – pes valgus
toes and feet – in alignment with lower leg
smooth, rounded medial malleolar prominences with
prominent heels and metatarsophalangeal joints
skin – smooth, free of corns and calluses
longitudinal arh – most of weight bearing is on foot
midline
Maria Carmela L. Domocmat, RN, MSN
176. o abnormal finding:
hallux valgus – laterally deviated great toe; possible overlapping of
2nd toe; formation enlarged, painful, inflamed bursa (bunion) on
medial side
pes planus or flat feet – feet with no arches
pes cavus – feet with high arches
corns – painful thickening of skin over bony prominences and at
pressure points
calluses – nonpainful thickened skin that occurs at pressure points
verruca vulgaris- painful warts
plantar warts – warts under a callus; appear as tiny dark spots
hammer toe – hyperextension at metatarsophalangeal joint with
flexion at proximal interphalangeal joint; common 2nd toe
Maria Carmela L. Domocmat, RN, MSN
178. pes planus or flat feet
Maria Carmela L. Domocmat, RN, MSN
http://www.eorthopod.com/images/ContentImages/child/child_foot_flatfoot_congeni
tal/child_flatfoot_causes01.jpg
181. Corns are areas of thick, hardened, dead skin. They form to protect the skin and structures
under the skin from pressure, friction, and injury. They may look grayish or yellowish, be less
sensitive to the touch than surrounding skin, and feel bumpy.
Corns
Corns are usually found where toes rub together. A soft corn is found between toes (usually
between the fourth and fifth toes), while a hard corn is often found over a bony part of a toe
(usually on the fifth toe).
Maria Carmela L. Domocmat, RN, MSN
http://images.rxlist.com/images/SlideShow/diabetes_foot_probl
ems_s8_corns.jpg
183. Corns and calluses form on the skin because of repeated pressure
or friction. A corn is a small, tender area of thickened skin that
occurs on the top or side of a toe. A callus is a rough, thickened
area of skin that appears because of repeated irritation or
Corns & callues
pressure to an area of skin. Calluses usually develop on the palms
of the hand and soles of the feet.
Maria Carmela L. Domocmat, RN, MSN
http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/19657.jpg
184. Warts, also called verrucae, are small benign growths usually
caused by a viral infection of the skin or mucous membrane. The
virus infects the surface layer of skin. The viruses that cause
warts are members of the human papilloma virus (HPV) family, of
which there are many different strains. Warts are not cancerous
but some strains of HPV, usually not associated with warts, have
been linked with cancer formation. Warts are contagious from
person to person and from one area of the body to another on
the same person.
verruca vulgaris
Maria Carmela L. Domocmat, RN, MSN
186. hammertoes are a contracture of the toes as a result of a muscle
imbalance between the tendons on the top and the tendons on
the bottom of the toe.
Hammer toe is a condition where a toe bends downward like a
claw. You can be born with hammer toe or develop it from
wearing short, narrow shoes. Symptoms of hammer toe include
foot pain, calluses on the sole of the foot, or corns on the top of
the toe. Treatment of mild cases and cases in children can include
foot manipulation and splinting of the toe. More severe cases may
need surgery to straighten the toe joint.
http://0.tqn.com/f/p/440/graphics/images/en/9360.jpg
Maria Carmela L. Domocmat, RN, MSN
187. http://images.rxlist.com/images/SlideShow/diabetes_foot_problems_s8_corns.jpg
A hammertoe is a toe that is bent because of a weakened muscle. The weakened muscle makes the tendons (tissues that
connect muscles to bone) shorter, causing the toes to curl under the feet. Hammertoes can run in families. They can also
be caused by shoes that are too short. Hammertoes can cause problems with walking and can lead to other foot problems,
hammer toe
such as blisters, calluses, and sores. Splinting and corrective footwear can help in treating hammertoes. In severe cases,
surgery to straighten the toe may be necessary.
Maria Carmela L. Domocmat, RN, MSN
190. o normal finding:
no tenderness, heat, swelling, nodules
o abnormal finding:
gouty arthritis- tender, painful, reddened, hot, swollen
metatarsophalangeal joint of great toe
rheumatoid arthritis – nodules of posterior ankle
pain and tenderness metatarsophalangeal joints –
inflammation of joints, rheumatoid arthritis,
degenerative joint dse
plantar fasciitis – tenderness of calcaneus of bottom of
foot
palpate tenderness, heat, swelling,
nodules
Maria Carmela L. Domocmat, RN, MSN
191. o dorsiflexion – point toes upward ;
plantar flexion –downward
o eversion – turn soles outward;
inversion – inward
o abduction – rotate foot outward ;
adduction – inward
o flexion – turn toes under foot ;
extension – upward
o repeat all with resistance
Test ROM
Maria Carmela L. Domocmat, RN, MSN
196. o normal finding:
200 dorsiflexion ankle and foot; 45 0 plantar
flexion
200 eversion; 300 inversion
100 abduction; 200 adduction
400 flexion; 400 extension
Maria Carmela L. Domocmat, RN, MSN
197. o abnormal finding:
decreased ROM without or against
resistance – muscle and joint dse
hammer toe – hyperextension of
metatarsophalangeal joint and flexion of
proximal interphalangeal joint
Maria Carmela L. Domocmat, RN, MSN