hello class this is Professor Williams and today we'll be discussing the musculoskeletal system the musculoskeletal system consists of the body's bones joints and muscles humans need the system for support movement protection of vital organs production of red butt cells and white butt cells platelets in the bone Mar and storage of minerals such as calcium and phosphorus in the bones the bone is hard rigid and very dense the joint or articulation is a place of Union of two or more bones joints are the functional unit of the muscular skeletal system because they permit the mobility needed for activities in daily living known as ADLs they are surrounded by a fibrous capsule and supported by ligaments ligaments are fibrous strains running directly from one bone to another bone that strengthens the joint and help prevents movement in undesirable directions the tenants connect muscle to Bone skeletal muscles are composed of bundles of muscle fibers and they are attached to the Bone by attendant which is a strong fibrous cord skeletal muscles produce the following movements flexion extension abduction adduction pronation superation circumduction circum vection inversion ersion rotation protection retraction elevation depression so please make sure that you reviewing page 574 on the different muscle movements we'll be performing some of these range of motions during our head to tog exam so you can see here the tendon binds the muscle to the Bone and then ligaments bind bone to bone and then these are just some types of body movement but please refer to the book they have a lot more you do not need to know all of them for the exam we will discuss which ones that you need to know so in regards to the older population osteoporosis is a gradual loss of bone density it is a disease involving the loss of mineralized bone mass which leads to porous bones and an increased risk for fractures so you can see here in this picture this is a normal bone and with osteoporosis it's super porous making the bone very weak aging women have a greater amount of bone mass loss compared with aging men due to their decreased levels of estrogen to reduce the risk of osteoporosis all adults should engage in regular physical activity including strength training strength training is super important because it strengths strengthens the bones and increases the bone density we can also reduce the risk of osteoporosis through balance training and fast walking it is also important to maintain a healthy body weight and get the recommended amount of calcium and vitamin D daily in regards to changing changes that occur in the muscular scul system as we age the bones do shorten with a decrease in height especially in our vertebral column between 3 to 5 cm this causes the shortening of the spine due to loss of water content and thinning of the intervertebral discs that is why there is a decrease in high in our older patients other postural changes that occur with aging includes thoracic curvature known as kyphosis a backward head to to compensate for the kyphosis and a slight flexion of the hip and knees there's also a loss of subcutaneous fat which leaves the bony prominences more marked in the vertebrae ribs iliac crest back of the head elbows so please make sure you are all always doing a thorough head to toe assessment of the skin with our patients whether they're new patients coming in or patients that have been there for weeks on the floor the older adults are at Super risk for skin injuries pressure injuries and breakdown there's also decrease in muscle mass and atrophy which unfortunately produces overall weakness so that is why we have to be super cautious in regards to safety with our patients we want to make sure that the bed is in the lowest position the bed rails are up and call is Within Reach so you can see here with the normal spine is that nice curvature with kyphosis there's that hump in the back area to neck and you can see it progressing here with that compensation of that head tilt so getting into our subjective data we want to assess the patient's joints romatoid arth arthritis known as ra involves the joints Ra's pain is worse in the morning and osteoarthritis OA is worse later in the day tendonitis is worse in the morning but improves during the day most movement increases joint pain except for RA in which movement decreases pain ra stiffness occurs in the morning in after rest periods so that is why it is super important that maybe we can get occupational therapy to come to help with those range of motions in the hands with this the joints using heat also really helps open up those areas um in the joints for ra patients as well we are also going to assess the knee joint as we get older we tend to notice more of our knees cracking this is known as crepitus next we're going to assess the muscles and look for any pain or cramping we're going to assess the patient's bones and note for any bone pain and any deformities if there was an accident or trauma as it ever affected the bone and did it grow well or back in place for that patient we're going to assess the function of the patient as well as how well they perform their ADLs we're going to assess their bathing toileting dressing grooming eating mobility and communicating and ask the patient if they have any deficits in these areas next we're going to ask the patient about their patient environmental exposure in regards to occupational hazards and if they are involved in any heavy lifting any repetitive movements or chronic stress on the joint and then we're going to ask the patient about their overall exercise habits and if they have a a recent increase in weight what their diet is any medications that they are taking because certain medications can affect calcium phosphorous absorption and Lead leading to the bones becoming more weak we also want to ask them about any hormonal therapy and then if they smoke or drink because this all increases the risk for bone loss and fractures in the future in older patients in particular we also want to ask the patient if they are drinking a lot of alcohol they already at increased risk for falling B falling based off of their physi ological changes as they age and putting on top of heavy drinking that just increases the risk even more next we're going to go into our objective data so first we're going to inspect the size and Contour of every joint we're going to inspect the skin and tissue over the joint for the color any swelling or any masses or deformities just as a reminder we talked about this in our skin video but please make sure that are checking the skin to assess for any skin breakdown or pressure injuries next we're going to palpate each joint we're going to note for any heat tenderness swelling or masses joints are normally not tendered to palpate in regards to the muscular skeletal system we have to do our neurovascular checks so nuro wise if they're having any decreased sensation tingling numbness bilaterally in the upper extremities and lower extremities and also we're going to be doing our pulse checks and cap refill and assess for the vascular aspect neurovascular so it's two- part so we're going to be assessing for profusion in those areas and we'll talk more about this in class but say if a patient comes in with a broken arm and they require a cast we're going to be assessing the patients um capillary refills that's why it's super important that we do that because we can't access the radial pulse right so if this cast goes all the way down from their elbow to their thumb capril is super important and remember if it's greater than three there's a delay in profusion so that is why again super important that we are doing our neurovascular checks when it comes to our skeletal muscle system as well next we're going to assess the patients's range of motion we're going to do this in lab but um we'll go over which ones we need to do there's some photos here that we will be performing these are some great tools so you can look at those and practice on a family member or yourself so with this we're going to have the patients squeeze our fingers and we're going to note the strength bilaterally this is really good for our stroke patients if they come in and they're complaining of stroke and we're deciding which side has decreased strength or what side is affected and then next we're going to put our hands on their forehand forearms and they're going to pull and we're going to assess for their strength of resistance and then we're going to have the patient's hands on our hands and they're going to push and we're I'm going to push towards patient they're going to push towards me and we're going to assess for the resistance strength if they're able to do these movements it's going to be five out of five based off the the muscle strength grading scale here and then at seating position we're going to assess for their hip flexion strength so we're going to place their hands on their lap and have them raise their knees up and they should have five out of five for normal adults and then we're going to put our hands behind their calves they're going to push towards the table going to assess for the resistance should be five out of five and this one we're going to put our hands on top of their feet they're going to apply resistance on putting their pulling their feet up and then also like a gas pedal um we're going to be putting our hands under the feet and they have them pushed down so with the strength test here please check page 587 talks about the normal ranges of findings from grade 0 to five um in regards to range of motion so there's passive and then active active is that the patient's able to lift their arm so that would be three out of five so if they're able to their arm up they're three out of five and then these are all resistance right here now with passive if they're not able to do that we're going to stabilize their joint and then move their arm and if they're able to move it with passive aggression the passive movement then it would be a one out of five or a two out of five so romatoid arthritis you will need to know this for the exam and OST osteoarthritis as well OA so in regards to ra it is an autoimmune disease characterized by chronic inflammation and pain patients are treated with anti-inflammatory agents but may still experience chronic pain despite inflammatory suppression is more common in women than in men and Peaks around the age of 30 to 60 years of age although it can occur at any age there's inflammation in the s tissue hyperplasia and swelling leading to fibrous cartilage and Bone destruction that's where we get our deformities here and they usually do this oner deviation of the metoc carpo frenal joints there's limited motion and there's visible deformity in the joints The Joint involvement is symmetrical and bilateral with heat redness swelling and painful motion of the affected joints occur people with ra experience fatigue weakness anorexia weight loss even a low grade fever please make sure you check the table 23.4 for the signs of RA and we talked about this earlier in the slides but there's going to be pain and stiffness of more than one joint and there's going to be mourning joint stiffness what helps with the pain is the constant movement when the patient is just staying there that's when you're going to get the pain pain so almost like the joints just freeze up there's a decrease in range of motion fatigue malce and a low grade fever with osteoarthritis this is a non-inflammatory localized Progressive disorder involving deterioration of the articular cartilages which are cushioned between the end of the bones and causing sovial inflammation there's an increased risk that occurs in the older age especially in females those who have obesity genetics does play a factor in OA and any major joint injury there's symmetrical joint involvement that affects the hands knees hips Lumbar and cervical segment of the spine affected joints have stiffening with hard bony protuberances protuberances pain with motion and limitation of motion please make sure you look at table 23.4 and you can see these nodes here uh for OA Heron's nodes you will need to know that for your exam and then there's also swelling in the other joints as well and this is not just only in the hand but affects the knees hips neck lower back and shoulder all right class thank you so much um looking forward to going going over the muscle skeletal system with you in lab and again we will be focusing on the specific range of motions on and the ones that you need to know for your head to toe video thank you we'll see you guys soon bye-bye