肌肉骨骼系统的检查ppt课件

1、.,1,Assessment of the Musculo-Skeletal System,Dr Essmat Gemaey 230 NUR,.,2,Outlines,Review of Anatomy and physiology of musculoskeletal system Physical Exam Inspection Palpation ROM (Rang of motion),.,3,Objectives,Apply knowledge of Anatomy and physiology of musculoskeletal system Differentiate betw

2、een normal and abnormal Implement physical assessment,.,4,.,5,What do muscles do ?,Muscles simply move you! Without muscles you couldnt open your mouth, speak, shake hands, walk, talk, or move your food through your digestive system. There would be no exploring, running, climbing, smiling, blinking,

3、 breathing. You couldnt move anything inside or outside you. The fact is, without muscles, you wouldnt be alive for very long,.,6,.,7,The skeleton is the name given to the collection of bones that holds our body up. Our skeleton is very important to us. It does three major jobs. 1. It protects our v

4、ital organs such as the brain, the heart, and the lungs. 2. It gives us the shape that we have. Without our skeleton we would just be a blob of blood and tissue on the floor. 3. It allows us to move. Because our muscles are attached to our bones, when our muscles move, they move the bones, and we mo

5、ve,.,8,Physical Exam,Inspection Observe any lack of symmetry and any evidence of trauma or disease. Look for muscle wasting; Inspect the joint contour (shape) and observe any evidence of swelling, deformity or inflammation.,.,9,Ask the client to point to, or otherwise identify, any painful areas, in

6、cluding sites of radiation of pain. Screening questions for musculoskeletal disorders 1. Do you have any pain or stiffness in your arms, legs or back?2. Can you walk up and down stairs without difficulty?3. Can you dress yourself in everyday clothes without any difficulty?,.,10,Assessment of Gait As

7、k the patient to walk back and forth across the room. Observe for equality of arm swing , balance and rapidity and ease of turning. Next, ask the patient to walk on his tiptoes, then on heels. Ask the patient to tandem walk. Test patients ability to stand with feet together with eyes open and then c

8、losed. (Rombergs test). Reassure patient that you will support him, in case he becomes unsteady. Normal: Person can walk in balance with the arms swinging at sides and can turn smoothly. Person should be able to stand with feet together without falling with eyes open or closed.,tiptoes,heels,tandem,

9、.,11,Upper Extremity Muscles,Inspect the muscles of the shoulder, arm, forearm and hand. Note muscle size (bulk). Look for asymmetry, atrophy and fasciculation. Look for tremor and other abnormal movement at rest and with arms outstretched.,.,12,Determine muscle power by,Gently trying to overpower c

10、ontraction of each group of muscles. Shoulder: Abduction (Deltoid) , Adduction , Shrug (Trapezius),Abduction,Adduction,Trapezius),.,13,Elbow: flexion (Biceps) Elbow extension (Triceps) Wrist: Flexion ( )and extension().,.,14,Hand: Grip opposition of thumb and index finger opposition of thumb and lit

11、tle finger and finger abduction and adduction.,Grip,.,15,Determine limb tone (resistance to passive stretch). With the patient relaxed Gently move the limb at the shoulder, elbow and wrist joints and note whether tone is normal, increased or decreased,.,16,Normal findings,Muscles are symmetrical in

12、size with no involuntary movements. In some, muscles may be slightly larger on the dominant side. Muscle power obviously varies. You should not be able to overpower with reasonable resistance. You have to learn to appreciate the normal tone from practice.,.,17,Neck: Range of Motion of,Fix the head w

13、ith one hand while you examine neck Inspection Note the normal concavity of cervical spine Identify Transverse process of C7 Observe Trapezius and Sternomastoid muscles Palpation Feel each spinous process looking for focal areas of tenderness Joint Feel for crepitus during passive motion Para spinal

14、 muscles Range of motion Active Touch chin for flexion Throw head back for extension,Touch chin,Throw head back,.,18,Touch each shoulder with ears for lateral flexion Touch each shoulder with chin for lateral rotation Passive Feel for crepitus during passive motion Normal: 30 degree rotation, able t

15、o touch chest with chin, 55 degree extension and 40 degree lateral bend. No resistance during the range of motion.,.,19,Muscles of Lower Extremity,Inspect the muscles of the hip, knee and ankle. Note muscle size (bulk). Look for asymmetry, atrophy and fasciculation. Look for abnormal movement. Deter

16、mine muscle power by gently trying to overpower contraction of each group of muscles. Hip: Flexion (Iliopsoas), Extension (Gluteus maximus), Abduction, Adduction.,Hip flexion,.,20,The Knee Exam,Inspection Make sure that both knees are fully exposed. The patient should be in either a gown or shorts.

17、Rolled up pant legs do not provide good exposure! Watch the patient walk. Do they limp or appear to be in pain? When standing, is there evidence of bowing (varus) or knock-kneed (valgus) deformity? There is a predilection for degenerative joint disease to affect the medical aspect of the knee, a com

18、mon cause of bowing.,varus Knee deormity, more marked on the left leg,.,21,Is there evidence of atrophy of the quadriceps, hamstring, or calf muscle groups? Knee problems/pain can limit the use of the affected leg, leading to wasting of the muscles.,While both legs have well developed musculature, t

19、he left calf and hamstring are bulkier than the right,.,22,Knee : Flexion (Hamstrings), Extension (Quadriceps) Ankle : Dorsiflexion (Tibialis anterior), Plantar flexion (Gastronemius). Determine limb tone resistance to passive stretch. With the patient relaxed, gently move the limb at the hip, knee and ankle and note whether tone is normal, increased or dicreased. Flex the hip and knee. Support the knee, dorsiflex the ankle sharply and hold the foot in this position checking for clonus.,Dorsiflexion,Knee extension