MPD MUSCOSKELETAL SYSTEM ASSESSMENT

I. SPINE 2. SPINE (SAME AS HIP)

- Central supporting structure of the body - FLEXION
- EXTENSION
COMPLEX MECHANISMS - ROTATION
- Vertebrae and intervertebral discs - LATERAL FLEXION
- Interconnecting system of ligaments
- Large Superficial Muscles
- Deeper Intrinsic Muscles II. HIP
- Muscles of Abdominal Wall - Deeply embedded in pelvis
- Notable for strength, stability, wide range of motion
CURVES - Essential for weight bearing
Concave Curves - Has strong, dense, articular capsule
- CERVICAL, LUMBAR spine
Convex Curves STRUCTURES
- THORACIC, SACROCOCCYGEAL spine - Psoas bursa (Iliopectineal/Iliopsoas)
- Trochanteric bursa
BONY STRUCTURES - Ischial bursa (Ischiogluteal)
- 24 vertebrae stacked on SACRUM and COCCX - Sciatic Nerve
- SPINOUS and ARTICULAR PROCESS
- VERTEBRAL AND INTERVERTEBRAL FORAMEN PHYSICAL EXAMINATION OF HIP
PHYSICAL EXAMINATION OF SPINE 1. INSPECTION
- Swing
1. INSPECTION - Stance and gait
- Posture - Difficulty during weight bearing
- Position of neck and back upon entering the room - Wide base
- Drape or gown the patient - Pain during weight bearing
- Should be standing upright in natural position - Waddling gait
- Identify Landmarks - Leg swings out to side (CIRCUMDUCTION)
- Inspect from side and behind - Lack of dorsiflexion
- Change in leg length
MEDICAL HISTORY
- Neck stiffness STANCE PHASE OF GAIT
- Lateral deviation 1. Heelstrike
- Tenderness on palpation 2. Footflat
- Kyphosis, Lordosis, Scoliosis 3. Midstance
- Unequal height 4. Push-off
- Sciatic nerve tenderness
- Limitations in ROM 2. PALPATION
- Bony landmarks
2. PALPATION - Inguinal structures
- Spinous processes
- Vertebral step offs RANGE OF MOTION AND MANEUVER
- Sacroiliac joint HIP
- Areas of tenderness - Hip flexion and flattening of Lumbar Lordosis

RANGE OF MOTION AND MANEUVER MUSCLE STRENGTH TEST

NECK
- Most mobile portion of spine FLEXION
- Bend your knee to your chest and pull it against your
MUSCLE STRENGTH TEST abdomen
- Performed during range-motion assessment - Iliopsoas
- Pain
- Tenderness HYPEREXTENSION
- Radiation of pain to leg - Lie face down, and then bend your knee and lift it up/ Lying
- Low back pain flat, move your lower leg away from the midline and down over
the side of the table
FLEXION - Gluteus maximus
- Bring your chin to your chest
- Sternocleidomastoid, Scalene, Prevertebral muscles ABDUCTION
- Lying flat, move your lower leg away from the midline
EXTENSION - Gluteus medius and minimus
- Look up at the ceiling
- Splenius capitis, Cervicis, Small Intrinsic Neck Muscles ADDUCTION
- Lying flat, bend your knee and move your lower leg toward the
ROTATION midline
- Look over one shoulder and then the other - Abductor brevis, Abductor Longus, Abductor Magnus, Pectineus
- Sternocleidomastoid, Small Intrinsic Neck Muscles graciis

LATERAL FLEXION
- Bring your ear to your shoulder
- Scalene, Small Intrinsic Muscles
EXTERNAL ROTATION
- Lying flat on your back, bend your knee and hip 90 degrees, IV. ANKLE AND FOOT
and turn your ankle and foot across your opposite leg - Total weight of body transmitted through ankle to foot
- Internal and external obturator, Quadratus femoris, Superior and - Must balance body
Inferior Gemelli - Absorb impact of heel strike and gait
- Frequent sites of sprain and bony injury
INTERNAL ROTATION
- Lying flat on your back, bend your knee and hip 90 degrees DESCRIBING LIMITED MOTION OF JOINT
and turn your lower ankle and foot away from your body - 160, 90, 45, 0
- Gluteus medius and minimus
PHYSICAL EXAMINATION
III. KNEE 1. INSPECTION
- Largest joint in the body - All surfaces
- Hinge joint - Deformities
- Two rounded condyles rest on tibial plateu - Nodule
- No inherent stability - Swelling
- Depends on ligaments to hold in place - Calluses
- Corns
STRUCTURES
MENISCI MUSCLE STRENGTH TEST
LIGAMENTS
- Collaterals PLANTAR FLEXION
- Cruciates - Point your foot toward the door
THREE BONES - Gastrocnemius, Soleus, Plantaris, Posterior Tibialis
- Femur, Tibia, Patella
JOINTS DORSIFLEXION
- Tibiofemoral joints (2) - Point your foot toward the ceiling
- Patellofemoral joint (1) - Anterior Tibialis, Extensor Digitorum Longus, Extensor Hallucis
- Trochlear groove Longus

PHYSICAL EXAMINATION INVERSION

1. INSPECTION - Bend your heel inward
- Gait - Posterior/Anterior Tibialis
- Smooth
- Rhythmic EVERSION
- Alignment - Bend your heel outward
- Contours - Peroneus Longus, Brevis
- Atrophy
- Edema
ABNORMALITIES OF FEET
2. PALPATION 1. ACUTE GOUTY ARTHRITIS
- Tibiofemoral joint - Hot, Red, Tender, Swollen
- Suprapatellar pouch
- Prepatellar bursa 2. FLAT FEET
- Anserine bursa - Medial border becomes convex
- Gastrocnemius - Sole touches floor
- Soleus
- Achilles tendon 3. HALLUX VALGUS
- Nanay
POSTERIOR SURFACE OF LOWER LEG
COMMON TENDON 4. MORTON NEUROMA
- Achilles palpable from about lower third of calf to insertion on - Neuroma on sole
calcaneus
5. INGROWN TOENAIL
MUSCLE STRENGTH TEST - Red, Tender, Granulaton Tissue

FLEXION 6. HAMMER TOE

- Bend or flex your knee or squat down to the floor - Hyperextended, Flexed toes
- Hamstring group, Biceps Femoris, Semiteninosius,
Semimembranosus 7. CORN
- Red, Thickened Small toe
EXTENSION
- Straighten your leg / After you squat down to the floor, stand up 8. CALLUS
- Quadriceps, Rectus Femoris, Vastus Medialis, Lateralis, 9. PLANTAR WART
Intermedius 10. NEUROPATHIC ULCER

INTERNAL ROTATION
- While sitting, swing your lower leg toward the midline
- Sartorius, Gracilis, Semitendinosus, Semimembranosus

EXTERNAL ROTATION
- While sitting, swing your lower leg away from midline
- Biceps femoris