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MS Assessment

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by

Kathi Bower

on 8 April 2013

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Transcript of MS Assessment

photo credit Nasa / Goddard Space Flight Center / Reto Stöckli The Final Frontier The Universe of Musculoskeletal Assessment Joint Classification Synarthrotic
Ampiarthrotic
Diathrotic
Hinge
Pivot
Condyloid
Ball & socket
Gliding Overview of Assessment Inspection Begin by observing gait & posture
Proceed from head to toe
Proximal to distal
Good body exposure and good lighting
Equipment
Marker
Goniometer
Tape measure Terminology Flexion
Extension
Hyperextension
Rotation
Abduction
Adduction
Ulnar deviation
Radial deviation
Inversion
Eversion Temporomadibular Joint Inspection
Palpation
ROM
Open/Close
Protrude/Retract
Side to Side
Muscle strength Thoracic and Lumbar Spine Inspection & palpation
Spinal processes
Scapulae
Iliac crests
Parvertebral muscles
ROM
Flexion
Extension
Hyperextension
Lateral flexion
Rotation
Muscle Strength Age and Cultural Considerations Aging
Decrease in height
Kyphosis
Decrease of fat distribution over periphery; increase deposits over hips/abdomen
Osteoporosis
Common with aging
Increased with sedentary lifestyle
Decreased/ delayed with physical activity Health History: Musculoskeletal Musculoskeletal Assessment Introduction Joint/Muscle/Bone
Pain (OLDCARTS)
Stiffness, swelling, heat, redness, movement limitations, numbness/tingling, weakness
Past history of injuries/deformity/trauma
Present history of self-care
“Normal” function (ADLs)
Past family history
Arthritis
Inspect skin over entire extremity
Inspect skin over joint
Inspect joint contour
Inspect the extremity for size/symmetry/alignment
Includes bones & muscles
Terms
Atrophy
Hypertrophy Overview of AssessmentPalpation Palpate joints
Crepitus
Clicking/popping
Pain/tenderness
Edema
Consistency
Temperature
Stability Palpate bones & muscles
Crepitus
Nodules/masses
Thickening
Muscle tone
Spasms
Pain/tenderness
Cramping/aching Range of Motion Range of Motion
2 types
Active
Passive
Use goniometer if necessary Overview of Muscle Strength Assess muscle strength
Apply resistance to muscle action
Compare side to side
Terms
Hemiparesis
Hemiplegia
Paraplegia
Quadraplegia Muscle Strength Rating Scale 0 = No voluntary muscle contraction
1 = Slight contractility, no movement
2 = Full ROM, passive
3 = Full ROM, active
4 = Full ROM against gravity, some resist.
5 = Full ROM against gravity, full resist. Neck/Cervical Spine Inspection
Palpation
ROM
Flexion
Extension
Hyperextension
Lateral flexion
Rotation
Muscle Strength Shoulders Inspection
Palpation
ROM
Flexion
Extension
Hyperextension
Abduction
Adduction
Internal rotation
External rotation Elbows Inspection
Palpation
ROM
Flexion
Extension
Pronation
Supination
Muscle Strength
Abnormals:
Tendonitis
Olecranon bursitis Wrists Inspection
Palpation
ROM
Flexion
Extension
Hyperextension
Radial deviation
Ulnar deviation
Muscle strength
Tinel Sign
Phalen’s Test Hands and Fingers Inspection
Palpation
ROM
Flexion
Extension
Hyperextension
Thumb opposition
Abduction
Adduction
Fist
Muscle strength Hips Inspection
Palpation
ROM
Flexion
Extension
Hyperextension
Abduction
Adduction
External rotation
Internal rotation
Muscle strength
Leg length discrepancy Knees & Legs Inspection/Palpation
Major landmarks
Tibial tuberosity
Medial & lateral tibial condyles
Medial & lateral epicondyles of femus
Adductor tubercle of femur
Patella
Collateral ligaments
ROM
Flexion
Extension
Muscle strength Ankles Inspection
Palpation
Malleolus
Anterior surface
Achilles tendon
ROM
Dorsiflexion
Plantar flexion
Abduction
Adduction
Inversion
Eversion
Rotation
Muscle strength Toes & Feet Inspection
Arch
Alignment of feet
Alignment of toes
Palpation
ROM
Flexion
Extension
Abduction
Adduction
Muscle Strength Spinal Deformities Scoliosis Key Points Able to perform ROM and oppose force to all joints. Name all movements
Variations from normal M/S findings
Common age-related/cultural variations Kyphosis Lordosis Critical Thinking 1) A female patient who is 37 weeks pregnant walks into your office. What is an expected finding of the spine?

2) What are the Tinel and Phalen signs? What do they test for?

3) What are you assessing for during palpation of the MS system? Muscle strength
Arm length discrepancy
Muscle size discrepancy
Abnormals:
Dislocated shoulder
Torn rotator cuff
Frozen shoulder Abnormals:
Carpal tunnel
Ankylosis
Ganglion cysts Abnormals:
Ulnar deviation
Swan neck
Boutonniere
Heberden nodes
Bouchard nodes
Polydactaly
Dupuytrn contractures Abnormals:
Leg length discrepancy
Congenital hip dislocation
Ortolani/Barlow maneuvers
Allis sign
Specialized testing
Trendlenburg sign Abnormals:
Osgood Schlatter
Genu Valgum
Genu Varum
Specialized testing:
Bulge test
Ballottment
McMurray Abnormals:
Hallux Vagus with bunion
Hammertoe
Club foot
Callous
Plantar wart
Ingrown toenail Spina Bifida Cross Cultural
Afro Americans
Long bones longer, narrower, denser than Whites
Less incidence of osteoporosis
Asians
Bone density less than Whites
Widespread MS disorder
Fibromyalgia
Full transcript